Utilization of Respiratory Therapist Driven Protocols and Respiratory Device-Related Skin Breakdown Incidence in US Hospitals

Abstract

Background:

Hospital-acquired skin injuries rose 6% from 2014 to 2017 in United States hospitals which adversely affects patients’ health and costs hospitals money and resources. Respiratory therapists (RTs) commonly use medical devices to assist breathing which increases the risk for skin breakdown. Prophylactic skin measures reduce device-related skin injuries. Therefore, this study assessed how many US hospitals utilize RT-driven protocols to prevent respiratory device-related skin breakdown.

Methods:

We conducted this descriptive, observational study of US hospitals between March 2023 to May 2023 through an online survey via AARConnect. Information related to the hospital setting, RT involvement with hospital skin committees, and RT departmental initiatives related to preventing respiratory device skin breakdown was collected. Results were analyzed using descriptive and chi-square statistics tested at alpha = 0.05.

Results:

Of 100 surveys, participants were: 50% directors/managers, 27% bedside staff, 22% clinical educators, and 1% quality improvement. Around 60% of respondents worked in academic hospitals and 48% worked in hospitals with more than 500 beds. Within the institution, 77% of respondents collaborated with the hospital-wide skin committee and 80% were involved in respiratory device-related skin breakdown initiatives. In RT departments, 47% of respondents had RT committees to review skin breakdown caused by respiratory devices and 63% had a RT-driven protocol to prevent respiratory device-related skin breakdown. For education, 87% of the respondents received education on skin breakdown prevention methods and 40% had training annually. Last year, 74% of respondents reported fewer than 20 incidences of respiratory device-related skin breakdown. Respondents who lacked education on skin breakdown prevention methods were more likely to report > 20 annual incidences of skin breakdown compared to recipients of education (46% vs 22%, P = .097). No significant association occurred between hospital size and annual skin breakdown incidence (P = .88).

Conclusions:

This first study to assess the use of RT-driven skin breakdown protocols in the US found approximately 63% of the respondents had protocols and nearly half utilized an internal RT committee to review skin breakdown. Although one-fourth of respondents reported more than 20 annual incidences of respiratory device-related skin breakdown, education appears to reduce the incidence.