{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T01:00:42Z","timestamp":1780275642197,"version":"3.54.0"},"reference-count":20,"publisher":"AACN Publishing","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n Background<\/jats:title>\n Respiratory medical device\u2013related pressure injuries are a persistent challenge in acute care, particularly among high-acuity patients requiring continuous respiratory support.<\/jats:p>\n <\/jats:sec>\n \n Local Problem<\/jats:title>\n At a 186-bed community hospital, respiratory medical device\u2013related pressure injury rates rose significantly in the intensive care and progressive care units following the COVID-19 pandemic.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Plan-do-study-act cycles guided implementation of this quality improvement project. Baseline data were collected from January 2019 through June 2023, followed by intervention implementation from July 2023 through January 2025 and outcome monitoring through March 2025. The project was conducted in a 19-bed intensive care unit and a 30-bed progressive care unit and involved 121 registered nurses and 28 respiratory therapists. During the intervention phase, 123 eligible patients requiring continuous respiratory support for more than 24 consecutive hours were audited for intervention and documentation compliance. Statistical process control chart analysis was used to track monthly respiratory device\u2013related pressure injury rates over time, identifying trends according to visual interpretation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Respiratory medical device\u2013related pressure injury rates declined by 52%, from 0.56 to 0.27 per 1000 patient days. Intervention compliance with placement of barrier dressings improved from 41 of 56 (71.7%) audit observations to 71 of 73 (97.8%) audit observations. Documentation compliance increased from 25 of 56 (43.4%) audit observations to 63 of 73 (89.7%) audit observations.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Standardizing preventive barrier use and strengthening interprofessional collaboration substantially reduced respiratory medical device\u2013related pressure injuries.<\/jats:p>\n <\/jats:sec>","DOI":"10.4037\/ccn2026303","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:03:12Z","timestamp":1780272192000},"page":"35-42","source":"Crossref","is-referenced-by-count":0,"title":["Reducing Respiratory Device\u2013Related Pressure Injuries in High-Acuity Patients: A Quality Improvement Project"],"prefix":"10.4037","volume":"46","author":[{"given":"Julie A.","family":"Gray","sequence":"first","affiliation":[{"name":"Julie A. Gray is a nurse practitioner, Duke University School of Nursing, Durham, North Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie R.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Katie R. Brooks is a nurse practitioner, Duke University School of Nursing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Eltz","sequence":"additional","affiliation":[{"name":"Amanda Eltz is a nurse practitioner, Duke Health Integrated Practice, Durham."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Staci S.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Staci S. Reynolds is a clinical professor, Duke University School of Nursing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey L.","family":"Yap","sequence":"additional","affiliation":[{"name":"Tracey L. Yap is a professor, Duke University School of Nursing."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"key":"2026053120030793000_b1-0460035","unstructured":"European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance\n . Haesler\u2008E, ed. Prevention and Treatment of Pressure Ulcers\/Injuries: Clinical Practice Guideline. The International Guideline. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance; 2019. Accessed January 6, 2026. https:\/\/static1.squarespace.com\/static\/6479484083027f25a6246fcb\/t\/6553d3440e18d57a550c4e7e\/1699992399539\/CPG2019edition-digital-Nov2023version.pdf"},{"issue":"3","key":"2026053120030793000_b2-0460035","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/iwj.13071","article-title":"The national cost of hospital-acquired pressure injuries in the United States","volume":"16","author":"Padula","year":"2019","journal-title":"Int Wound J"},{"issue":"1","key":"2026053120030793000_b3-0460035","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/WON.0000000000000734","article-title":"Hospital-acquired pressure injuries and acute skin failure in critical care: a case-control study","volume":"48","author":"Pittman","year":"2021","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"2026053120030793000_b4-0460035","unstructured":"The Joint Commission\n . Quick safety 25: preventing pressure injuries. July\u20082016. Updated March 2022. Accessed January 6, 2026. https:\/\/digitalassets.jointcommission.org\/api\/public\/content\/Quick-Safety-25-UPDATE-3-21-22"},{"issue":"1","key":"2026053120030793000_b5-0460035","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jtv.2022.10.004","article-title":"Determination of medical device-related pressure injury in COVID-19 patients: a prospective descriptive study","volume":"32","author":"Togluk Yi\u011fito\u011flu","year":"2023","journal-title":"J Tissue Viability"},{"key":"2026053120030793000_b6-0460035","unstructured":"Lewis\u2008CP, Colcord\u2008KE, Peterson\u2008A, et