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Research ArticleOriginal Research

Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit

J Julia Krzyzewski, Kristine K Rogers, Andrea M Ritchey, Connie R Farmer, April S Harman and Joana S Machry
Respiratory Care January 2022, 67 (1) 24-33; DOI: https://doi.org/10.4187/respcare.08850
J Julia Krzyzewski
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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  • For correspondence: [email protected]
Kristine K Rogers
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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Andrea M Ritchey
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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Connie R Farmer
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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April S Harman
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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Joana S Machry
Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.
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Abstract

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.

  • pressure injury
  • pressure ulcer
  • neonatal
  • skin
  • device-related pressure injury
  • noninvasive ventilation

Footnotes

  • Correspondence: J Julia Krzyzewski MAS RRT RRT-NPS, Respiratory Care, Johns Hopkins All Children’s Hospital, 501 6th Street South, Saint Petersburg, FL 33701. E-mail: jkrzyze2{at}jhmi.edu
  • The authors have disclosed no conflicts of interest.

  • Ms Krzyzewski presented a version of this paper as an abstract at the Pediatric Academic Society meeting held May 5–8, 2018, in Toronto, Ontario, Canada.

  • This quality improvement project was performed at Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida.

  • Copyright © 2022 by Daedalus Enterprises
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In this issue

Respiratory Care: 67 (1)
Respiratory Care
Vol. 67, Issue 1
1 Jan 2022
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Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit
J Julia Krzyzewski, Kristine K Rogers, Andrea M Ritchey, Connie R Farmer, April S Harman, Joana S Machry
Respiratory Care Jan 2022, 67 (1) 24-33; DOI: 10.4187/respcare.08850

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Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit
J Julia Krzyzewski, Kristine K Rogers, Andrea M Ritchey, Connie R Farmer, April S Harman, Joana S Machry
Respiratory Care Jan 2022, 67 (1) 24-33; DOI: 10.4187/respcare.08850
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  • Article
    • Abstract
    • Introduction
    • Methods
    • The Use of Skin Barrier Products
    • Frequency of Skin Assessments
    • Education
    • Skin Barrier Placement in Delivery Room
    • Bedside Reference Materials
    • Process Measure Audits
    • Results
    • Discussion
    • Education and Navigating Adaptive Change
    • Application of Skin Barrier Products, Skin Integrity Assessments, Device Type, and Rotation
    • Process Measure Audits and Bedside Reference Materials
    • Incidence Reporting
    • Conclusions
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
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Keywords

  • pressure injury
  • pressure ulcer
  • neonatal
  • skin
  • device-related pressure injury
  • noninvasive ventilation

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