P125 The effect of preventative hydrocolloid nasal dressings in acute non invasive ventilation (niv)-related nasal bridge pressure ulceration

Introduction There are over 4000 acute mask application episodes coded in the treatment of acute respiratory failure in the UK every month according to a 2017 survey (NCEPOD). Most guidelines on acute NIV use suggest good skin care strategies including regular mask pressure relief. However, data on the magnitude of the problem of nasal bridge pressure ulceration and the effect of proactive preventative steps (e.g., hydrocolloid dressings) remains scant. A previous smaller but similar survey in a district general hospital showed a trend in the reduction of Grade2 Pressure ulcer rates following change in practice but fell short of statistical significance (Stygall G, Morley K, Pickup L, et al. Thorax 2016. 71:3. A124–125.). We set out on a quality improvement project and systematically examined the effect of a proactive approach to prevent Grade2 Pressure ulcers in a dedicated ward-based Physiotherapy-led acute NIV service in a teaching hospital serving a population of about 4 00 000. Methods In addition to the routine acute NIV data for the unit, additional data was collected from 30/10/14 to 31/08/2015 on: NIV mask used (model and size), total number of admissions with days of NIV (NIV bed-days) and nasal bridge tissue viability grading. This included a 12 month period before (period1) and a 12 month period after (period2) the introduction of the proactive prevention approach. A pressure ulcer was defined as Grade2 or above. Pearson’s chi-squared test for comparison between groups and Fisher’s exact test were applied to assess significance. Results [See Table] In period1, there were 161 admissions and 9 Grade2 pressure ulcers from 666 NIV bed-days (ulceration rate=9/666); in period2 there were 134 admissions and 0 pressure ulcers from 718 NIV bed-days (ulceration rate=0/718). There was a statistically significant reduction in Grade2 Pressure ulceration rates (Pearson’s chi-square statistic=7.786; p-value=0.0013 in period2 compared to period1). Conclusions Application of an early prophylactic pressure-relieving hydrocolloid nasal dressing reduces the chance of developing Grade2 pressure ulcers in patients using NIV acutely. Further longitudinal studies including data on a preventative approach towards NIV-related nasal bridge pressure ulceration are needed to confirm the utility of this approach.