High-stage Device-related Pressure Injury Reduction in a Neonatal Intensive Care Unit: A Quality Improvement Project.

Area of Science:

• Neonatal intensive care
• Quality improvement science
• Patient safety

Background:

• Neonates in intensive care units (NICUs) face a high risk of hospital-acquired pressure injuries.
• Device-related high-stage hospital-acquired pressure injuries (HAPIs) were identified as a significant problem at Rady Children's Hospital, exceeding national rates.
• The primary goal was to decrease device-related high-stage HAPIs by 30% within 12 months.

Purpose of the Study:

• To implement a quality improvement initiative to reduce device-related high-stage hospital-acquired pressure injuries (HAPIs) in a neonatal intensive care unit (NICU).
• To decrease the incidence of device-related high-stage HAPIs by 30% within a 12-month period.

Main Methods:

• An interdisciplinary quality improvement (QI) task force was established to address device-related injuries.
• Care bundles were developed using QI methodology, and staff engagement was fostered by sharing device-related HAPI data.
• Outcome, process, and balancing measures were tracked using statistical process control charts.

Main Results:

• Device-related HAPIs were reduced by 60%, decreasing from 0.94 to 0.37 per 1,000 patient days.
• Incidents related to electroencephalography (EEG) and continuous positive airway pressure (CPAP) devices were eliminated and sustained for 10 months.

Conclusions:

• Interprofessional collaboration and a data-driven approach were critical for reducing high-stage pressure injuries.
• The successful QI strategy is replicable in other units facing similar patient safety challenges.