Authors (including presenting author) :
Wong HS(1), Chan KL(1), Cheng MY(1), Wong C(1)
Affiliation :
(1) Neonatal Intensive Care Unit, Department of Paediatrics, Kwong Wah Hospital
Introduction :
Pressure injuries from medical devices are common but preventable in patients of all ages. Neonates who required Nasal continuous positive airway pressure (CPAP) for respiratory support have an increased risk for developing skin breakdown. Risk factors included
1. Tight device securement induced poor circulation and friction.
2. Poor patient position.
3. Lack of awareness by staff.
4. Lack of routinely assessment of skin and devices.
5. Moisture and heat increased perspiration and macerated skin.
The incidence of nasal prong related pressure injury reported in KWH NICU was 6% (12 cases) from Sept. 2017 to Aug. 2018.
Objectives :
A Nursing Care Bundle has been developed to standardize the practice in this project. This bundle included nursing working instruction, nasal interface reference chart and use the checklist for guiding practice. This bundle educated and guided NICU nursing staff to assess the skin under nasal prong, apply proper size nasal interface, secure the device and provide appropriate nursing care. The objective of this project is to reduce the incidence of nasal prong related pressure injury in NICU.
Methodology :
This project was conducted in Kwong Wah Hospital NICU from September 2018. The nursing care bundle was applied to the patient on nasal CPAP in NICU. All NICU nurses have been educated this nursing care bundle in Aug. 2018. The nursing care bundle included
1. Nursing care working instruction on correct use of nasal prong and ventilator tubing fixation.
2. Nasal Interface Reference Chart to choose proper size of nasal prong.
3. Check the skin under device integrity and release the nasal prong pressure point every 4 hours to prevent skin breakdown.
4. Cushion and protect the skin with dressing.
5. Alternative change of nasal mask and nasal prong daily in extremely low birth weight neonates.
6. Use the checklist to guide nursing practice and increase the awareness of staff.
Result & Outcome :
At first three months of this project, 3 cases of pressure injury were reported and afterwards no new cases were found for twelve months. The incidence rate was decreased from 6% to zero. The standardized nursing care bundle is effective to prevent nasal prong related pressure injury in NICU. Standardized nursing practice, assessment and increase staff awareness are essential for prevent the pressure injury.
