Nursing and Respiratory Collaboration Prevents BiPAP-Related Pressure Ulcers

Published:April 25, 2015DOI:https://doi.org/10.1016/j.pedn.2015.04.001
      In early 2012, an increase in the incidence of BiPAP-related pressure ulcers was noted in the progressive care unit of a large pediatric facility. An interdisciplinary team of nursing and respiratory staff and leadership formed a collaborative to address the gaps in practice, recommend, and implement evidence-based interventions using a quality improvement model. Interventions included piloting new masks, changing the skin barrier from a hydrocolloid dressing to a foam dressing and using a template for better fit, including skin assessments every 4 hours as part of nursing and respiratory therapists' workflow, and implementing a notification process that included Wound Ostomy Continence Nurses, respiratory, and nursing leadership for any redness of skin noted. Weekly rounding and communication by nursing and respiratory leadership ensured consistency and sustainability of practice. Aside from implementation of interventions, the primary focus was to develop a collaborative relationship between nursing and respiratory teams for shared ownership and accountability of patients on BiPAP support. Three months after the implementation of interventions, the occurrence of BiPAP-related pressure ulcers decreased from eleven in the first three quarters to one occurrence in the fourth quarter of fiscal year (FY) 2012. In 2013, the occurrence decreased to five for the entire fiscal year. Since the end of FY 2013, there has only been one occurrence of a BiPAP-related pressure ulcer in the progressive care unit. Close collaboration between respiratory and nursing has been the primary factor in decreasing BiPAP-related pressure ulcers. An important lesson learned is that interdisciplinary collaboration leads to improved patient outcomes.

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      References

        • Baharestani M.M.
        • Ratliff C.R.
        Pressure ulcers in neonates and children: An NPUAP white paper.
        Advances in Skin & Wound Care. 2007; 20: 208-220
        • Davies P.
        • Rippon M.
        Comparison of foam and hydrocolloid dressings in the management of wounds: A review of the published literature.
        World Wide Wounds. 2010; (Available from: http://www.worldwidewounds.com/2010/July/DaviesRippon/Daviesl)
        • Despins L.A.
        Patient safety and collaboration of the intensive care unit team.
        Critical Care Nurse. 2009; 29: 85-91
        • Fauroux B.
        • Lavis J.F.
        • Nicot F.
        • Picard A.
        • Boelle P.Y.
        • Clement A.
        • et al.
        Facial ide effects during noninvasive positive pressure ventilation in children.
        Intensive Care Medicine. 2005; 31: 965-969
        • Grap M.
        • Strickland D.
        • Tormey L.
        • Keane K.
        • Lubin S.
        • Emerson J.
        • et al.
        Collaborative practice: Development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation.
        American Journal of Critical Care. 2003; 12: 454-460
        • Hess D.R.
        Noninvasive ventilation in neuromuscular disease: Equipment and application.
        Respiratory Care. 2006; 51: 896-912
        • Schindler C.A.
        • Mikhailov T.A.
        • Fischer K.
        • Lukasiewicz G.
        • Kuhn E.M.
        • Duncan L.
        Skin integrity in critically ill and injured children.
        American Journal of Critical Care. 2007; 16: 568-574
        • Schindler C.
        • Mikhailov T.
        • Kuhn E.
        • Christopher J.
        • Conway P.
        • Ridling D.
        • et al.
        Protecting fragile skin: Nursing interventions to decrease development of pressure ulcers in pediatric intensive care.
        American Journal of Critical Care. 2011; 20: 26-34
        • Yamaguti W.P.
        • Moderno E.V.
        • Yamashita S.Y.
        • Gomes T.
        • Maida A.
        • Kondo C.
        • et al.
        Treatment-related risk factors for development of skin breakdown in subjects with acute respiratory failure undergoing noninvasive ventilation or CPAP.
        Respiratory Care. 2014; 59: 1530-1536