Executive Summary: Preventing Pressure Injuries from Endotracheal Tubes in the Intensive Care Unit

Abstract

Background: Endotracheal tubes (ETTs) are a common device used in intensive care units (ICUs) for mechanical ventilation and are a leading cause of medical device-related pressure injuries (MDRPIs). These injuries negatively affect patient outcomes, quality of care, and healthcare costs. Following three ETT MDRPIs within a six-month period at the project site, an evidence-based practice initiative was implemented to reduce the incidence through increased ETT repositioning frequency and staff education. Objectives: The primary objective was to reduce ETT MDRPIs by increasing ETT repositioning frequency from every 12 hours to every four hours. Secondary objectives included improving registered nurse (RN) and respiratory therapist (RT) knowledge and confidence regarding ETT MDRPI prevention and evaluating patient-related risk factors for pressure injury development. Methods: Guided by the IOWA Model of Evidence-Based Practice, an interdisciplinary quality improvement project was implemented over 12 weeks. Education was provided to RNs and RTs through an interactive learning module. Compliance with ETT repositioning and oral care every four hours was monitored through frequent electronic medical record (EMR) audits. Results: Twenty-nine mechanically ventilated patients met the inclusion criteria. A total of 710 scheduled ETT repositioning and oral care interventions were evaluated, with compliance rates of 85.0% and 96.3%, respectively. Thirty-one clinicians completed the educational module. The percentage reporting they were very or extremely knowledgeable regarding ETT MDRPI prevention increased from 54.8% to 83.9%, while confidence increased from 58.1% to 83.9%. No ETT MDRPIs were observed in the 12-week implementation of this quality improvement initiative. Conclusions: Increasing the frequency of ETT repositioning to every four hours, combined with education and routine compliance monitoring, was associated with high protocol adherence, improved clinician knowledge and confidence, and elimination of ETT MDRPIs during the project period. No ETT MDRPIs were reported during the implementation period.