al. C.A.R.E. to prevent medical device related pressure injuries. American Nurse. June\u20082, 2021. Accessed January 6, 2026. https:\/\/www.myamericannurse.com\/c-a-r-e-to-prevent-medical-device-related-pressure-injuries\/"},{"issue":"10","key":"2026053120030793000_b7-0460035","doi-asserted-by":"publisher","first-page":"2881","DOI":"10.1002\/ppul.26606","article-title":"Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients","volume":"58","author":"Maue","year":"2023","journal-title":"Pediatr Pulmonol"},{"issue":"7","key":"2026053120030793000_b8-0460035","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1177\/0885066617746089","article-title":"Implementation of a goal-directed mechanical ventilation order set driven by respiratory therapists improves compliance with best practices for mechanical ventilation","volume":"34","author":"Radosevich","year":"2019","journal-title":"J Intensive Care Med"},{"issue":"2","key":"2026053120030793000_b9-0460035","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1097\/WON.0000000000000742","article-title":"Reducing the incidence of medical device-related pressure injuries from use of CPAP\/BiPAP masks: a quality improvement project","volume":"48","author":"Arundel","year":"2021","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"19\u201320","key":"2026053120030793000_b10-0460035","doi-asserted-by":"publisher","first-page":"6863","DOI":"10.1111\/jocn.16790","article-title":"Interventions and strategies to prevent medical device-related pressure injury in adult patients: a systematic review","volume":"32","author":"Lyu","year":"2023","journal-title":"J Clin Nurs"},{"issue":"10","key":"2026053120030793000_b11-0460035","doi-asserted-by":"publisher","first-page":"22","DOI":"10.25270\/wmp.2020.10.2229","article-title":"Implementing a pressure injury prevention bundle to decrease hospital-acquired pressure injuries in an adult critical care unit: an evidence-based, pilot initiative","volume":"66","author":"Rivera","year":"2020","journal-title":"Wound Manag Prev"},{"issue":"12","key":"2026053120030793000_b12-0460035","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1089\/wound.2019.1002","article-title":"Effects of multilayer silicone foam dressings for the prevention of pressure ulcers in high-risk patients: a randomized clinical trial","volume":"9","author":"Oe","year":"2020","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"2","key":"2026053120030793000_b13-0460035","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s00134-020-06234-9","article-title":"Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study","volume":"47","author":"Labeau","year":"2021","journal-title":"Intensive Care Med"},{"issue":"4","key":"2026053120030793000_b14-0460035","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/j.jtv.2023.06.006","article-title":"Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors","volume":"32","author":"Ayd\u0131m Kudu","year":"2023","journal-title":"J Tissue Viability"},{"issue":"8","key":"2026053120030793000_b15-0460035","first-page":"193","article-title":"Hydrocellular foam versus hydrocolloid plate in the prevention of pressure injuries","volume":"31","author":"da Silva Augusto","year":"2019","journal-title":"Wounds"},{"key":"2026053120030793000_b16-0460035","volume-title":"The Health Care Data Guide: Learning From Data for Improvement","author":"Provost","year":"2022","edition":"2nd"},{"issue":"5","key":"2026053120030793000_b17-0460035","doi-asserted-by":"crossref","first-page":"26","DOI":"10.25270\/wmp.2021.5.2632","article-title":"An interdisciplinary team approach to decrease sacral hospital-acquired pressure injuries: a retrospective cohort study","volume":"67","author":"Isaacs","year":"2021","journal-title":"Wound Manag Prev"},{"issue":"2","key":"2026053120030793000_b18-0460035","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1097\/01.ASW.0000725184.13678.80","article-title":"The effectiveness of the SKINCARE bundle in preventing medical-device related pressure injuries in critical care units: a clinical trial","volume":"34","author":"Tayyib","year":"2021","journal-title":"Adv Skin Wound Care"},{"key":"2026053120030793000_b19-0460035","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-59403-9_28","article-title":"Measuring clinical workflow to improve quality and safety","volume-title":"Textbook of Patient Safety and Clinical Risk Management [Internet]","author":"Tanzini","year":"2021"},{"issue":"6","key":"2026053120030793000_b20-0460035","doi-asserted-by":"publisher","first-page":"499","DOI":"10.4037\/ajcc2022659","article-title":"Prevention of tracheostomy-related pressure injury: a systematic review and meta-analysis","volume":"31","author":"Moser","year":"2022","journal-title":"Am J Crit Care"}],"container-title":["Critical Care Nurse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/46\/3\/35\/170379\/35.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/46\/3\/35\/170379\/35.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:03:14Z","timestamp":1780272194000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article\/46\/3\/35\/33036\/Reducing-Respiratory-Device-Related-Pressure"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ccn2026303","relation":{},"ISSN":["0279-5442","1940-8250"],"issn-type":[{"value":"0279-5442","type":"print"},{"value":"1940-8250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}