Although noninvasive ventilation (NIV) helps minimize long-term respiratory complications from mechanical ventilation, the nasal interfaces employed were well-known for putting patients at risk for NIV device-related pressure injuries (PIs). In a level IV NICU, an increase in stage 2 or worse occurrence and deep tissue injury (DTI) PI was seen after clinical practice guidelines supporting closing NIV interfaces for respiratory support was implemented. The introduction of a comprehensive skincare bundle (SCB) was expected to lower the incidence of NIV device-related PI. The impact of deploying an SCB for patients supported with NIV via a nasal interface was assessed using quality improvement methods. Stage 2 or worse incidence rates and DTI PI were reported per 100 NIV days for 4 different periods: pre-NIV guideline, post-NIV guideline, post SCB, and sustainability phase. The one-sided P values from the Farrington-Manning test of equal risks with a significance level of 0.05 were used to make incidence comparisons. Following the implementation of NIV standards, the NICU witnessed a significant increase in NIV device-related PI (0.01 vs 0.34 per 100 NIV days; P=.01). Following an SCB, there was a 79% reduction in NIV device-related skin PI (0.34 vs 0.07 per 100 NIV days; P=.04). A collaborative and multidisciplinary team approach was adopted to address preventable harm to enhance interaction with healthcare professionals. The deployment of a multimodal PI prevention bundle helped reduce damage while allowing a particularly vulnerable patient population in the NICU to continue receiving proper respiratory assistance.


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