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

Introduction: Pressure injuries are a common complication in neonatal intensive care settings, and neonates are at high risk for this hospital-acquired condition. Pressure injury rates in the neonatal intensive care unit (NICU) at Rady Children's Hospital were higher than reported national comparisons in 2018. Device-related high-stage hospital-acquired pressure injuries (HAPI) were the most common injury source. We aimed to reduce the rate of device-related high-stage HAPIs per 1,000 patient days by 30% within 12 months. Methods: We formed an interdisciplinary quality improvement (QI) task force to address device-related injury. The team identified opportunities and interventions and created care bundles using QI methodology. To engage staff, device-related HAPI data were shared at nursing and respiratory therapy meetings. The team and stakeholders chose metrics. Outcome, process, and balancing measures were analyzed and displayed on statistical process control charts. Results: Device-related HAPIs were reduced by 60% from 0.94 to 0.37 per 1,000 patient days. electroencephalography and CPAP-related events were decreased to 0 and sustained for 10 months. Conclusions: Interprofessional collaboration, and a strong reliance on data were keys to reducing high-stage pressure injuries. This approach can be replicated and implemented by other units experiencing similar challenges.

Licensure: if not now, when?

Professional licensure protects the scope of practice for the profession, is regulated, and is a means of protecting patients from bad practice. ASET--The Neurodiagnostic Society has been working to implement professional licensure and has developed a model bill. This bill outlines the basic structure and provisions for what should be included in Neurodiagnostic licensure legislation at the state level. Many steps have been taken towards implementing professional licensure for Neurodiagnostic technologists. Licensure is a state level regulation and it will take a great deal of effort by many people to reach the strategic goal of licensure for Neurodiagnostic professionals in one or more states by 2015.