Abstract
Background:
Noninvasive ventilatory respiratory support (NRS), including CPAP and BPAP, is being used more frequently as an alternative to invasive ventilation in patients with acute and chronic respiratory failure. While there have been significant improvements in nasal and oronasal mask designs and fixation techniques, patients continue to be at risk for developing pressure injuries on the face and nose, especially those using support over longer periods. As part of a quality improvement (QI) initiative, we sought to track our incidence of noninvasive support-related pressure injuries and evaluate the effect of several interventions intended to reduce these injuries.
Methods:
Patients receiving CPAP and BPAP were identified on a monthly basis as part of our hospital's QI process. Using a bedside computerized tool, clinical staff reported all pressure injuries related to noninvasive support in an electronic form. Pressure injuries were reported as rate of pressure ulcers/100 NRS days. Several interventions were staged over a 2-year period to prevent pressure injuries, including: 1) bubble CPAP (B-CPAP; prevalent use of Neotech RAM cannula) in Q4 of 2015 and 2) a novel standardized noninvasive skin barrier policy in Q3 of 2016.
Results:
We observed a total of 10, 405 patient NRS days and 14 noninvasive pressure-related injuries from 2015-2017. Following implementation of B-CPAP and the skin barrier policy, we observed a 68% reduction in mean rate of pressure ulcers/100 NRS days related to these interventions (see Figure).
Conclusions:
We were able to decrease our rate of NRS-associated pressure injuries over a 2-year period. We speculate that the largest reduction in pressure injuries is related to the increased use of Neotech RAM cannulas with B-CPAP, which may apply less pressure to the skin due to simplistic fixation and reduced weight from a pressure generator located distal to the patient (water-seal).
Disclosures:
Mr. DiBlasi has received funding from Chiesi, Draeger, Neotech, Aerogen Pharma, Mallinckrodt Medical, and Vapotherm.
Rate of Pressure Ulcers associated with NIV from 2015 to 2017
Get full access to this article
View all access options for this article.