Decreasing Dermal Damage from Endotracheal Tubes in the Intensive Care Unit: A Team Based Approach

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MR Cooper, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA.


The objective of this project was to decrease the incidence of dermal damage to patients with endotracheal tubes in the critical care units of an academic, suburban medical center. Respiratory devices can cause hospital acquired pressure ulcers (HAPU). The damage can cause pain, increase infection risk, lead to scarring and may require surgical repair. These injuries are classified as “never” events by Medicare and are reported which can subject the organization to financial penalties. In 2014 our incidence of HAPU secondary to endotracheal tubes and stabilization devices was 0.79/1000 ventilator days which increased in 2015 to 1.72/1000 ventilator days. There was a significant increase in patient case mix index documenting the increase in patient acuity between 2014 and 2015. The baseline measurement for 2014 and 2015 was 1.31 HAPU/1000 ventilator days. Define measure, analyze, improve, and control (DMAIC) performance improvement methodology was utilized by a multidisciplinary team to address this challenge. Improvement initiatives implemented included process standardization with visual cues and electronic prompts, multimedia education, dermal rounding, process auditing with peer coaching, return demonstration competency assessments, cross discipline training and defined quality metrics tied to employee performance pay. All improvement initiatives were implemented over a two month period. The team goal was to reduce dermal breakdown by 50% over the baseline and have a 90% process compliance rate. Both goals were achieved. Significant improvement resulted with the HAPU rate decreasing from 1.31 to 0.44/1000 ventilator days during the eight month period following the implementation phase. The control plan is designed to assure ongoing success with peer audits and coaching, multidisciplinary dermal rounding and new team member orientation to hardwire the well-defined, standardized process.

Presentation: 41:13

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