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, NJ, 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.

Jersey City Medical Center shared governance councils reduced oral mucosal pressure injuries in ventilated patients from 12 incidents to just one over 18 months through evidence-based practice changes.

Identifying the Problem

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

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

Evidence-Based Solution

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 evaluated the data and then conducted an evidence-based literature search, using the hospital librarian and collaborating with the respiratory therapy (RT) department and the nursing research council. After reviewing current best practice for securing OETTs, the team discovered that no standard of practice existed. According to the literature, best practice recommended repositioning the OETT every two hours to prevent pressure injuries. As a result, staff nurses and RT proposed a trial of an OETT holder found in the literature to reduce mucosal-pressure injuries. This holder allowed staff to reposition the OETT every two hours with ease.

Results and Policy Change

The team conducted a four-month trial with education provided to staff from the product manufacturer. The trial resulted in fewer mucosal-pressure injuries in the vented population. Consequently, the team revised the policy for OETT securement and maintenance and presented it to both the acute care committee and the quality and safety council for approval. After the shared governance councils approved the policy, the standard of practice changed to reflect current best practices found in the literature.

In the twenty months before the policy change, 12 incidents of oral mucosal pressure injuries occurred in orally vented patients. However, in the eighteen months after implementing this standard of practice, only one incident of oral pressure injury occurred. This example clearly demonstrates how a specific best practice change, implemented through interprofessional shared governance councils, achieved a remarkable improvement in patient outcomes.