Reducing Nasogastric Pressure Ulcers
Helping Patients Through Collaboration and Innovation
During FY2015 on the adult inpatient hospital units, 5.26 percent of patients with a nasogastric or small-bore feeding tube developed a device-related nares (nostril) pressure ulcer.
A study to prevent nares breakdown was approved by the Institutional Review Board and was initiated with great initial success, using a hydrocolloid, circular-shaped dressing (107 enrolled with 0 pressure ulcers). However, the study was suspended due to a suspected safety issue with the dressing shape.
A Rush Way interprofessional process improvement team consisting of nursing, risk management and anesthesia was convened in December 2015 to determine and implement a revised version of the hydrocolloid dressing.
After a thorough literature review, an innovative “T”-shaped design was chosen and trialed. The new dressing design was piloted in the surgical intensive care unit (SICU) and helped reduce their nares-acquired pressure ulcers from 10 in the first half of FY2016 down to three in the latter half of the fiscal year.
With this success in the SICU, a bundle approach was created and disseminated, which incorporated the following:
- The “T”-shaped hydrocolloid dressing
- A tube holder securement device
- Recommended frequency for assessment and dressing change
The nares-acquired pressure ulcer prevention or “NAPU” bundle was rolled out in June 2015. Nares-acquired pressure ulcers were decreased by the end of FY2016 from a rate of 5.26 percent to 3.46 percent. In FY2017, the goal is to maintain these improvements and keep Rush patients free from pressure ulcers.