One Stage III Pressure Ulcer Requiring Treatment ,I.E. Extended Stay Or Plastic Surgery

NK7-22 Pilot for Pressure Ulcer Ear Protection During last four quarters of Pressure Ulcer Prevalence Studies, 63% of pressure ulcers were found onears associated with oxygen tubing. This pilot studied three different types of ear protection from Jan. 1 to March 30, 2012.

4th Floor Soft cannulas – 14 ft. / Forms Returned
Completed at discharge. / Patients without nasal cannula (no O2 ordered or on hi flow) / Patients answering all 3's
(3 is highest possible) / Patients with 2's and 3's. Only a few 1's noted / Comments / Patients inspected visually for PU by Rochelle / Patients with redness on ears
175 / 43 / 73 / 19 / Most indicated a "2" for "Stays in Place"
Days in place = 1/2 to 7.
Many positive from patients: staff- better than current. / 106 / 9
Soft cannulas made- easy to stretch too tightly around ears.
BBU
White thick foam / Forms Returned
7 / Ease of use 1= difficult,
3 = easy
1.5 / Did product stay in place (all were taped)
No = 2
NA = 7 / Comments
Better than current – 4 yes
Staff and pts hated them: too fat, hard to tape in place, discomfort / 11 / 2 - one was Stage I pr ulcer

11 Current 14 ft nasal cannula with no foam covers. Gray foam covers - had to be picked separately by nurse from supply room AND taped onto cannula. No forms. Control Unit.

Patients who had nasal cannula oxygen but were not ususing gray covers = 64 / Patients who had nasal cannula oxygen, were using gray covers = 6 / One Stage I PU. Found one red ear despite having gray foam cover / Patients inspected visually for PU by Rochelle - 64
PILOT SUMMARY / Per cent redness on ears / Ear PU found, Stage I / N= (Inspected by Rochelle) / Patient Satisfaction / Cost each
PH 4 Soft nasal cannulas / 5.1% / 0% / 106 / 3 (scale 1-3) / .90
PH 11 Current tubing –requires addition of foam protector by staff from separate package / 29.7% / 1.5% (n=1) / 64 / n/a / .77 (cannula) + .49 (ear cover) = 1.26
BBU
White foam covers / 28.6% / 9% (n=1) / 11 / n/a / .83
Patient Days on Oxygen obtained from Finance (7/1 – 8/31/2011) averaged for 1 month then x 12. Usage supplied by SCM for one yr / Annual Cost for Individual Unit
Fourth Floor - Soft nasal cannula / $.90 x 546 / 491.4
Eleventh floor - Current tubing with NO attached foam covers (14ft) Gray foams (in separate pkg) / $0.77 x 414
$0.42 x 414
Total cost = $1.26 / Total = 1043.28
BBU - White Foam covers / $.83 x 73 (data from Dec) x 12 / 876

Cost Benefit

One Stage III pressure ulcer requiring treatment ,i.e. extended stay or plastic surgery = $40,000

Current tubing with pre attached foam covers (14ft) (in use at SMC) is $1.50 each

Total Cost for all inpatient units for one year

Soft Cannulas .9 x 5604 = 5043.60

Current tubing with gray foam added: 5604 x 1.26 = 7061.04

Recommendation

Based on these results I would recommend the item with the fewest redness associated problems AND that which does not require any additional steps, i.e. picking an additional item to add to the tubing. Staff tend to NOT pick an additional item, regardless of proximity of item, as seen on 11th floor.

Short stay/procedure units should continue with the current nasal cannulas with hard tubing.