Standardising Emollient Prescribing in Critically Ill Patients: A Quality Improvement Project

Introduction Critically ill patients are vulnerable to skin dryness, irritation, and skin barrier impairment due to factors associated with critical illness and prolonged intensive care admission. Consistent skin care and the use of a standardised emollient may support a more uniform approach to skin barrier protection. However, variation in prescribing and product selection may result in inconsistent practice. This quality improvement project aimed primarily to increase prescribing of the locally recommended standard emollient, thereby reducing variation in product selection and standardising emollient therapy. Materials and methods This single-centre quality improvement project was conducted in a general intensive care unit (GICU) and was reported with reference to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 framework. A baseline audit of 30 adult inpatients was conducted over two weeks in March 2026. Data were collected to assess documentation of skin assessment, emollient prescribing, documentation of moisturiser or emollient application, and prescription of the locally recommended standard emollient. An anonymous nursing staff survey was also undertaken; 42 responses were collected, representing all nurses invited to participate. The survey explored reported knowledge and practice, product selection, and perceived barriers to consistent moisturiser use. Findings informed an intervention of staff education and visual prescribing prompts promoting the locally recommended standard emollient. A repeat audit of a further 30 adult GICU inpatients was conducted over two weeks in August 2026 using the same outcome measures and data collection methods. The primary outcome was the proportion of patients prescribed the locally recommended standard emollient. Secondary outcomes included prescription of any emollient, documentation of moisturiser or emollient application, and documentation of skin assessment. Results At baseline, skin assessment was documented in 25 of 30 patients (83.3%), while documentation that a moisturising product had been applied was present in 21 patients (70.0%). An emollient was formally prescribed in two patients (6.7%), and the locally recommended standard emollient was prescribed in one patient (3.3%). Among 42 nursing staff surveyed, 39 (92.9%) reported applying moisturisers to their patients, while 28 (66.7%) reported using any moisturiser available in the ICU. The most frequently reported barrier was lack of product availability (81.0%). Following the intervention, prescribing of any emollient increased to 21 of 30 patients (70.0%), while prescribing of the locally recommended standard emollient increased to 19 patients (63.3%). Thus, although overall emollient prescribing increased substantially, not all emollient prescriptions were for the locally recommended standard product. Documentation of skin assessment increased to 26 patients (86.7%), whereas documentation of moisturiser or emollient application decreased slightly to 20 patients (66.7%). Conclusion Baseline assessment identified substantial variation in skin barrier protection practices within the general ICU, particularly a marked discrepancy between documented emollient application and formal prescribing. Standardised prescribing provides a practical approach to reducing variation in product selection and may support more consistent skin barrier protection in critically ill patients.