title: 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.affiliation: 1 Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: O'Toole
authors.affiliation: 2 Division of Nursing, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Jacobs
authors.affiliation: 3 Department of Otolaryngology-Head and Neck Surgery, Loma Linda Medical Center, Loma Linda, California, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hondorp
authors.affiliation: 2 Division of Nursing, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Crawford
authors.affiliation: 2 Division of Nursing, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Boudreau
authors.affiliation: 1 Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Jeffe
authors.affiliation: 4 Department of Medicine, Division of Pulmonary Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Stein
authors.affiliation: 1 Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: LoSavio
mesh_terms: D000328:Adult; D001458:Bandages; D047070:Bandages, Hydrocolloid; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes; D011182:Postoperative Care; D003668:Pressure Ulcer / Q000517:prevention & control*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects*
chemical_list: D011140:Polyurethanes
keywords: PS/QI; acquired; bundle; hospital; pressure; prevention; tracheostomy; ulcer