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A Quality Improvement Project to Reduce Peristomal Skin Injuries in a Surgical Neonatal Intensive Care Unit
Nimmy Georgekutty1, Priya Govindaswamy, Charmaine Richards
1Author Affiliations: The Children's Hospital at Westmead, Sydney, New South Wales, Australia (Georgekutty, Govindaswamy, Richards, and Dalrymple); The University of Sydney, Sydney, New South Wales, Australia (Govindaswamy and Dalrymple); and The University of New South Wales, Sydney, New South Wales, Australia (Dalrymple).
Implementing an individualized bedside stoma care plan significantly reduced peristomal skin injuries in Neonatal Intensive Care Unit (NICU) patients. This initiative improved nursing confidence and standardized care, leading to better outcomes for neonates requiring ostomies.
Area of Science:
- Neonatal care
- Surgical outcomes
- Wound healing
Background:
- Ostomy formation is a critical intervention for neonates with congenital conditions, yet it presents significant challenges in Neonatal Intensive Care Units (NICUs), particularly concerning stoma care and associated skin breakdown.
- Peristomal skin injuries are a common complication in neonates with ostomies, impacting patient well-being and requiring intensive nursing management.
Purpose of the Study:
- To achieve a 60% reduction in peristomal skin injuries within six months of implementing a new stoma care protocol.
- To enhance the quality of care for neonates with ostomies by minimizing skin complications.
Main Methods:
- Utilized Evidence-based Practice for Improving Quality methodology and Plan-Do-Study-Act cycles for project development in the NICU.
- Conducted a pre-project survey to identify knowledge and confidence gaps in nursing staff regarding stoma care.
- Implemented a bedside stoma care plan template, supported by comprehensive bedside education and practical demonstrations for nurses.
Main Results:
- Achieved a 62% reduction in peristomal skin injuries within six months, exceeding the 60% target.
- Sustained improvements over 12 months, with injury rates decreasing to 8.3%.
- Post-project surveys indicated increased nurse confidence and more consistent stoma care practices.
Conclusions:
- An individualized bedside stoma care plan template effectively addressed the need for standardized and improved ostomy care in the NICU.
- Enhancing nurses' knowledge and confidence, alongside standardizing clinical practices, led to a significant reduction in stoma-related injuries.
- Further research is recommended to explore the generalizability of these findings to other units and patient populations.
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An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies:
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