Reducing Respiratory Device-Related Pressure Injuries in High-Acuity Patients: A Quality Improvement Project

Respiratory medical device-related pressure injuries are a persistent challenge in acute care, particularly among high-acuity patients requiring continuous respiratory support.

At a 186-bed community hospital, respiratory medical device-related pressure injury rates rose significantly in the intensive care and progressive care units following the COVID-19 pandemic.

Plan-do-study-act cycles guided implementation of this quality improvement project. Baseline data were collected from January 2019 through June 2023, followed by intervention implementation from July 2023 through January 2025 and outcome monitoring through March 2025. The project was conducted in a 19-bed intensive care unit and a 30-bed progressive care unit and involved 121 registered nurses and 28 respiratory therapists. During the intervention phase, 123 eligible patients requiring continuous respiratory support for more than 24 consecutive hours were audited for intervention and documentation compliance. Statistical process control chart analysis was used to track monthly respiratory device-related pressure injury rates over time, identifying trends according to visual interpretation.

Respiratory medical device-related pressure injury rates declined by 52%, from 0.56 to 0.27 per 1000 patient days. Intervention compliance with placement of barrier dressings improved from 41 of 56 (71.7%) audit observations to 71 of 73 (97.8%) audit observations. Documentation compliance increased from 25 of 56 (43.4%) audit observations to 63 of 73 (89.7%) audit observations.

Standardizing preventive barrier use and strengthening interprofessional collaboration substantially reduced respiratory medical device-related pressure injuries.