Document Type


Publication Date


Publication Title

WIN Conference 2023




2023 Western Institute of Nursing Research (WIN)

Leveraging Technology to Advance Nursing and Equity in Research, Practice, and Education

HAPI-Related to BIPAP in DSU

Carmyle Seville, BSN, RN, PCCN

Angelica C. Taneca, BSN, RN, PCCN

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) provides 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.


· This Hospital Acquired Pressure Injury Improvement was initiated to reduce and eliminate BIPAP related pressure injuries using evidence-based solutions

· To identify problem areas promptly for early treatment and prevention


· Design: Evidence-based quality improvement

· Sample: Patients using BIPAP

· Setting: DSU and SDU

· Intervention: Historic data was obtained from leadership, unit nurses acquired curagel nasal silicone pads and engaged respiratory therapy in the project. Staff education was conducted 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, regular Braden Scores, use of silicone pads, and documentation of HAPI.

· Time frame: The project was implemented from October 2019 until March 2020

· Data: Conducted 20 monthly audits of four-eyes, Braden Score, presence of Silicone pad, and presence of HAPI

· Analysis: October 2019 to March 2020, there was zero occurrence of BIPAP related HAPI. Silicone pad proved to be effective in eliminating BIPAP associated pressure injuries.

Results: From 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 proved to be 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."