Solving the problem of pressure ulcers resulting from cervical collars.

Cervical orthotic devices (cervical collars) are integral to the treatment of patients with suspected or confirmed fracture of the cervical spine. Pressure ulcers can develop under the cervical collar on the occipital protuberance and on the chin due to both prolonged immobilization and the collar construction. A multidisciplinary team at a Northwest Ohio trauma center led an investigation of this problem when a one day study of pressure ulcer prevalence revealed that of 4% of nosocomial pressure ulcers, 2% were attributed to cervical collars. To solve this problem, the team visualized risk factors using a fishbone diagram, investigated by calling manufacturers and other institutions and by searching the literature, developed educational programs on skin care and correct collar fitting, conducted a product trial on a new collar, and continuously monitored the results. The conclusions of the team were that the pressure ulcers were the result of the construction of the previous cervical collars used. The product trial resulted in zero skin breakdown for the 20 patients involved. Changes implemented as a result were an improved skin care regimen, education on proper fitting and appropriate choice of collars, and implementation of the new collar for trauma patients.