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An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries
Anne E Urquhart1, Elizabeth Savage, Keri Danziger
1At NYU Langone Health, New York, New York, Anne E. Urquhart, MS, APRN, AGCNS-BC, CCRN, CMC, is Clinical Nurse Specialist, Adult Medical ICU; Elizabeth Savage, MSN, APRN, ACNS-BC, CWON, IIWCC-NYU, is Clinical Nurse Specialist and Program Manager for Wound, Ostomy, & Continence Nursing Service; Keri Danziger, MA, CCC-SLP, is Supervisor, Adult Inpatient Speech and Swallowing Services, Rusk Rehabilitation; Tara Easter, MA, RN, is Nurse Manager, Adult Medical ICU; Anish Terala, BS, is Data Analyst; and Mark Nunnally, MD, FCCM, is Professor, Departments of Anesthesiology, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, and Director of Adult Critical Care Services. The authors have disclosed no financial relationships related to this article. Submitted January 20, 2021; accepted in revised form March 4, 2021; published online ahead of print December 2, 2021.
A standardized bundle significantly reduced tracheotomy-related pressure injuries (TRPIs) by 50%. This initiative also established an escalation process for improved patient care and outcomes in tracheostomy management.
Area of Science:
- Quality Improvement
- Patient Safety
- Interprofessional Collaboration
Background:
- Tracheostomy-related pressure injuries (TRPIs) pose a risk to patient safety.
- Standardized care protocols are needed for tracheostomy insertion and management.
- An escalation process is crucial for addressing clinician concerns.
Purpose of the Study:
- To establish a Tracheostomy Steering Committee (TSC) to prevent TRPIs.
- To standardize tracheostomy care and insertion practices.
- To implement an escalation process for clinical concerns regarding tracheostomy patients.
Main Methods:
- A quality improvement initiative using the Define, Measure, Analyze, Improve, and Control (DMAIC) framework.
- Development of a TRPI-prevention bundle including dressings, suture care, skin assessment, and positioning.
- Implementation of an electronic tracheostomy report for enterprise-wide tracking.
Main Results:
- A 50% reduction in the daily rate of TRPIs was observed post-intervention.
- The standardized TRPI-prevention bundle demonstrated effectiveness.
- An electronic reporting system facilitated patient tracking.
Conclusions:
- The TRPI-prevention bundle significantly reduced injury incidence.
- Timely escalation and feedback reinforced best practices.
- Interprofessional collaboration is key for optimal tracheostomy care and outcomes.
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