Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and...
by Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP
Recently, one of my awesome staff nurses coined a phrase that stuck with me—Mr. DoctoR Pressure Injury (MDRPI), also known as medical device-related pressure injury. MDRPIs are a common yet usually preventable problem. We wanted to raise awareness of MDRPIs for World Wide Pressure Injury Prevention Day in November of 2018, and one of our staff nurses was quite creative in doing so! She thought of using a doctor’s briefcase with medical devices inside, many of which can and do cause pressure injuries. Being creative and using mnemonics are great ways not only to engage staff, but also to be sure that they remember the information provided to them. Additionally, hands-on props and interactive stations require engagement, which appeals to many different types of learners.
Medical Device-Related Pressure Injury Risk Assessment
Mr. DoctoR Pressure Injury is important because, as nursing professionals, we are encountering medical devices every day: nasal cannulas, prosthetics, face masks (BiPap or CPAP), non-rebreather masks, arterial lines, PICCs, IVs, tubes including nephrostomy tubes, Foley catheters, JP drains, fecal management systems, etc. These medical devices are intended to help keep our patients safe and promote their healing; however, if sites and placement are not rotated and checked frequently, compromises in skin integrity may occur.
A culture of hypervigilance is necessary for pressure injury prevention. Frequent skin assessments, rotating tube placement, and checking device or tube placement during hourly rounding are key. Remember to rotate your PEG tube bumpers, check under trach plates, and be sure all tubing is secured using an appropriate tube securement device. Additionally, if a tube or device is no longer needed, discuss the situation with the medical team to see whether the device is able to be safely removed.
Paying attention to our patients and their habits is also important. Does the patient wear eyeglasses and oxygen tubing? Protect those ears! Does the patient have hearing aids? Be sure they’re removed at bedtime. Does the patient have any kind of tube or device? Be sure that it is secured with a tube securement device. Is there a prosthesis (leg, arm, foot, offloading shoe, shoe filler)? Be sure it is removed at intervals with frequent skin checks performed. If there is edema in an extremity, check even more frequently, and if the prosthesis is too tight, it should not be worn until it fits properly. Prevention is key! If we can prevent MDRPIs before they occur, we are a step ahead of the game.
How to Involve Staff in Preventing Medical Device-Related Pressure Injuries
Device-related rounds are a great way to involve staff and prevent MDRPIs. In a long-term care setting, these rounds may be performed as frequently as needed with leadership, frontline staff, a wound specialist, provider, and/or whomever is on your team. Round on the patients and check each patient with a device, to make sure it is secured appropriately and that there is no skin damage. This is also a great time to educate staff and bring awareness to the patient, involving them in their care, and creating a culture of prevention.
Primary Prevention of Medical Device-Related Pressure Injuries is the Best Management Strategy!
I am sure I’ve said this before, but I can’t stress enough— involve staff and patients as much as possible, educate, be present, and create a culture of prevention. If something means a lot to you and it shows, you can more easily instill these values in your staff and patients. Buy-in from leadership is important, as are follow-up and follow-through by the wound specialist. Bring awareness to concerns, and put prevention measures in place.
In the hospital and long-term care setting, our patients frequently depend on medical devices. As nursing professionals, it is our duty to keep the patients safe. So, while they need these devices, we need to be checking, assessing, and putting prevention measures in place. Specific strategies for prevention will be discussed in the near future. For now, do your best to prevent any office visits with Mr. DoctoR Pressure Injury!
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.