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Publication Date



2021 prov rn ca; 2021 prov rn poster; california; orange; sjh




Background: Most medical-device related pressure injuries develop when skin or underlying tissues are subjected to a sustained pressure or shear from medical devices. Dressings have shown substantial biomechanical effectiveness in alleviating facial tissue deformations and stresses by providing localized cushioning to the tissue at risk. Our units (DSU and SDU) provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial support such as patients on BIPAP management. In the 4 months (June-Sept 2019) before the project initiation, one patient per month had BIPAP related pressure injury.

Purpose: This Hospital Acquired Pressure Injury Improvement was initiated to reduce and eliminate BIPAP related pressure injuries using evidence-based solutions and to identify problem areas promptly for early treatment and prevention.

Methods/Approach: Design: Evidence-based Practice Setting: DSU and SDU Participants for clinical outcomes: Patients using BIPAP Procedures: Historic data was obtained from leadership. Unit nurses acquired curagel nasal silicone pads and engaged respiratory therapy in the project. Staff members were educated in new procedures: alternating mask use between full mask and total face mask every 6 hours, incorporating skin assessment under medical device during 4 eyes, Skin Braden Scores, use of silicone pads, documentation of HAPI. Random chart audits were done to evaluated compliance and clinical outcomes. Results: Between October 2019 through March 2020, there were no BIPAP related HAPI and audits demonstrated 100% compliance on all measures.

Conclusion: Alternating face masks, and application of silicone pads were effective in eliminating pressure injuries related to BIPAP use. Under normal conditions, the interventions produced complete elimination of pressure ulcer.

Implications for practice: Application of evidence to a significant care issue resulted in zero occurrence of BIPAP-related HAPI from October 2019 to March 2020. Audits will continue to help keep project on track. Education and re-education will be done as needed for continued success.



Conference / Event Name

2021 Providence RN Conference


Virtual Conference

HAPI- Related BIPAP in DSU

Included in

Nursing Commons