O'Toole TR, Jacobs N, Hondorp B, Crawford L, Boudreau LR, Jeffe J, Stein B, LoSavio P, et al.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-.... Date of publication 2017 Apr 1;volume 156(4):642-651.
1. Otolaryngol Head Neck Surg. 2017 Apr;156(4):642-651. doi:
10.1177/0194599816689584. Epub 2017 Feb 14.
Prevention of Tracheostomy-Related Hospital-Acquired Pressure Ulcers.
O'Toole TR(1), Jacobs N(2), Hondorp B(3), Crawford L(2), Boudreau LR(2), Jeffe
J(1), Stein B(4), LoSavio P(1).
Author information:
(1)1 Department of Otorhinolaryngology-Head and Neck Surgery, Rush University
Medical Center, Chicago, Illinois, USA.
(2)2 Division of Nursing, Rush University Medical Center, Chicago, Illinois, USA.
(3)3 Department of Otolaryngology-Head and Neck Surgery, Loma Linda Medical
Center, Loma Linda, California, USA.
(4)4 Department of Medicine, Division of Pulmonary Medicine, Rush University
Medical Center, Chicago, Illinois, USA.
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.
DOI: 10.1177/0194599816689584
PMID: 28195000 [Indexed for MEDLINE]
