Reducing device-related pressure injuries in high-risk neonates receiving nasal continuous positive airway pressure: a quality improvement study

Objective Neonates requiring Non-InVasive respiratory Support (NIVS) are at high risk of device-related pressure injury (DRPI), with incidence rates of 20%–60% in extremely premature infants. Over a 4-year period, our team undertook a Quality Improvement Project to review aspects of the clinical management of NIVS: types of interfaces, introduction of hydrocolloid dressing and the development and implementation of nasal injury care plan (NICP) to reduce DRPI in high-risk neonates. Design A prospective descriptive study was completed in three stages: trial of nCPAP interfaces, preintroduction NICP (2016–2018), post-NICP (2018–2020) and (2021–2022) to measure sustainability of implementation. Data included: gestational age (GA), birth weight, NIVS days, incidence, grade and day of DRPI. Statistical analysis of incidence rate ratio was completed between pre and postgroups. Setting Australian neonatal intensive care unit. Patients All neonates ≤32 weeks requiring nCPAP. Interventions Evaluation of types of interfaces, introduction of hydrocolloid dressing and the development and implementation of NICP Main outcome measures: incidence and severity of DRPI. Results Total DRPI recorded in all CPAP babies pre/post NICP were (59/659 (9.0%), 26/574 (4.5%), p=0.0032, respectively). Analysis showed DRPI incidence rates per 1000 NIVS days ((10.6, 5.5), p=0.0001, respectively). 75 (88%) of DRPI occurred in the ≤32 week group of neonates requiring NIVS. Review of babies ≤32 weeks across the three intervals showed significant improvement with time (55 (19%); 27 (13%); 19 (9%), p=0.0001). Conclusions Preferred nCPAP interface, nasal dressing and NICP have reduced the incidence and severity of DRPI in the NICU.