Abstract
Background: Working in collaboration with the NICU Skin team to evaluate pressure injury rates (HAPI Healthcare acquired pressure injury) it was discovered that a large amount of the injuries was related to respiratory therapy devices. With these results, a literature review was conducted to evaluate the findings compared to published results. The Journal of Neonatal Nursing found 247 neonatal patients were reviewed, of these infants 77 were identified as having a skin injury (a prevalence rate of 31.2%). The Respiratory therapy noninvasive CPAP delivery devices were associated with 14.0% of those HAPI. The mean gestational age was 28 weeks. A Literature review on prevention of HAPI found the use Hydrocolloid dressing to be beneficial in the preventing nasal trauma secondary to nasal CPAP in preterm infants. (2) Along with continuous education to nursing and respiratory therapy were found to be beneficial to decreasing the rate of HAPI events (3). Methods: Continue to perform NICU skin assessments and collect data starting January 1st 2017 till April 2019 with a total of 812 babies assessed. Starting January 2017 event reports were completed for all issues including redness. Prior to 2017 multiple changes were implemented to include standardizing equipment to use only Fisher & Paykel Flexi trunk CPAP system. Starting simultaneous RN and RT skin assessment along with nasal prong and mask sizing any changes occurred at this time. The team instituted the use of Septal H, a hydrocolloid barrier device. Results: The NICU HAPI rate was < 2% of annual admissions and assessments (15/812). The Respiratory Therapy related injuries were 1.3% (9/812) of the HAPI. The mean gestational age was 26 weeks. The HAPI rate remained stable at < 2% of NICU admissions. In 2017, with the introduction of Septal H there was 5 HAPI in a 2 month time frame. This was analyzed and found not to be the product itself, but due to a deviation from traditional skin assessment technique. From September 2017 till March 2019 the HAPI rate remained less than 2%. Conclusions: Strong nursing and respiratory therapy relationship can achieve a significant reduction in Neonatal HAPI. While there are many CPAP interfaces available, mastering proper fit and sizing along with attentive skin assessment will lead to reduction in HAPI. . While being successful in all of the previously mentioned changes, continuing education for RT and RNs had the largest impact on the reduction of HAPI.
Reported HAPI VS published national average
Footnotes
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