An evidence based practice project to improve care of pediatric patients receiving non-invasive ventilation (NIV).

2.50
Hdl Handle:
http://hdl.handle.net/10755/203222
Type:
Presentation
Title:
An evidence based practice project to improve care of pediatric patients receiving non-invasive ventilation (NIV).
Abstract:
(Summer Institute) Problem: Medical advancements have changed the treatment and prognosis of respiratory compromise in the pediatric population. As a result, non-invasive ventilation (NIV) has gained prevalence as an effective way to manage respiratory compromise while avoiding the potential adverse effects of invasive airway intubation. Skin injury is a documented adverse effect of NIV. Evidence: A comprehensive literature review revealed that pediatric NIV is associated with skin breakdown and nasal damage. Despite a paucity of research evidence to guide practice, evidence from numerous published clinical practice guidelines identifies that appropriate physical assessment and care can reduce skin breakdown and nasal damage. Strategy: A data collection tool was created to measure compliance with the hospital NIV standard of care. Over a 4 week period (December, 2010), hospital-wide audits (N=146) assessed care of children (M=6.63 yrs., sd=7.31, 0.01-24 years old) receiving NIV. Skin injury occurred in 15/93 (16%) of cases. Practice Change: Evaluation of audit data revealed practice compliance issues, such as frequency of skin assessment documentation. An implementation plan is in progress which includes modifying the NIV standards and communicating those changes to staff. Education will include computer assisted learning and high fidelity simulation of care for the child receiving NIV. We hypothesize that practice consistent with published guidelines can decrease the occurrence of preventable skin injury, secondary to NIV. Evaluation: We will complete a post implementation audit targeting practice components such as frequency of skin assessment documentation and prevalence of skin injury to determine project impact. Results: Data will be presented comparing audits pre and post implementation specific to variables of interest such as number of days on NIV, patient age, NIV mode and interface. Recommendations: pending project completion Lessons: Reliance on records to audit practice is limited by the reality that documentation is often incomplete. Finding time to participate and plan in an EBP project can be difficult as a staff nurse, especially when it is a hospital wide interdisciplinary project. Bibliography: Barrington, K. J., Bull, D., & Finer, N. N. (2001), Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics. 107(4), 638-641. Carlisle, H. R., Kamlin, C. O. F., Owen, L. S., Davis, P. G., & Morley, C. J. (2010). Oral continuous positive pressure (CPAP) following nasal injury in a preterm infant. Archives of Disease in Childhood Fetal and Neonatal Education, 95, F142- F143. Davis, P. G. & Smart, D. J. (2009). Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews, Issue 2, 1-31. McCoskey, L. (2008) Nursing Care Guidelines for Prevention of Nasal Breakdown in Neonates Receiving nasal CPAP. Advances in Neonatal Care, 8(2), 116-124. Robertson, N. J., McCarthy, L.S., Hamilton, P.A., & Mos, A. L. H. (1996). Nasal deformities resulting from flow driver continuous positive airway pressures, Archives of Disease in Childhood, 75,F209-F288. Smith, Z. K. (2006). Adapting a Soft Silicone Dressing to Enhance Infant Outcomes, Ostomy Wound Management, 52(4), 30 -32. Squires, A. J. & Hyndman, M. (2009). Prevention of nasal injuries secondary to NCPAP application in the ELBW infant. Neonatal Network, 28(1), 13-27. Yong, S-C., Chen, S-J., Boo, N-Y. (2005). Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomized control study. Archives of Disease in Child, Fetal and Neonatal Education, 90, F480-F483. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Pediatric; NIV
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAn evidence based practice project to improve care of pediatric patients receiving non-invasive ventilation (NIV).en_GB
dc.identifier.urihttp://hdl.handle.net/10755/203222-
dc.description.abstract(Summer Institute) Problem: Medical advancements have changed the treatment and prognosis of respiratory compromise in the pediatric population. As a result, non-invasive ventilation (NIV) has gained prevalence as an effective way to manage respiratory compromise while avoiding the potential adverse effects of invasive airway intubation. Skin injury is a documented adverse effect of NIV. Evidence: A comprehensive literature review revealed that pediatric NIV is associated with skin breakdown and nasal damage. Despite a paucity of research evidence to guide practice, evidence from numerous published clinical practice guidelines identifies that appropriate physical assessment and care can reduce skin breakdown and nasal damage. Strategy: A data collection tool was created to measure compliance with the hospital NIV standard of care. Over a 4 week period (December, 2010), hospital-wide audits (N=146) assessed care of children (M=6.63 yrs., sd=7.31, 0.01-24 years old) receiving NIV. Skin injury occurred in 15/93 (16%) of cases. Practice Change: Evaluation of audit data revealed practice compliance issues, such as frequency of skin assessment documentation. An implementation plan is in progress which includes modifying the NIV standards and communicating those changes to staff. Education will include computer assisted learning and high fidelity simulation of care for the child receiving NIV. We hypothesize that practice consistent with published guidelines can decrease the occurrence of preventable skin injury, secondary to NIV. Evaluation: We will complete a post implementation audit targeting practice components such as frequency of skin assessment documentation and prevalence of skin injury to determine project impact. Results: Data will be presented comparing audits pre and post implementation specific to variables of interest such as number of days on NIV, patient age, NIV mode and interface. Recommendations: pending project completion Lessons: Reliance on records to audit practice is limited by the reality that documentation is often incomplete. Finding time to participate and plan in an EBP project can be difficult as a staff nurse, especially when it is a hospital wide interdisciplinary project. Bibliography: Barrington, K. J., Bull, D., & Finer, N. N. (2001), Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics. 107(4), 638-641. Carlisle, H. R., Kamlin, C. O. F., Owen, L. S., Davis, P. G., & Morley, C. J. (2010). Oral continuous positive pressure (CPAP) following nasal injury in a preterm infant. Archives of Disease in Childhood Fetal and Neonatal Education, 95, F142- F143. Davis, P. G. & Smart, D. J. (2009). Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews, Issue 2, 1-31. McCoskey, L. (2008) Nursing Care Guidelines for Prevention of Nasal Breakdown in Neonates Receiving nasal CPAP. Advances in Neonatal Care, 8(2), 116-124. Robertson, N. J., McCarthy, L.S., Hamilton, P.A., & Mos, A. L. H. (1996). Nasal deformities resulting from flow driver continuous positive airway pressures, Archives of Disease in Childhood, 75,F209-F288. Smith, Z. K. (2006). Adapting a Soft Silicone Dressing to Enhance Infant Outcomes, Ostomy Wound Management, 52(4), 30 -32. Squires, A. J. & Hyndman, M. (2009). Prevention of nasal injuries secondary to NCPAP application in the ELBW infant. Neonatal Network, 28(1), 13-27. Yong, S-C., Chen, S-J., Boo, N-Y. (2005). Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomized control study. Archives of Disease in Child, Fetal and Neonatal Education, 90, F480-F483. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectPediatricen_GB
dc.subjectNIVen_GB
dc.date.available2012-01-16T11:04:15Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:04:15Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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