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.
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- Article
- Abstract
- Introduction
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- The Use of Skin Barrier Products
- Frequency of Skin Assessments
- Education
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- Process Measure Audits
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- Discussion
- Education and Navigating Adaptive Change
- Application of Skin Barrier Products, Skin Integrity Assessments, Device Type, and Rotation
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