Abstract

Problem
Medical device-related pressure injuries (MDRPIs) are a significant concern in ICU settings with endotracheal tubes (ETTs). The incidence of MDRPIs can reach up to 34%, with oral pressure injuries affecting up to 45% of ICU patients, impacting outcomes and costs (Kuniavsky et al., 2020). Using a standardized tool like the modified Reaper Oral Mucosa Pressure Injury Scale (m-ROMPIS) can improve assessment consistency and accuracy (Fitzgerald et al., 2023; Genc & Yildiz, 2022).

Purpose
This project aims to evaluate oral pressure injuries associated with ETTs and pilot the m-ROMPIS tool during routine oral care in the ICU. The goal is to equip RNs and RTs with the skills to assess and manage these injuries, enhancing patient outcomes (Genc & Yildiz, 2022).

Theoretical Framework
Betty Neuman's Systems Model is used to address stressors contributing to oral pressure injuries in ICU patients with ETTs. The model focuses on mitigating stressors through education on assessment and management, enhancing patient outcomes.

Methodology
A multi-phase approach includes a baseline assessment of ICU staff knowledge, development and delivery of an education module, and integration of the m-ROMPIS tool into routine assessments. Data on oral pressure injuries will be collected pre- and post-intervention to evaluate effectiveness.

Implementation
The project will be implemented in the ICU of St. Elizabeth’s Medical Center, involving ICU RNs, RTs, and a multidisciplinary team. Educational materials and training sessions will be developed and conducted. RNs and RTs will complete m-ROMPIS assessments via surveys to gather data on oral pressure injuries.

Evaluation
A bedside documentation survey incorporating the m-ROMPIS scale will be completed by ICU staff following oral care and/or ETT repositioning. Data collection will extend over three weeks, followed by a one-month follow-up. The anticipated outcome is a clinical practice guideline for standard oral care in intubated patients.

Results
Over three weeks, 100 m-ROMPIS patient surveys were completed. The average intubation duration was 5.4 days. There were 68 instances of Stage 0, 14 of Stage 1, 5 of Stage 2, and 3 of Stage 3 injuries. Post-implementation surveys indicated staff appreciated the tool for enhancing oral mucosa assessment and valued interdisciplinary collaboration.

Implications for Practice
Baseline and post-implementation data will provide insights into the impact of the m-ROMPIS tool on pressure injury rates. A proposed clinical practice guideline will ensure continued use of the m-ROMPIS tool, promoting long-term improvements in patient care. The project underscores the importance of interprofessional collaboration and effective communication in the ICU.