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Tracheostomy Pressure Injury Prevention

Mary Egger

University of Saint Mary

NU 611 Informatics in Nursing

12/6/2020
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Tracheostomy Pressure Injury Prevention

Nurses come across data every day, even if they do not realize it. As the nurse is

assessing a patient, data is collected and recorded. Every blood pressure and pain score a nurse

enters into a patient’s chart creates data. The data recorded on a patient’s chart generates a trend

for the interdisciplinary care team to monitor. Even adverse events, like pressure injuries,

produce data. Hospitals and health systems monitor pressure injuries to prevent harm from

medical devices that cause these never events. The data that is tracked can provide information

that leads to the prevention of a pressure injury in the future. Each pressure injury that is

identified is harmful to the patient. They are damaging to the patient’s healing process and can

cost the hospital extra money. The prevention of tracheostomy associated pressure injuries

begins with the collection of data. The goal is to discover and implement a solution to prevent

tracheostomy associated pressure injuries through the use of data and informatics.

In the assessment of a patient with a newly sutured tracheostomy, data is obtained and

documented. This data is recorded so that it can be observed and studied for future use. An

increase in tracheostomy associated pressure injuries documented on patients with new sutured

tracheostomies has been discovered. The increase incidence sparks the question as to why these

device associated pressure injuries are occurring frequently. These pressure injuries are caused

by a medical device that is necessary for airway management and therapeutic effects.

Tracheostomy associated pressure injuries, like any other hospital-acquired pressure injury

(HAPI), can be prevented. It is important to question the reasoning for this data to be repeatedly

occurring. Possible reasons that a patient may develop a tracheostomy associated pressure injury

are tightly sewn sutures, swelling, and lack of a protective barrier dressing (Dixon et al., 2018).

Harm that occurs in the care of a patient can be prevented with the use of informatics.
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Through data and nursing informatics, trends can be produced to identify the number of

these device associated pressure injuries. Over a year, a chart review will yield a set of data to

begin the process of implementing change for patients with newly sutured tracheostomies. Data

from previous patients will reveal common trends from interventions, or lack thereof, in the care

for this patient population. This information is strongly based on a nurse’s assessment. The data

that is gathered will provide information to create a bundle that will be implemented for patients

with sutured tracheostomies. The Electronic Medical Record (EMR) can be programed to

generate a flag on patients who obtain a newly sutured tracheostomy so that the nurses can

identify each part of the bundle. Another use of informatics is to create an order set for these

patients so that physicians can aide in the standardization of tracheostomy care. This bundle will

be applied to all patients who receive a sutured tracheostomy to decrease the incidence of

pressure injuries.

The concept of preventing HAPIs is nothing new. There is a plethora of research

surrounding this topic. In contrast, tracheostomy associated pressure injuries have not been

researched as extensively. These pressure injuries are specific to a tracheostomy, but this patient

population should not be ignored. That being said, there is enough evidence to understand ways

that will be beneficial in the prevention of pressure injuries from tracheostomies. There should

be a bundle that nurses apply towards these patients with sutured tracheostomies. There is a

quality improvement article about the implementation of a bundle that decreased tracheostomy

associated pressure injuries by 80% in one year (Dixon et al., 2018). There has to be a solution,

or improvement, for this problem. A bundle that includes a protective foam dressing placed

under the plate of the tracheostomy, frequent tracheostomy care every eight hours, and

maintaining the patient’s neck in a neutral position are the main parts of the bundle (Dixon et al.,
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2018). The article proves that a bundle can be effective towards the prevention of these pressure

injuries. The implementation of the bundle will take time, education, and resources. The data

provided by a chart review will provide a baseline of tracheostomy associated pressure injury

incidences.

The general concepts of this project will be tracheostomies and pressure injuries. A

concept map will be established to understand the relationship between these two main concepts.

The concepts of tracheostomies can be broken down into the different types of tracheostomies

and the care that is involved with both. Other concepts that will be utilized are informatics and

data. The concepts will be defined and organized to display the role each has on the prevention

of tracheostomy associated pressure injuries. Further concepts that will be explored will be the

components of the tracheostomy associated pressure injury prevention bundle and the causes for

these pressure injuries.

