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Clinical Nurse Specialist–Facilitated Collaborative Skin Assessments for Respiratory Care Devices

Mahramus Hunt, Tara L., MSN, APRN-CNS, CCNS, CCRN; Penoyer, Daleen A., PhD, RN, CCRP, FCNS, FCCM

doi: 10.1097/NUR.0000000000000458
Feature Article

Purpose/Aim: To evaluate a collaborative skin assessment intervention between respiratory therapists and registered nurses.

Design: A quality improvement design was used to determine feasibility of a collaborative skin assessment.

Methods: The collaborative skin assessment intervention included skin assessments, documentation of findings, and use of a treatment guideline for patients using a respiratory care device. Perceptions of the collaborative intervention and pressure injury numbers were measured after a 2-month intervention period.

Results: Respiratory therapists and registered nurses reported satisfaction with the collaborative intervention; stating it was best practice and could prevent respiratory care device–related pressure injuries. However, timing the skin assessment together was difficult. One device-related pressure injury occurred during the intervention period.

Conclusions: Respiratory therapists and nurses should partner to perform skin assessments under respiratory devices each shift and develop a plan of care to prevent skin injury. Protocol orders to prevent and treat skin alterations found under respiratory care devices and a dedicated area in the medical record to document skin assessments may be helpful to support efforts to prevent injuries. Additionally, as a result of these efforts, pressure injuries specific to endotracheal tubes declined greater than 50% in 2 critical care units in the year following this quality improvement project.

Author Affiliations: Clinical Nurse Specialist (Ms Mahramus Hunt), Advance Practice and Research, Orlando Health; and Director (Dr Penoyer), Center for Nursing Research Orlando Health, Florida.

The authors report no conflicts of interest.

Correspondence: Tara L. Mahramus Hunt, MSN, CNS, CCNS, CCRN, 175 Wild Strawberry Run, Winter Garden, FL 34787 (

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