Preventing Pressure Injuries in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: An Interprofessional Quality Improvement Project.

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) can be caused by multiple factors including pressure, shear, friction, moisture/incontinence, device-related pressure, immobility, inactivity, and nutritional deficits. Along with immobility, medical device-related (MDR) HAPIs are a primary cause of pressure injury in neonates, as the clinical practice setting has become increasingly technologically advanced. It is estimated that up to 50% of HAPIs are MDR in pediatric patients. Neonates are at particular risk for HAPI because of their specific anatomical, physiological, and developmental vulnerabilities. A specific example of confluent factors that may increase risk for HAPI is the application of therapeutic hypothermia (TH) and continuous electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy (HIE). INTERVENTIONS: An interprofessional team collaborated to expand upon existing evidence-based standards of care to address the needs of this specific population within the neonatal intensive care unit (NICU). Interventions centered on revision of current protocols, with efforts to optimize product selection, hardwire assessment practices, and refine documentation of patient care and outcomes. METHODS: The team primarily utilized plan-do-study-act (PDSA) cycles to test and refine specific methods and strategies to reduce HAPIs. Tested solutions were adopted, adapted, or abandoned. RESULTS: A sustained zero HAPI rate in the HIE population resulted. The team continues to collect, report, and utilize near-miss data to continue to refine the process as new risks are identified. IMPLICATIONS FOR PRACTICE: Recognizing the unique skin protection needs of special populations within the NICU, such as those undergoing TH, is crucial. When evidence-based standards of care fail to adequately meet such needs, a collaborative approach to identifying, testing, and implementing population-specific solutions is essential. IMPLICATIONS FOR RESEARCH: A paucity of literature regarding the unique skin protection needs for babies undergoing TH exists. Work should be done to better describe the influence of TH on skin integrity, with the goal of identifying population-specific protective measures.

The Journey to High Reliability in the NICU.

Neonatal intensive care units (NICUs) are at high risk for medical errors due to the population, setting, and complexity of care. Furthermore, "near misses" often precede actual errors yet are mostly underreported and unrecognized as safety concerns. There is a growing recognition that a systems approach to quality and safety is foundational to improving care at the bedside and patient outcomes. The High Reliability Organization model is one such approach. It recognizes the challenges of a highly complex system and combines this recognition with a continual emphasis on reducing errors. Although the principles of the High Reliability Organization hold promise in accelerating quality and safety in the NICU, it is imperative that nurses at the bedside as well as nurse leaders actually learn how to operationalize high reliability principles and strategies that lead to better outcomes. This article outlines the necessary principles, culture, strategies, and behaviors that NICU nurses and nurse leaders must adopt to achieve high reliability in their units.

Technology-Enabled Population Health Management: Two Communities' Use of an Electronic Care Alert System.

Population health management is an approach to improve the health outcomes of a specific group of people, such as frequent users of the emergency department or those at high-risk for hospital admissions. When combined with quality improvement strategies, the targeted application of health information exchange and health information technology (health IT) can swiftly move health care systems and providers from basic to advanced population health management. One such tool is an electronic alert system (alert system), which informs a provider or site about a patient's visit to the emergency department or hospital admission on a daily basis. This article highlights the use of such an alert system in 2 communities to help address gaps in population health management.