The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Patricia A. Achuff1, Maura Nitka2, Elizabeth Kramer2, Joseph Bolton1, Daniel Dawson1, Leane Soorikian1, Laura Miske2; 1Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA; 2Department of Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA

Background: The use of non-invasive positive pressure ventilation (NIPPV) in children has rapidly increased. Occurrence of skin breakdown, an interface associated complication, is clinically significant in children using NIPPV. Accurate skin assessment, interventions, and documentation of care have the potential to decrease Incidence of avoidable injury related to NIPPV. Methods: A data collection tool was created to measure compliance with the hospital NIPPV standard of care. Over a 4 week period (November 2010) hospital –wide audits (N=91) assessed care of children (all measured in means: age=3 yrs, weight=14.2 kg, therapy days=6, hours on NIPPV=16.5) receiving NIPPV. Skin injury occurred in 14/91 (15%) of cases. A multi-disciplinary team revised the current standard of care. The new standard highlighted collaborative and more frequent skin assessments involving Nursing and Respiratory Care, skin protection with a silicone based dressing, and guidelines for alternating interfaces. Requirements for documentation, plus error reporting, were enhanced. In preparation for this practice change, Respiratory Therapists received education regarding skin assessment techniques, identification of skin injury, and interface strategies. Nurses and Respiratory Therapists were trained on the revised standard of care using collaborative return demonstration, facilitated by qualified observers, and online interactive self learning module with inclusive simulated patient care video. The revised standard of care was implemented hospital wide. Existing data collection tool was used for post-education audit to measure compliance with new revised NIPPV standard. Wilcoxon rank sum and Chi-square tests were used to compare data. Results: New hospital wide audits (November 2011, N=72) assessed care of children (all measured in means: age=2 yrs, weight= 12 kg, therapy days= 5.5, hours on NIPPV=17.5) receiving NIPPV under new revised standard. Audit data after one year revealed skin injury occurred in 4/72 (6%) of cases. Hours between interface changes and documentation of Respiratory Therapy and Nursing were also reviewed. Conclusions: Respiratory Therapist and Nurse training on consistent collaborative standard practice of improved skin assessment, interventions, and documentation can decrease occurrence of avoidable skin injury secondary to NIPPV. Sponsored Research - None Audit Outcomes Table