Development of a pressure ulcer prevention protocol for patients requiring non-invasive positive pressure ventilation

Purpose:
To develop a hospital-acquired pressure ulcer (HAPU) prevention protocol for patients requiring continuous non-invasive positive pressure ventilation (NIPPV)

Significance:
NDNQI prevalence studies revealed several stage 3 HAPU in patients utilizing prolonged continuous non-invasive ventilation devices (NIPPV). To ensure a proper seal, NIPPV must be applied tightly. This creates increased pressure over the nasal bridge resulting in extensive tissue damage.

Strategy and Implementation:
Utilizing a multidisciplinary approach including nursing, CWOCN, and respiratory therapy cases were reviewed and strategies developed to prevent future occurrences of nasal bridge HAPU. The use of NIPPV for prolonged periods of time was identified as the root cause of the HAPU. Strategies to prevent the reoccurrence included 3 steps. The first step was to research and evaluate current masks available on the market and best practices for long term use patients. This resulted in having available 3 different mask types, with varying pressure point allowing for the redistribution of pressure.The second step evaluated four different skin protective barriers to protect the nasal bridge. A final product was evaluated; trialed and selected that was a non-adherent, reusable, gel pad that cushioned the nasal bridge and reduced pressure as well as improved patient comfort. The third step was the development and education of a new NIPPV HAPU prevention protocol to nursing and respiratory staff.

Evaluation:
Nasal skin barrier products were trialed on 35 NIPPV patients and a skin barrier was selected for use under the mask. Since the implementation of the new protocol and skin barrier no new HAPU have occurred on the nasal bridge.

Implications for Practice:
Utilizing an interdisciplinary approach to evaluate, develop and implement a pressure ulcer prevention protocol can prevent nasal bridge HAPU, and increase awareness of the problem with staff and patients.