Impact of Systematic Training and CPAP Checklist in the Prevention of NCPAP Related Nasal Injuries in Neonates- A Quality Improvement Study

Nasal continuous positive airway pressure (NCPAP) related nasal injury in neonates is a type of device-related pressure injury and is a common event with the varying incidence in different hospitals. Understanding and adhering to the recommendation of the manufacturer in fixing the NCPAP interface is vital for the prevention of nasal injuries. A quality improvement initiative was undertaken to decrease the incidence of NCPAP related nasal injuries in a Level 3 neonatal unit by using a customized NCPAP checklist and application of the checklist using Plan-Do-Study-Act (PDSA) cycles. A baseline audit was conducted for two months. An evidence-based checklist was formed by a quality improvement team and was exercised by a designated CPAP nurse using videos, small seminars, handouts, and hands-on training. Modifications in the checklist were done during the study using three PDSA cycles. A total of 129 babies with a median gestational age of 31 wk (IQR: 28–34 wk), median birth weight of 1320 g (IQR: 1030–1842 g) were studied. The mean duration of NCPAP was 5.4 d. The incidence of CPAP injuries decreased from 91 per 1000 CPAP days to 8 per 1000 CPAP days over 8 mo. The compliance with fixing NCPAP as per recommendation improved from 35% to 95% during the study with p values <0.05. Nurses training based on a structured checklist and highlighting important features of standardized NCPAP care helps in preventing NCPAP related nasal injury.