Prevention of Tracheostomy-Related Hospital-Acquired Pressure Ulcers.

Abstract

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

• Authors: Thomas R O'Toole, Natalie Jacobs, Brian Hondorp, Laura Crawford, Lisa R Boudreau, Jill Jeffe, Brian Stein, Phillip LoSavio
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 156 Issue 4 Pg. 642-651 (04 2017) ISSN: 1097-6817 [Electronic] England
• PMID: 28195000 (Publication Type: Journal Article)

Chemical References

• Polyurethanes

Topics

• Adult
• Bandages
• Bandages, Hydrocolloid
• Female
• Humans
• Iatrogenic Disease (prevention & control)
• Male
• Middle Aged
• Polyurethanes
• Postoperative Care
• Pressure Ulcer (prevention & control)
• Retrospective Studies
• Tracheostomy (adverse effects)