• Jessica Schroeder and Verna Sitzer.
• Jessica Schroeder is the clinical lead of the Wound Healing Department, Sharp Memorial Hospital, San Diego, California. Verna Sitzer is the Director, Professional Practice, Research and Innovation, Sharp Memorial Hospital.
• Crit Care Nurse. 2019 Dec 1; 39 (6): 54-63.

BackgroundNurses certified in wound, ostomy, and continence monitored an increasing incidence of hospital-acquired pressure injury of the nares due to medical devices, specifically nasogastric tubes, in a metropolitan hospital. A majority of these pressure injuries occurred in patients in the intensive care unit. The organization lacked formal guidelines for preventing such injuries.ObjectiveTo decrease the incidence of nasogastric tube-related hospital-acquired pressure injury.MethodsThe organization's process improvement model, comprising steps to define, measure, analyze, improve, and control, guided the project. The incidence rate of nasogastric tube-related hospital-acquired pressure injury before the intervention was determined for calendar year 2015 and compared with data obtained after the intervention, for calendar year 2016. An interprofessional team created, implemented, and evaluated the effectiveness of evidence-based guidelines and surveillance strategies for preventing nasogastric tube-related hospital-acquired pressure injury. The team implemented guidelines using the simple mnemonic "CLEAN": correct tube position, stabilize tube, evaluate area under/near tube, alleviate pressure, note date and time.ResultsThe incidence rate of nasogastric tube-related hospital-acquired pressure injury (0.13 per 1000 patient days in 2015) decreased 100% (0.0 per 1000 patient days in 2016) after the guidelines were implemented in the organization. This rate was sustained for a full year, after which it increased slightly because temporary and new staff lacked knowledge of the guidelines.ConclusionsThe creation and implementation of clear and specific guidelines for assessing and securing nasogastric tubes successfully reduced nasogastric tube-related hospital-acquired pressure injury.©2019 American Association of Critical-Care Nurses.

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