Linda Arundel, MSN, RN, CWOCN , Nursing Administration, Wound and Ostomy Coordinator, Inova Fair Oaks Hospital, Fairfax, Virginia.
Evelyn Irani, MSN, RN, CCRN, NE-BC , Clinical Director ICU, Inova Fair Oaks Hospital, Fairfax, Virginia.
J Wound Ostomy Continence Nurs. 2021;48(2):108-114. doi: 10.1097/WON.0000000000000742.
The purpose of this work was to reduce the number of hospital-acquired pressure injuries on the nasal bridge resulting from the use of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy.
Patients with medical device-related pressure injuries (MDRPI) receiving continuous/intermittent CPAP/BiPAP in a 12-bed critical care unit in a Magnet-designated, 182-bed community hospital in the mid-Atlantic region of the United States.
An interprofessional team collaborated to assess factors contributing to an increase in MDRPI development in critical care unit patients using CPAP/BiPAP. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, conduct a partial or incomplete skin assessment. The project consisted of conducting a literature search on MDRPI, developing a standard work process for skin assessment and documentation in the medical record, using skin protection under the mask, and evaluating whether a different model of mask would minimize pressure on the nasal bridge.
Through active collaboration, the interprofessional team implemented standard work processes, completed product evaluation of masks, and monitored key process indicators related to documentation of daily and every 4-hour skin assessments, implementation of a thin foam dressing under the CPAP/BiPAP mask for any nonblanchable or blanchable erythema, and escalation to the certified wound, ostomy, and continence nurse. In 2016, the unit identified 4 CPAP/BiPAP mask-related MDRPIs. By December 2017, only 1 stage 1 injury was identified and it resolved quickly after appropriate assessment and prompt interventions. This showed a 75% reduction in actual injuries with a zero escalation to stage 2 or greater injuries.
An interprofessional team approach to CPAP/BiPAP-related MDRPI improved patient outcomes in critical care unit patients.
本研究旨在减少因使用持续气道正压通气（CPAP）和双水平气道正压通气（BiPAP）治疗而导致的鼻桥医源性压力性损伤（MDRPI）的数量。
在位于美国中大西洋地区的一家 182 床位社区医院的 12 床位重症监护病房中，对使用 CPAP/BiPAP 治疗的患有与医疗器械相关的压力性损伤（MDRPI）的患者进行研究。
多学科团队合作评估导致接受 CPAP/BiPAP 的重症监护病房患者发生 MDRPI 增加的因素。患者对高压氧气的依赖导致护士不愿取下口罩，从而无法进行部分或不完全的皮肤评估。该项目包括对 MDRPI 进行文献检索、制定皮肤评估和记录的标准工作流程、在口罩下使用皮肤保护剂，并评估不同型号的口罩是否可以最小化对鼻桥的压力。
通过积极合作，多学科团队实施了标准工作流程，完成了口罩的产品评估，并监测了与每日和每 4 小时皮肤评估记录、在 CPAP/BiPAP 口罩下使用薄泡沫敷料处理任何不可褪色或褪色性红斑、以及向认证的伤口、造口和失禁护士报告的关键过程指标。2016 年，该病房发现 4 例 CPAP/BiPAP 口罩相关 MDRPI。到 2017 年 12 月，仅发现 1 例 1 期损伤，在进行适当的评估和及时干预后很快得到解决。这表明实际损伤减少了 75%，且没有 2 期或更高级别的损伤升级。
CPAP/BiPAP 相关 MDRPI 的多学科团队方法改善了重症监护病房患者的预后。
