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Published on: November 29, 2017
Neonatal Electroencephalogram Electrode-Related Pressure Injury Prevention Quality Improvement Study
Laura A Blazier1, Frances A Boyle, Kristin L Cooper
1At Riley Hospital for Children at Indiana University Health, Indianapolis, Laura A. Blazier, MSN, RN, ACCNS-P, RNC-NIC, is NICU Clinical Outcomes Specialist and Frances A. Boyle, BA, is NeuroNICU Program Coordinator. Kristin L. Cooper, MBA, R.EEG/EPT, CLTM, CNIM, RPSGT, RST, is Neurophysiology Director, Indiana University Health Academic Health Center, Indianapolis. Also at Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Sarah E. Wing, MD, is Child Neurologist and Assistant Professor of Clinical Neurology and Beatrice M. Stefanescu, MD, MBA, MS, is NICU Medical Director and Associate Professor of Clinical Pediatrics.
Insights
Implementing a flexible hydrogel electrode and daily skin assessments significantly reduced electroencephalogram electrode-related pressure injuries (EERPIs) in neonates. This quality improvement initiative achieved zero EERPI events within one year.
Area of Science:
- Neonatal intensive care
- Medical device innovation
- Patient safety
Background:
- Neonatal intensive care units (NICUs) face challenges with device-related skin injuries.
- Electroencephalogram (EEG) electrode-related pressure injuries (EERPIs) are a concern in neonates requiring continuous monitoring.
- Existing EERPI rates necessitate improved preventive strategies.
Purpose of the Study:
- To reduce the incidence of EERPIs in neonates undergoing continuous EEG monitoring.
- To achieve a target of 100 EERPI-free days within six months and sustain 200 EERPI-free days annually.
- To implement and evaluate a quality improvement intervention for EERPI prevention.
Main Methods:
- A quality improvement study conducted in a level IV NICU over three epochs (baseline, intervention, sustainment).
- Key interventions included daily EEG skin assessments, use of flexible hydrogel EEG electrodes, and rapid-cycle staff education.
- Data collected on EERPI events and continuous EEG (cEEG) monitoring days across study epochs.
Main Results:
- EERPI incidence decreased from 13.2% in epoch 1 to 2.5% in epoch 2, and 0% in epoch 3.
- EERPI-free days increased from an average of 34 days to 182 days, and finally to 365 days (zero harm).
- No statistical difference in median cEEG days across epochs, indicating intervention effectiveness independent of monitoring duration.
Conclusions:
- Structured interventions, including electrode modification and skin assessment, effectively eliminated EERPIs in neonates.
- Preventive measures at the cEEG-electrode interface are crucial for reducing EERPIs.
- The study demonstrates a successful strategy for achieving and sustaining zero harm from EERPIs in a NICU setting.
Objective:
To lengthen the days between electroencephalogram electrode-related pressure injury (EERPI) to 100 EERPI-free days in 6 months of study implementation with a goal to maintain 200 EERPI-free days thereafter (≤1 EERPI event/year).
Methods:
This quality improvement study took place in a level IV neonatal ICU over three epochs spanning 2 years: epoch 1 or baseline (January-June 2019), epoch 2 or implementation of intervention (July-December 2019), and epoch 3 or sustainment (January-December 2020). A daily electroencephalogram (EEG) skin assessment tool, introduction in practice of a flexible hydrogel EEG electrode, and successive rapid-cycle staff-education sessions were key interventions of the study.
Results:
Seventy-six infants were monitored for 214 continuous EEG (cEEG) days, of which six (13.2%) developed EERPI in epoch 1. Eighty infants were monitored for 193 cEEG days, of which two (2.5%) developed EERPI in epoch 2. One hundred thirty-nine infants were monitored for 338 cEEG days, and none developed EERPI in epoch 3. There was no statistical difference with respect to the median cEEG days among study epochs. A G-chart of EERPI-free days showed an increase in EERPI-free days from an average of 34 days in epoch 1 to 182 days in epoch 2 and 365 days (or zero harm) in epoch 3. Skin erythema from EEG electrodes was noted during the study.
Conclusions:
The structured study interventions eliminated EERPI events in infants monitored with cEEG. Preventive intervention at the cEEG-electrode level coupled with skin assessment successfully reduced EERPIs in neonates.
