University Medical Center at Brackenridge Respiratory Care/WOCN Team • Team Mission: – proactive identification of high risk patients, and – quick implementation of a new skin preparation process to minimize and/or alleviate skin pressure ulcers/breakdown. • The Team developed a skin preventative care process for Intubated/Rotoprone Patients: – Preparing the skin prior to prone positioning, – A method for securing the ETT with prone positioning, and – A protocol for interventional steps should breakdown occur. METHODS • Work began between Respiratory Care Skin Champions (UMCB Respiratory Therapists focused primarily on skin initiatives) and the Wound Ostomy Continence Nurse (WOCN) developing protocols for all respiratory devices. – oxygen delivery – Bipap/cpap – Intubated/supine patients – Intubated/Rotoprone patients METHODS • • • • The Team developed a skin QI audit tool Skin preparation boxes were placed in the AICU. Educational literature placed in the AICU Respiratory Skin Champions provided bedside support to RTs and RNs and launched a bedside educational campaign. • Wound Assessment/Care computer site was built to include Respiratory Care as a Discipline Managing Wound Assessment and Wound Care. • Documentation on the Compass computer site will be multidisciplinary to include: – Nursing, Physical Therapy, Occupational Therapy, Wound Ostomy Continence Nurse and Respiratory Care. Skin Prevention for Respiratory Related Devices Note: If there is a wound you must chart not intact and notify the nurse and/or WOCN. You will then describe and document the wound in the Wound care band. Skin Prevention: Wound Charting Device Related HAPU Rate 2.5% University Medical Center Brackenridge Respiratory Therapy Device Related Hospital Acquired Pressure Ulcer Rate Quarter 1 2008 - Quarter 4 2012 % of Ulcers RT Device Related 2.0% 1.5% 1.0% 0.5% Fiscal Year Quarter RT Device Related HAPU Rate 2 per. Mov. Avg. (RT Device Related HAPU Rate) Q4 2012 Q3 2012 Q2 2012 Q1 2012 Q4 2011 Q3 2011 Q2 2011 Q1 2011 Q4 2010 Q3 2010 Q2 2010 Q1 2010 Q4 2009 Q3 2009 Q2 2009 Q1 2009 Q4 2008 Q3 2008 Q2 2008 Q1 2008 0.0% RESULTS • Our team has been successful with a decrease in skin breakdown • UMCB respiratory care device-related pressure ulcer rate: – First quarter of 2008 = 18% (Source: 2008 Prevalence Data). – First quarter of 2009 = 10% following an initial ETT and BIPAP skin preparation trial process in. • With the addition of the skin preparation for intubated and RotoProneTM patients our device-related pressure ulcer dropped to ZERO and maintained this percentage for 18 months. • Data from August 2009 to February 2011 resulted in the bedside assessment, treatment and quality improvement of 1,527 patients by the Respiratory Care Skin Champions in the AICU at UMCB. • This information is entered in the computer tracking tool and used to assist the bedside RT, WOCN and RN with real time evaluation and immediate modification of taping and securing methods for ETTs and evaluation of skin integrity of critical care patients. CONCLUSION • A network goal of zero preventable PUs for all respiratory care devices has been established. • Identification and prevention of PUs is a major area of interest for hospitals and regulatory agencies. • Finding new ways to help patients and prevent suffering and life-long disfigurement to the face has been rewarding for our team. • The UMCB team skin protection procedure has been accepted and spread across all ten Austin-area Seton Network hospitals encompassing 1,200 beds and serving the Central Texas region of 1.8 million people.