The purpose of this poster presentation is to share the process used at a 60-bed acute rehabilitation facility to address the individual needs of admitted patients regarding their needs for pressure ulcer prevention and/or treatment. Since nearly all patients admitted (spinal cord injury, brain injury, stroke, and general rehabilitation) are identified as being at risk for pressure ulcers upon admission, it is critical that the team quickly identify and implement measures to prevent breakdown and/or promote healing. Because the average length of stay in rehabilitation is only about 16 days, it is vital to focus both on the quality of care and the efficiency of its delivery. The thorough admission assessment process utilizes a rehabilitation interdisciplinary team consisting of the staff nurse and clinical nurse specialist (CNS), physician, physical therapist, occupational therapist, speech therapist, nutritionist, pharmacist, and psychologist. This admission assessment guides the decision making for type of bed, style of wheelchair and cushion, nutritional interventions, turning schedules, activity schedules, type of bowel and bladder programs and therapy interventions. The patient and family members are included in the assessment and decision-making process to facilitate their learning and follow-through. If a patient is admitted with a pressure ulcer, the rehabilitation CNS evaluates the wound and makes further recommendations for care. The chronic wound team, which includes the rehabilitation CNS, the WOC nurses and a plastic surgeon, are consulted for sharp debridement, for a non-healing ulcer evaluation and recommendations, or for a complicated wound that will need follow-up in the outpatient wound clinic after discharge from rehabilitation.STATEMENT OF CLINICAL PROBLEM: Donor site care and dressing changes often cause discomfort for the patient and create issues related to healing. Using evidence-based practice, healing time and complications can be decreased, and discomfort lessened for the patient. DESCRIPTION OF PAST MANAGEMENT: At our organization, standard of care for donor site dressing changes was iodine impregnated petroleum gauze* applied directly to the donor site in the operating room, along with heat lamp therapy. Dressing changes began several days post-op and consisted of traumatic removal of the gauze with intense pain and bleeding, disrupting healing and new cell growth. There was often confusion by nurses as to the best procedure, as they relied solely on the written physician order that was usually vague and incomplete. CURRENT CLINICAL APPROACH: The involvement of the CWOCNs included review of evidence-based practice and mentoring of the physicians. After utilizing the antimicrobial hydrofiber dressing with silver on several patients resulting in positive OUT-COMES, the physicians were convinced of the effectiveness of this dressing for donor site care. Eventually, the Donor Site Care Orders was formally created, increasing nurse satisfaction related to improved communication and continui...

OBJECTIVE:To examine the prevalence and characteristics of medical device–related pressure injuries (MDR PIs) in a large, generalizable database.METHODS:This study is a retrospective analysis of the 2016 International Pressure Ulcer Prevalence data. Data were limited to US and Canadian facilities. Facilities included acute care, long-term care, rehabilitation, long-term acute care hospitals, and hospice. Analysis included 102,865 adult patients; 99,876 had complete data and were the focus of the analysis and are reported in the results below.RESULTS:The overall PI prevalence was 7.2% (n = 7189), and the facility-acquired prevalence was 3.1% (n = 3113). The prevalence of MDR PIs was 0.60% (n = 601), which included both mucosal and nonmucosal MDR PIs. In this study, 75% of MDR PIs were facility acquired, whereas non-MDR PIs were most commonly present on admission. Facility-acquired MDR PIs formed 3 days faster than facility-acquired non-MDR PIs (12 vs 15 days; P < .05). By stage, most MDR PIs were superficial (58% were Stage 1 or 2), 15% were deep-tissue PIs, and 22% were full-thickness PIs (Stage 3 or 4 or unstageable). The most common anatomic locations for MDR PIs were the ears (29%) and the feet (12%). The most common devices associated with MDR PIs were nasal oxygen tubes, 26%; other, 19%; cast/splints, 12%; and continuous positive airway pressure/bilevel positive airway pressure masks, 9%.CONCLUSIONS:Because MDR PIs form faster than non-MDR PIs, timely proactive assessment and prevention measures are critical. Most MDR PIs occurred at the face and head region, and the ears specifically. The most common devices linked with MDR PIs were oxygen tubing and masks, making assessment and prevention efforts critical for patients who require those devices.

No abstract