Methods

1. Reduction of Oral Pressure Ulcers Following Implementation of the Hollister Anchorfast ET Tube Securing Device™ and the B&B Medical Universal Bite Block™ Christopher Teegardin RRT, Respiratory Care Department; Sunniva Zaratkiewicz, RN, BSN, CWCN, Clinical Education Department; Joel Ray RRT, Respiratory Care Department, Harborview Medical Center, Seattle, WA Methods The HAPU Daily Incidence Tracking System and Algorithm used at our institution monitors daily pressure ulcer incidence, providing an improved method of early pressure ulcer identification, tracking, and prevention. Staff RNs complete a skin assessment of their patients each shift and record that assessment in the Electronic Medical Record (EMR). The mouth and lips are also assessed by staff RTs each shift and recorded on the RT Flowchart in the EMR. Data from this system and a retrospective EMR chart review was compiled to determine the number of pressure ulcers on the lips, mouth, gums, and tongue of orally intubated patients for three different time periods: Phase 1 - Five months prior to introduction of the ETAD. Phase 2 - Five months after the introduction of the ETAD. Phase 3 - Ten months after the AnchorFast was established as the primary securing device. Introduction The Centers for Medicare and Medicaid Services (CMS) identified hospital acquired pressure ulcers (HAPUs) among the most preventable conditions. Recognition and prevention of HAPUs is an important element of patient care, effecting patient morbidity and treatment cost. The Hollister ETAD ET Tube securing device™ - in conjunction with the B&B Medical Universal bite block™ – was introduced at our institution, a level 1 trauma and burn center, in July 2007. In December 2007, Hollister replaced the ETAD with the AnchorFast ET Tube securing device™. By April 2009, the AnchorFast and Universal bite block became the standard devices and method used to secure oral ET tubes (94% of adult patients). In April 2009, a subjective survey of critical care nurses and respiratory care practitioners compared the AnchorFast to the previous securing devices used. Over 90% of those surveyed felt the AnchorFast was more maneuverable and provided better access and assessment of the mouth. We hypothesized the use of the AnchorFast would lead to a decrease of HAPUs on the lips, mouth, gums and tongue of orally intubated critical care patients. Abstract BACKGROUND: Prevention of hospital acquired pressure ulcers (HAPU) is an important element of patient care, effecting patient morbidity, treatment cost, and reimbursement issues. The Hollister AnchorFast ET Tube securing device™ - in conjunction with the B&B Medical Universal bite block™ – was introduced at our institution, a level 1 trauma and burn center, in December 2007. By April 2009, they became the standard devices and method used to secure oral ET tubes (94% of adult patients). In April 2009, a subjective survey of critical care nurses and respiratory care practitioners compared the AnchorFast to the previous securing devices used here. Over 90% of those surveyed felt the AnchorFast was more maneuverable and provided better access and assessment of the mouth. We hypothesized the use of the AnchorFast would lead to a decrease of HAPUs on the lips, mouth, gums and tongue of orally intubated critical care patients. METHOD: The HAPU Daily Incidence Tracking System and Algorithm used at our institution monitors daily pressure ulcer incidence, providing an improved method of early pressure ulcer identification, tracking, and prevention. Using data collected from this system and a retrospective electronic medical record chart review, the number of pressure ulcers on the lips, mouth, gums, and tongue of orally intubated patients for the ten months prior to introduction of the AnchorFast (Pre-A) was compared to the same data collected for the ten months after the AnchorFast (Post-A) had been established as the standard securing device. RESULTS: In the Pre-A group, 3039 patients were initiated on mechanical ventilation with an undetermined majority supported via an oral ET tube. 21 HAPUs on the lips or in the oral cavity of orally intubated patients was reported. In the Post-A group, 3010 patient were initiated on mechanical ventilation with an undetermined majority supported via an oral ET tube. 2 HAPUs on the lips or in the oral cavity of orally intubated patients was reported during this second interval. CONCLUSION: The reported incidence of HAPUs on the lips and in the oral cavity decreased following introduction of the AnchorFast and Universal Bite Block in our institution. Results In Phase 1 (Figure 1), 1517 patients were initiated on mechanical ventilation and remained mechanically ventilated for a total of 7175 ventilator days (Average 4.73 days per patient). 19 HAPUs on the lips or in the oral cavity of orally intubated patients was reported. In Phase 2 (Figure 2), The use of the ETAD was undetermined, but it was the only known change related to oral care and assessment at that time.1522 patients were initiated on mechanical ventilation and remained mechanically ventilated for a total of 7592 ventilator days (average 4.99 days per patient). 2 HAPUs on the lips or in the oral cavity of orally intubated patients was reported during this interval. In Phase 3 (Figure 3), 3010 patients were initiated on mechanical ventilation and remained mechanically ventilated for a total of 14328 ventilator days (average 4.76 days per patient). 2 HAPUs were reported during this interval. Figure 1 Figure 2 Conclusion The reported incidence of HAPUs on the lips and in the oral cavity decreased following introduction of the ETAD, AnchorFast, and Universal Bite Block in our institution. Acknowledgements Disclosure of presenter conflict(s) of interest – none Disclosure of any research funding, sponsorship, or financial support – none Figure 3 For further information Please contact Christopher Teegardin at email address: cbtee@uw.edu