Innovative Strategies to Decrease Cervical Collar Related Pressure Ulcers

Purpose:
In late 2009 and early 2010, the SICU of a NYS Regional Trauma and Academic Medical Center, noted an increase in the number of cervical spine injuries requiring the placement of a cervical collar for greater than 72 hours. The majority of these patients developed collar related pressure ulcers.

Significance:
Pressure ulcers are a serious problem for hospitals. They can cause infections that require treatment leading to longer stays, higher costs, or even death. While cervical collar related pressure ulcers documented in the literature range from 20-50%, this particular unit had a much higher incidence.

Strategy and Implementation:
The Nurse Educator in SICU researched the issue of cervical collar related pressure ulcers. Trauma center protocols from all over the world were reviewed and best practices from these centers were used as the foundation for the creation of a new procedure for cervical spine injury patients. Multidisciplinary trauma meetings and surgical quality improvement meetings were the forums for discussions related to care of patients in cervical collars and pressure ulcer incidence. It was determined that a knowledge deficit among the team in the SICU regarding spinal precautions, responsibility for manual neck immobilization, and the fit, removal and care of cervical collars presented a major challenge, as did the lack of a formal multidisciplinary and interdepartmental procedure to refer to. A procedure for care of patients with cervical collars was collaboratively developed and approved. Education on the procedure and care of cervical collars was provided to the SICU team in July 2010.

Evaluation:
From January-June 2010, 7 of 10 patients with cervical collars in place for greater than 72 hours developed collar related pressure ulcers, a 70% incidence. After implementation of the new procedure and education, only 1 of 16 patients from July-December developed a related pressure ulcer, or 6.25%

Implications for Practice:
Multidisciplinary commitment to development of evidence-based policies and procedures, implementation of interdepartmental protocols, and educational initiatives to support practice at the bedside will provide the health care team with the tools needed to provide care and improve patient outcomes