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Published on: October 28, 2022
Preventing Pressure Injuries in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: An
Alexandra Luton1, Jae Hernandez, Clive Robert Patterson
1Newborn Center, Texas Children's Hospital, Houston (Ms Luton); CMHH Quality & Safety, Children's Memorial Hermann Hospital, Houston, Texas (Ms Hernandez); Neurodiagnostic Technology School, Medical Education and Training Campus, Fort Sam Houston, Texas (Mr Patterson); MoonPenny Consulting, Delaware, Ohio (Ms Nielsen-Farrell); Neurophysiology Department, Texas Children's Hospital, Houston (Ms Thompson); and Departments of Pediatrics (Section of Neonatology) and Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX (Dr Kaiser).
Insights
Implementing targeted interventions significantly reduced hospital-acquired pressure injuries (HAPIs) in neonates undergoing therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). This collaborative approach optimized care for this vulnerable population, achieving a zero HAPI rate.
Area of Science:
- Neonatal intensive care unit (NICU) care
- Medical device-related pressure injuries
- Skin integrity in vulnerable neonates
Background:
- Hospital-acquired pressure injuries (HAPIs) are multifactorial, with medical device-related (MDR) HAPIs being a primary concern in neonates.
- Neonates undergoing therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE) are at increased risk due to unique vulnerabilities.
- Existing evidence-based standards may not adequately address the specific skin protection needs of this population.
Purpose of the Study:
- To develop and implement population-specific strategies to reduce HAPIs in neonates with HIE undergoing TH.
- To enhance existing evidence-based standards of care for this high-risk NICU population.
- To optimize product selection, assessment practices, and documentation for HAPI prevention.
Main Methods:
- An interprofessional team revised current protocols and care standards.
- Plan-do-study-act (PDSA) cycles were utilized to test and refine interventions.
- Focus on optimizing product selection, standardizing assessments, and improving documentation.
Main Results:
- A sustained zero rate of HAPIs was achieved in the HIE population undergoing TH.
- Near-miss data collection and analysis are ongoing for continuous process refinement.
- Successfully adapted and implemented targeted solutions for HAPI prevention.
Conclusions:
- Recognizing and addressing the unique skin protection needs of special NICU populations, like those on TH, is critical.
- Collaborative, population-specific solutions are essential when standard care is insufficient.
- Further research is needed to understand TH's influence on skin integrity and develop specific protective measures.
Background:
Hospital-acquired pressure injuries (HAPIs) can be caused by multiple factors including pressure, shear, friction, moisture/incontinence, device-related pressure, immobility, inactivity, and nutritional deficits. Along with immobility, medical device-related (MDR) HAPIs are a primary cause of pressure injury in neonates, as the clinical practice setting has become increasingly technologically advanced. It is estimated that up to 50% of HAPIs are MDR in pediatric patients. Neonates are at particular risk for HAPI because of their specific anatomical, physiological, and developmental vulnerabilities. A specific example of confluent factors that may increase risk for HAPI is the application of therapeutic hypothermia (TH) and continuous electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy (HIE).
Interventions:
An interprofessional team collaborated to expand upon existing evidence-based standards of care to address the needs of this specific population within the neonatal intensive care unit (NICU). Interventions centered on revision of current protocols, with efforts to optimize product selection, hardwire assessment practices, and refine documentation of patient care and outcomes.
Methods:
The team primarily utilized plan-do-study-act (PDSA) cycles to test and refine specific methods and strategies to reduce HAPIs. Tested solutions were adopted, adapted, or abandoned.
Results:
A sustained zero HAPI rate in the HIE population resulted. The team continues to collect, report, and utilize near-miss data to continue to refine the process as new risks are identified.
Implications For Practice:
Recognizing the unique skin protection needs of special populations within the NICU, such as those undergoing TH, is crucial. When evidence-based standards of care fail to adequately meet such needs, a collaborative approach to identifying, testing, and implementing population-specific solutions is essential.
Implications For Research:
A paucity of literature regarding the unique skin protection needs for babies undergoing TH exists. Work should be done to better describe the influence of TH on skin integrity, with the goal of identifying population-specific protective measures.
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