Skin Rounds: A Standardized Approach to Pressure Injury Detection and Reporting in the Neonatal Intensive Care Unit

Newborn Care Poster Presentation Purpose for the Program Avoiding skin injury is critical to optimizing outcomes in hospitalized patients. High rates of pressure injuries have been reported among patients in pediatric and adult intensive care units (ICUs), but less data on incidence or prevention are available for neonatal ICU patients. The aim of this quality improvement program is to standardize the skin care of patients in our neonatal intensive care unit (NICU). Proposed Change An interdisciplinary team was formed in an acute care, Level IIIC, all referral NICU. This team is responsible for weekly rounds on patients to assess and document skin injuries, collect demographic information, provide education to bedside caregivers, and provide recommendations for skin care. Implementation, Outcomes, and Evaluation The team underwent standardized training over a 4-week period to detect and stage pressure injuries. Weekly skin rounds began in July 2011. Initial staff resistance to the change in routine was overcome by education via in-services and self-studies on skin injury prevention; this led to a gradual shift in perception and skin rounds are now an accepted routine. There was also tremendous support from administration and nursing, respiratory, and medical leadership, which helped integrate skin rounds into the unit culture. Between July 2011 and August 2013, the skin injury team rounded on a median of 47 patients per week for 100 weeks, for a total of 4,672 patient assessments. The overall incidence of Stage II or greater pressure injuries was 2.79 injuries per 1,000 patient days. Stage II pressure injuries accounted for 64.5% of the injuries assessed. Stage III pressure injuries accounted for 2.8% of the injuries. Suspected deep tissue injuries accounted for 21.5% of the injuries. Injuries that could not be staged accounted for 3.7% of the injuries. Mucosal injuries accounted for 7.5% of the injuries. No Stage IV pressure injuries were detected. The greatest cause of pressure injuries was respiratory devices followed by immobility. The incidence of pressure injuries after the formation of the unit-based skin team increased significantly (from a baseline of 0.49 injuries per 1,000 patient days), which demonstrated an improved detection of injuries with standardized skin rounds. Implications for Nursing Practice We have created the largest database of skin injury in the NICU by means of an interdisciplinary team focused on skin injury prevention, education, and regular skin assessments of all infants. This database provides a stable platform upon which to build and measure prevention strategies. This skin care approach could serve as a model for other institutions.