The Adult Services tackled the rising issue of medical device-related pressure injuries with a targeted project focusing on nasogastric tubes and BiPAP masks. Despite a reduction in nasogastric tube injuries from 2022 to 2023, BiPAP-related injuries doubled, signaling the urgent need for standardized guidelines and collaborative interventions. The initiative is spearheaded by the Inpatient Wound/Ostomy Department team — Raisa Pangilinan, BSN, RN CWON, Lindsay Fletcher BSN, RN CWON, Dawn Davis Clinical Wound Associate under the leadership of Charity Shelton DNP, RN, NE-BC.
Led by wound-certified nurses, the initiative united nursing leadership, respiratory therapists, and shared governance councils. For nasogastric tubes, the team introduced the “CLEAN” framework: correct tube positioning, stabilize tube, evaluate area under/tube, alleviate pressure, and note date and time. This evidence-based approach became the cornerstone of updated workflows. Medical-surgical staff received hands-on training to ensure adherence during annual skill days.
In BiPAP care, challenges like opaque foam padding that obscured skin assessments were addressed with a clear gel barrier, selected after collaborative trials with respiratory therapy. This change allowed for real-time skin evaluations while maintaining patient comfort. A new standardized workflow defined the roles of respiratory therapists and nurses, ensuring seamless communication and accountability.
By mid-2024, the project achieved zero pressure injuries for both devices, highlighting the success of interdisciplinary collaboration and evidence-based interventions. With plans to expand regionally, this initiative demonstrates how targeted strategies, teamwork, and frontline engagement can drive sustainable improvements in patient safety and care quality, setting a higher standard for device-related injury prevention.
