Abstract
Background:
Pressure injuries (PI) are serious, reportable adverse events that cause pain, infection, and prolonged hospitalization. They are defined as an injury to the skin caused by pressure or shear. Some of the most serious PIs can even necessitate surgery. Many PIs in neonates are caused by respiratory devices. This can prevent the use of noninvasive ventilation (NIV), necessitating invasive ventilation. As such, prevention of device-related injury, early detection, and management are essential to decrease the severity of PIs. A PI prevention program may result in increased reporting of injuries as caregivers become more diligent in documenting and investigating potential injuries. Staff trained in device selection, application, and use of barriers can improve the success of NIV in the neonatal population.
Methods:
A multidisciplinary approach using evidenced-based practices to evaluate the impact of implementing a bundle for skin care practices was applied. PI data specific to respiratory devices was evaluated and shared. A pareto chart of causes identified the areas of focus for the improvement plan. A team of bedside champions was provided detailed education and tools for NIV device choice and maintenance while also identifying early possible pressure injuries at the bedside. This workshop presentation with videos and graphics reviewed the selection and application of various NIV interfaces and appropriate pressure redistribution devices and nuances of each. The training culminated with learners being evaluated on conducting skin assessments, identifying, and preventing issues that contribute to NIV-related PIs using a standardized checklist, and a discussion on the importance of frequent and thorough skin assessments. IRB approval obtained.
Results:
Following the implementation of these prevention strategies, the total number of PIs was unchanged, but severity decreased. Data showed that the number of stage 1 pressure injuries increased by 70% (pre n = 14, post n = 20) and after implementation no stage 4 pressure injuries were recorded (Figure 1). This positive change represents an awareness of staff to monitor and report potential PIs before the severity worsens.
Conclusions:
The adoption of clinical practices supported by evidence aiming for the best long-term outcomes for these patients was challenging. A multidisciplinary team approach and the implementation of a prevention bundle contributed to reducing harm, while allowing for continued use of the appropriate NIV support for these patients.
Figure 1
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