The main stakeholder who would be directly affected by the implementation of a

tracheostomy associated pressure injury prevention bundle would be the patients. The bundle

would directly impact them in the prevention of harm. The reason for the data collection is to

promote patient safety from these adverse events. Another stakeholder is the nurse who

implements the bundle because without them, the bundle would not be implemented. Nurses are

the main healthcare worker who is directly involved in the care of this patient population so they

must have the knowledge about the bundle. It is important the nurses have the appropriate

education regarding the care of a patient with a newly sutured tracheostomy. A proper

assessment and application of the bundle are crucial to the prevention of pressure injuries. The

health system or hospital is invested as a stakeholder as well because of data monitoring and
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budgeting. The final stakeholders are the physicians who order the bundle and the informaticists

who created the chart pop-up for all patients with new tracheostomies.

The main group that will benefit from the implementation of the bundle is the patients.

The tracheostomy associated pressure injury prevention bundle is created specifically for them.

The standardization of tracheostomy care with the use of this bundle is aimed to help this patient

population manage their new airway without complications. Nurses are also going to benefit

from the implementation of this bundle, especially with the use of informatics and

documentation of the bundle. Their record of data from the assessment drives research for this

project. They will be educated on the reasoning behind its use as well as each component of the

bundle. Nurses will apply this evidence based intervention for the benefit of each patient. The

hospital will benefit from their staff being able to apply evidence based practices at the bedside.

The beneficiary of this project is the patient population. The standardization of

tracheostomy management can improve a patient’s quality of life (Zhu et al., 2014). This project

aims to reduce the amount of tracheostomy associated pressure injuries so that patients can

manage their airway without any adverse events. This nursing intervention uses informatics for

the beneficiary of the patient.

A proposal will be made after data has been collected from a chart review. This chart

review will record each tracheostomy associated pressure injury and which post-operative day a

patient obtained this injury. After the data has been collected, a tracheostomy associated pressure

injury bundle will be implemented for patients with newly sutured tracheostomies. A team of

nurse informaticists will help monitor this patient population after the bundle has been

implemented so that the data can be compared to the data prior to the bundle’s initiation. The

bundle will include a preventative dressing that is placed under the tracheostomy plate, skin
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assessments every eight hours with tracheostomy care, neutral neck positioning, and a set suture

removal time (Dixon et al., 2018). Another beneficial aspect of this proposal is the

interdisciplinary approach. When using a multidisciplinary team approach, each member can

bring experience and is accountable for any problems that may occur (Zhu et al., 2014). To

determine success, another chart review will be performed and compared to the initial review.

The new set of data will be analyzed, and if any pressure injuries occur, they will be studied

further to determine the cause so they can be potentially prevented in the future. The collection

of data is key to the success of this project.

After the implementation of this bundle, there should be a decrease in tracheostomy

associated pressure injuries. During this phase of implementation, the data can be tracked and

monitored through Excel (Maydick-Youngberg, 2020). The project will be analyzed, and the

data displayed in a graph with the X axis representing the months and the Y axis representing the

number of incidences of tracheostomy associated pressure injuries in the given month. Results

should show a decrease in these pressure injuries after the implementation of the bundle. Once

the tracheostomy associated pressure injury prevention bundle is implemented, there should be

less data indicated a pressure injury has been recorded. Each interdisciplinary team member will

be accountable for their role and aim to prevent harm towards this patient population. The

collaborative effort from the interdisciplinary team will work in unison to prevent device

associated pressure injuries.

The data that is observed in the chart review will provide information that will change the

way that patients with newly sutured tracheostomies are cared for. Through the use of data,

informatics, and research these patients will have a decrease in device associated pressure

injuries. The analysis of the beneficiaries and stakeholders in this project were developed with
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improved patient outcomes in mind. Concepts were examined to show a relationship between

each element of the tracheostomy associated pressure injury prevention bundle. This bundle was

generated from the collection of data to prevent tracheostomy pressure injuries with the help of

informatics. Alterations in the electronic chart allow for flags and pop-ups so that the bundle can

be implemented. The reduction of device associated pressure injuries begins with the assessment

and collection of data.

References
Dixon, L. M., Mascioli, S., Mixell, J. H., Gillin, T., Upchurch, C. N., & Bradley, K. M. (2018).

Reducing tracheostomy-related pressure injuries. AACN Advanced Critical Care, 29(4),

426–431. https://doi.org/10.4037/aacnacc2018426

Maydick-Youngberg, D. (2020). An evidence-based interprofessional collaborative practice

approach to decrease tracheostomy-related pressure injury. MEDSURG Nursing, 29(3),

189–218.

Zhu, Das, P., Woodhouse, R., & Kubba, H. (2014). Improving the quality of tracheostomy

care. Breathe, 10(4), 286–294.

https://doi-org.stmary.idm.oclc.org/10.1183/20734735.011114