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Skin Rounds: A Quality Improvement Approach to Enhance Skin Care in the Neonatal Intensive Care Unit

Nist, Marliese Dion MS, RNC-NIC; Rodgers, Elizabeth A. BSN, RN; Ruth, Brenda M. BSN, RN, CWON; Bertoni, C. Briana MD; Bartman, Thomas MD, PhD; Keller, Leah A. BSN, RN; Dail, James W. MBA, CLSSBB; Gardikes-Gingery, Renee MSN, RN; Shepherd, Edward G. MD

Section Editor(s): Forsythe, Paula L.

doi: 10.1097/ANC.0000000000000337
Outcomes of Neonatal Care
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Background: Skin injuries are common among neonatal intensive care unit (NICU) patients and may lead to significant complications. Standardized methods of preventing, detecting, and treating skin injuries are needed.

Purpose: The aim of this project was to standardize the assessment, documentation, and tracking of skin injuries among hospitalized neonatal patients and to determine the incidence of pressure ulcers in this patient population.

Methods: (1) Creation of an interdisciplinary skin team to identify skin injuries through weekly skin rounds. (2) Assessment of all patients at least twice daily for the presence of skin injuries. Interventions were implemented upon identification of a skin injury. Pressure ulcers of Stage II or more were further assessed by wound/ostomy nurses.

Findings: A total of 2299 NICU patients were hospitalized and assessed between July 2011 and December 2015. After the initiation of skin rounds, the baseline incidence of pressure ulcers increased from 0.49 per 1000 patient days to 4.6 per 1000 patient days, reflecting an improvement in detection and reporting. The most common skin injuries detected included erythema, skin tears, and ecchymosis; the most common cause of injuries was medical devices.

Implications for Practice: A dedicated skin team can improve the detection and reporting of skin injuries among NICU patients. Determination of the incidence of pressure ulcers in this population is critical to develop targeted interventions.

Implications for Research: Further research is needed to determine the most effective interventions to prevent and treat skin injuries among hospitalized neonates.

Nationwide Children's Hospital, Columbus, Ohio (Mss Nist, Rodgers, Ruth, Keller, and Gardikes-Gingery, Mr Dail, and Drs Bertoni, Bartman, and Shepherd); and The Ohio State University, Columbus (Ms Nist and Dr Shepherd).

Correspondence: Marliese Dion Nist, MS, RNC-NIC, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (marliese.nist@nationwidechildrens.org).

Funding for this project was provided by Neonatal Services, Nationwide Children's Hospital.

The authors declare no conflicts of interest.

© 2016 by The National Association of Neonatal Nurses