Best Practice, Jersey City Medical Center

Best Practice: Reduction of Injuries in Critical Care Vented Population Through Shared Governance Councils.

Shaden Mustafa, MSN, RN, CNL, Jersey City Medical Center, Jersey City, NJsmlaura,  is currently a critical care and trauma nurse at Jersey City Medical Center, Jersey City, NJ. She is chair of the Quality & Safety Nursing Council.

In our critical care unit, we discovered, through our incident reporting system, a significant number of oral mucosal and lip pressure injuries in our vented population, which required oral endotracheal tubes (OETT) for ventilation.

Our risk manager, who trends the data from our incident reporting system, initially brought this incident of injuries to the attention of the critical care director. Our staff nurses submit these incidents to alert hospital risk-management of patient complications or near misses. The critical care director then shared this data with the critical care unit practice council (UPC) chair.

The UPC is the unit-based shared governance council, consisting of critical care staff nurses who advocate for best practices to optimize patient outcomes. These staff nurses then evaluated the data and conducted an evidence-based literature search for best practice, using the hospital librarian and in collaboration with the respiratory therapy (RT) department and the nursing research council. After a review of the current best practice for securing OETTs, it was discovered that we did not have a standard of practice. Best practice recommended for the OETT to be repositioned every two hours, hence preventing pressure injuries from occurring. Staff nurses along with RT proposed a trial of an OETT holder found in literature to reduce the incidence of mucosal-pressure injuries. This holder allowed for the OETT to be easily repositioned every two hours by the staff.

A four-month trial with education provided to staff from the manufacturer of the product was conducted. The trial resulted in a reduction in the number of mucosal-pressure injuries in our vented population. We revised our policy for the securement and maintenance of the OETT and presented it to both our acute care committee and the quality and safety council for approval. After the policy was approved via our shared governance councils, our standard of practice was changed to reflect the current best practices found in literature. Twenty-months before the policy change and change in standard of practice, we had 12 incidents of oral mucosal pressure injuries in our orally vented patients. Eighteen months after the implementation of this standard of practice, we have had only one incident of oral pressure injury in this population. This is a clear example of how a specific best practice change was implemented through our interprofessional shared governance councils to acieve a remarkable improvement in our patient outcomes.