Diaper Dermatitis Algorithm and Scoring Tool in the Neonatal Intensive Care Unit (NICU): A Quality Improvement Project.

IF 1.7 3区 医学 Q2 NURSING
Meredith Sharp
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引用次数: 0

Abstract

Purpose: The purpose of this quality improvement project was to implement and evaluate an algorithm for management and prevention of diaper dermatitis (DD) embedded in a scoring tool. The specific aim of the project was to decrease DD occurrences with a severity score of 3 to 4 by 25%.

Participants and setting: Quality improvement participants comprised 164 neonates; 89 were cared for prior to project implementation and 75 post-implementation. Data were collected over a 3-month period. The setting of this quality improvement project was a 98-bed, Level IV neonatal intensive care unit (NICU) located in the Midwestern United States (Oklahoma City, OK). The NICU is part of a freestanding children's hospital affiliated with a university.

Approach: Diaper dermatitis occurrences and severity scores were collected prior to and 3 months after the protocol was implemented in the NICU. We collected pre-implementation data, followed by staff education concerning the DD protocol. We also provide guidance for protocol implementation at the bedside and in our Electronic Medical Record. Data on DD rates and severity were provided during the National Database for Nurse Quality Indicators (NDNQI) prevalence days the 4th quarter of 2020 and the 1st quarter of 2021. We compared data before and after protocol implementation to evaluate its effect on DD rates and severity.

Outcomes: Analysis before and after implementation of the protocol showed no significant differences in DD occurrences or severity scores. The unintended introduction of water-based cleansing wipes was identified as a confounding factor that we believe influenced outcomes. The DD scoring system and algorithm were permanently implemented for DD score quantification, DD management and treatment guidance, and ease of DD documentation with interventions, despite non-significant group differences.

Implications for practice: Next steps for this project are to implement the water-based cleansing wipes facility wide, along with the scoring tool and DD prevention protocol.

新生儿重症监护病房(NICU)尿布皮炎算法和评分工具:质量改进项目。
目的:本质量改进项目的目的是实施和评估嵌入评分工具的尿布皮炎(DD)管理和预防算法。该项目的具体目标是将严重性评分为3到4的DD发生率降低25%。参与者和环境:质量改善参与者包括164名新生儿;89人在项目执行前得到照顾,75人在项目执行后得到照顾。数据收集时间为3个月。本质量改进项目的背景是位于美国中西部(俄克拉荷马城,OK)的一个有98个床位的四级新生儿重症监护病房(NICU)。新生儿重症监护室是一所大学附属的独立儿童医院的一部分。方法:在NICU实施该方案之前和3个月后收集尿布皮炎发生率和严重程度评分。我们收集了实施前的数据,然后对员工进行了关于DD协议的教育。我们还为床边和电子病历的协议实施提供指导。在国家护士质量指标数据库(NDNQI)流行日(2020年第四季度和2021年第一季度)期间提供了DD发病率和严重程度的数据。我们比较了方案实施前后的数据,以评估其对DD率和严重程度的影响。结果:实施方案前后的分析显示,DD发生率或严重程度评分无显著差异。无意中引入的水基清洁湿巾被认为是影响结果的混杂因素。尽管没有显著的组间差异,但DD评分系统和算法被永久实施,用于DD评分量化、DD管理和治疗指导,以及干预措施中DD文件的便利性。实践意义:该项目的下一步是广泛实施水基清洁湿巾设施,以及评分工具和DD预防协议。
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来源期刊
CiteScore
3.10
自引率
34.60%
发文量
186
审稿时长
6-12 weeks
期刊介绍: ​​The Journal of Wound, Ostomy and Continence Nursing (JWOCN), the official journal of the Wound, Ostomy and Continence Nurses Society™ (WOCN®), is the premier publication for wound, ostomy and continence practice and research. The Journal’s mission is to publish current best evidence and original research to guide the delivery of expert health care. The WOCN Society is a professional nursing society which supports its members by promoting educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies and continence care needs.
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