PT  - JOURNAL ARTICLE
AU  - J Julia Krzyzewski
AU  - Kristine K Rogers
AU  - Andrea M Ritchey
AU  - Connie R Farmer
AU  - April S Harman
AU  - Joana S Machry
TI  - Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit
AID  - 10.4187/respcare.08850
DP  - 2022 Jan 01
TA  - Respiratory Care
PG  - 24--33
VI  - 67
IP  - 1
4099  - http://rc.rcjournal.com/content/67/1/24.short
4100  - http://rc.rcjournal.com/content/67/1/24.full
AB  - BACKGROUND: Noninvasive ventilation (NIV) has become the preferable modality of respiratory support for spontaneously breathing premature infants in the neonatal ICU (NICU). Whereas NIV support contributes to the prevention of long-term respiratory sequelae from mechanical ventilation, the nasal interfaces used are well known for placing patients at risk for development of NIV device-related pressure injuries (PIs). After implementing clinical practice guidelines promoting the use of sealing NIV interfaces for respiratory support in a level IV NICU, an increase in the frequency of stage 2 or worse and deep tissue injury (DTI) PI was observed. We hypothesized that the implementation of a multifaceted skin care bundle (SCB) would reduce the incidence of NIV device-related PI.METHODS: Quality improvement methodology was used to evaluate the impact of implementing an SCB for patients supported with NIV via a nasal interface. Incidence rate of stage 2 or worse and DTI PI was reported per 100 NIV days over 4 distinct time periods: (1) pre-NIV guideline, (2) post-NIV guideline, (3) post SCB, and (4) sustainability phase. Incidence comparisons were made using one-sided P values from the Farrington-Manning test of equal risks with a significance level of 0.05.RESULTS: The NICU experienced a notable rise in NIV device-related PI after implementation of NIV guidelines (0.01 vs 0.34 per 100 NIV days; P = .01). After application of an SCB, a decrease in NIV device-related skin PI was achieved (0.34 vs 0.07 per 100 NIV days; P = .04), representing a 79% reduction.CONCLUSIONS: A collaborative and multidisciplinary team approach was used to promote engagement with clinical staff to address a preventable harm. The implementation of a multifaceted PI prevention bundle contributed to reducing harm while permitting the continued use of appropriate respiratory support to a highly vulnerable patient population in the NICU.