Reducing Nares Acquired Pressure Injuries "Protect the Nares Because I Care" Project in Adult Inpatients: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population. PARTICIPANTS AND SETTING: Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States. APPROACH: Through our organization's "RUSH Way" QI model, we developed an evidence-based NAPI Bundle comprising a "T"-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated. RESULTS: In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal. CONCLUSION: The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.

COVID-19 and Nurse-Sensitive Indicators: Using Performance Improvement Teams to Address Quality Indicators During a Pandemic.

BACKGROUND: Nurse-sensitive quality indicators have historically been used as a metric of nursing care quality in health care organizations. PROBLEM: At our academic medical center, critically ill COVID-19 patients led to a dramatic change in the organizational standard of care resulting in an increase in nurse-sensitive health care-associated infections. APPROACH: Nursing performance improvement teams provided the structure for development of innovative strategies implemented in real time by our frontline clinicians to address the quality and safety issues found with these elevated health care-associated infections. OUTCOMES: A new COVID-19 CLABSI (central line-associated bloodstream infection) Tip Sheet and a Prone Positioning Kit for HAPI Prevention are strategies developed to address quality of care issues experienced with the COVID-19 patients. CONCLUSIONS: Deployment of these innovative practice strategies has led to a decline in health care-associated infections and instituted a new care standard for the COVID-19 patients.

Reducing nasal pressure ulcers with an alternative taping device.

Mucosal tissues are vulnerable to nasal pressure ulcers (NPUs) secondary to nasogastric tubes, and can cause hospital-associated complications and increased length of stay. The findings of this study suggest a commercially available device significantly reduces NPUs and is more adherent compared to conventional adhesive taping.

Fecal containment in bedridden patients: economic impact of 2 commercial bowel catheter systems.

BACKGROUND: Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections. OBJECTIVES: To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups. METHODS: A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded. RESULTS: The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low. CONCLUSION: Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day.