Reducing the Incidence of Medical Device-Related Pressure Injuries From Use of CPAP/BiPAP Masks: A Quality Improvement Project.

Abstract

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.