Introduction - Texas Center for Quality & Patient Safety

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
• 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,
– A protocol for interventional steps should breakdown
• 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
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
University Medical Center Brackenridge
Respiratory Therapy Device Related Hospital Acquired Pressure Ulcer Rate
Quarter 1 2008 - Quarter 4 2012
% of Ulcers RT Device Related
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
• 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.
• 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.

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