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An 80 Percent Reduction in Tracheostomy-related Pressure Ulcers — One Health System Proves It's Possible

Reducing tracheostomy-related pressure ulcers

The Christiana Care Health System in Delaware was able to improve patient care, in part, by reducing pressure injuries by 80 percent.1 That’s significant given the prevalence and cost impact of these occurrences.

Pressure injuries are unfortunate events that hospitals can be reluctant to acknowledge but try to avoid. Pressure ulcers impact 2.5 million patients a year across the US, which can be costly for those who care for those patients and can even put them at risk of legal action.2 In fact, pressure ulcer claims are the second most common lawsuit after wrongful death — more than falls and emotional distress.2 It makes sense to practice prevention — so why are we not working harder to fix this issue?

Finding solutions saves money. Pressure ulcers cost $9.1–$11.6 billion per year in the U. S. And, Medicare estimates that each pressure ulcer adds up to $43,180 in additional costs for a hospital stay.2

Tracheostomy-related pressure ulcers

The National Pressure Ulcer Advisory Panel has a definition for pressure injuries. It’s localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device.1 Despite becoming more common, preventing medical device-related pressure injuries can be more complicated than preventing other types. That’s because devices, like a tracheostomy tube, may be essential to treatment.1 It’s estimated that 12.5 percent of adult tracheostomy surgery patients experience tracheostomy-related pressure ulcers3 and 8.3 percent of children suffer from them.4

Impaired mobility, malnutrition, and neurologic injury are risk factors for pressure ulcers in patients who require tracheostomies. Factors specific to the tracheotomy procedure and tracheostomy care can also increase the risk of the skin around the tube.5 A common area where pressure ulcers can occur is at the base of the flange of a tracheostomy tube. Tight sutures can cause pressure-related swelling leading to prolonged pressure under the tracheostomy flange after insertion.1

We’re working toward a healthcare system that is increasingly focused on value for our patients and reducing facility costs. Consider the value of reducing pressure-related injuries within your facility. As always, our Mission is to alleviate pain, restore health, and extend life. So we’d like to provide some context as to how facilities are implementing new plans to drastically reduce their tracheostomy-related pressure injuries.

The benefits of implementing a tracheostomy care procedure

A study at Delaware’s Christiana Care Health System shows how clinicians were able to reduce tracheostomy-related pressure ulcers. They implemented a new tracheostomy care procedure using a flexible flange tracheostomy tube — like the Shiley™ flexible adult tracheostomy tube.

The interprofessional team at two Christiana hospitals implemented a bundle of six interventions for patients receiving either percutaneous or open tracheostomies.1 They used:

  • A more flexible tracheostomy tube with a translucent flange
  • Standardized suturing and suture removal timing
  • Placement of a hydrocolloid dressing under the tube flange immediately after insertion until removal of sutures
  • A polyurethane foam dressing under the tube flange after removing sutures and hydrocolloid dressings
  • Nurse assessments of the skin every eight hours
  • Neutral head and neck positioning

The results: reducing tracheostomy-related pressure ulcers

After one year of implementing this bundle of interventions, the Christiana Care Health System show significant improvements in patient care including:1

  • 80 percent reduction in the number of patients who developed pressure injuries
  • A decrease of 5.7 days for the average time to suture removal
  • No unplanned decannulations

By implementing a tracheostomy care bundle like the one used by Christiana Care Health System, your facility may be able to reduce their tracheostomy-related pressure injuries. This can save your hospital money — and ultimately improve patient outcomes.

Learn more about this study. Click here.

1. Dixon LM, Mascioli S, Mixell JH, Gillin T, Upchurch CN, Bradley KM. Reducing Tracheostomy-Related Pressure Injuries. AACN Adv Crit Care. 2018;29(4):426–431. doi: 10.4037/aacnacc2018426

2. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality, Preventing pressure ulcers in hospitals. Accessed June 17, 2019.

3. American Hospital Association. Reducing tracheostomy-related hospital-acquired pressure ulcers Reducing tracheostomy-related pressure injuries through a bundle approach. Accessed June 24, 2019.
4. Romero J, Gales Z, Elamin E. Incidence of tracheostomy associated pressure ulcers in adults before and after utilization of a standardized tracheostomy care protocol. Am J Respir Crit Care Med. 2013;187:A2799.
5. O’Toole TR, Jacobs N, Hondorp B, et al. Prevention of tracheostomy-related hospital -acquired pressure ulcers. Otolaryngol Head Neck Surg. 2017;156(4):642–651. doi: 10.1177/0194599816689584

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TOPIC: Shiley™ Tracheostomy

About the Author

Brett Swidey is an Account Manager in the upper Midwest region. He covers the Shiley™ airway portfolio, including Shiley™ tracheostomy tubes, Shiley™ endotracheal tubes, and DAR™ breathing systems. He works with clinicians and care teams to help develop solutions and protocols to improve patient outcomes.

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