Original Publication Date
Odyssey Conference 2021 / Stepping Stones to Excellence in Wound Care 2021;
Date of Submission
Purpose: The purpose of this evidence-based practice (EBP) project was to decrease medical device pressure injury (MDPI) related to Cervical Collar (C-collar) clearance in adult blunt trauma patients. PICO: In the adult obtunded blunt trauma patient, should a c-collar be cleared with a negative CT, compared to a negative CT with adjunct imaging to reduce adverse events such as MDRPI?
Background: Our unit observed an incidence in C-collar MDRPI of 3 in 2019 and 3 in 2020 based on the date of the survey. C-collar clearance in the blunt trauma patient is a crucial step to avoid MDRPI. There are two validated and widely accepted guidelines for the stable and alert trauma patient, NEXUS and Canadian C-spine rule. Many trauma critical care patients fail to meet these criteria and therefore may have prolonged periods of C-collar use and increased risk for MDRPI. Therefore, our goal was to evaluate current evidence related to C-collar clearance.
Methods: A literature search was conducted to identify best practices of C-Collar clearance in the obtunded adult blunt trauma patient. Databases searched include Pubmed, Embase, and CINAHL. The search strategy included “Adult” AND “Blunt Trauma” AND Cervical Collar” AND “Clearance” within the last 5 years. English Language only. 20 articles resulted and 8 were included for content and reliability to the clinical question and evaluated based on Johns Hopkins Nursing EBP guidelines.
Results/Findings: A review of the findings was presented to the trauma performance improvement and patient safety (PIPS) committee. Based on current evidence, the Trauma PIPS committee revised the existing guideline to include C-Collar clearance 24 hours or less based on initial CT scan and clinical findings. Since implementation, our unit observed zero C-collar MDRPIs with a significant reduction in MRIs ordered for purpose of C-collar clearance. Which resulted in a significant reduction in cost, increased safety, and decreased risk of pressure injury development.
Conclusions and Implications for Practice: Translation of EBP to the bedside is the most critical step in promoting positive patient outcomes. Protocols and guidelines should be updated regularly with the most up-to-date evidence-based practices. In this EBP project, a modification to a practice guideline led to a decrease in MDRPIs.
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VCU Health Nursing