Authors :
Presenting Author: Sheri Jones, MPH, MBA, REEGT, RRT-SDS – Parkland Hospital
Nancy Ornelas, BSN, RNC-NIC – Parkland Hospital
Katie Bloodgood, MSHCAD, BSN, RN, RNC-NIC – Parkland Hospital
Linda Castleman, BSN,RN,NE-BC – Parkland Hospital
Janice Owen, RN, CWOCN – Parkland Hospital
Bino Benjamin, RN, WCC – Parkland Hospital
Debbie Cedillo, REEGT – Parkland Hospital
Agnes Todd, REEGT – Parkland Hospital
Katherine Stumpf, MD – UT Southwestern
Venkat Kakkilaya, MD – UT Southwestern
Jesse Banales, MD – UT Southwestern
Cari Brown, BSN, RNC-NIC – Parkland Hospital
Aimee Russell, BSN, RNC-NIC – Parkland Hospital
Maricel Maxey, NNP – Parkland Hospital
Rachel Leon, MD, PhD – UT Southwestern Medical Center
Deepa Sirsi, MD – University of Texas Southwestern Medical Center, Dallas, Texas
Jamie Walker, RN – Parkland Hospital
Maritza Molina, RN – Parkland Hospital
Abigail Jacob, BSN, RN – Parkland Hospital
Jennifer Basham, BSN, RN – Parkland Hospital
Nicole Muggler, BSN, RN – Parkland Hospital
Jennifer Thomas, MD-C – UT Southwestern
Thao Vu, MPH, BSN-RN, CPN – Childrens Medical Center Dallas
Amy Caccamo, BS, NA-CLTM, R.EEGT/EPT – Childrens Medical Center Dallas
Andrea Grundy, REEGT – Childrens Medical Center Dallas
Rationale:
Neonates are highly susceptible to skin injury due to fragile skin, device use, and extended hospital stays. Those receiving therapeutic hypothermia and continuous EEG (cEEG) for hypoxic-ischemic encephalopathy (HIE) are at especially high risk. At Parkland Health, 109 NICU patients underwent EEG since January 2024, with 35 (32%) developing skin injury under the electrodes. Among 34 cooled infants, 18 (58%) experienced breakdown.
Specific Aim
To reduce skin injuries in EEG-monitored NICU patients—by 12% overall (32% to 20%) and by 30% in cooled infants (58% to 28%)—by March 31, 2025, using a standardized EEG care bundle.
Methods:
Methods
Aligned with Parkland Health’s high-reliability goals and Strategic Priority 2 (Quality & Patient Safety), a multidisciplinary team created a care bundle. Collaborators included NICU nurses, nurse practitioners, physicians, neurologists, neurophysiologists, EEG technologists, epilepsy leadership, and wound care specialists from Parkland Health, UTSW, and Children’s Health.
Interventions
The bundle features gold electrodes, Mepitel barrier film, mesh hats for secure placement, reduced lead count (26 to 21), and staff education. Chart audits and safety reports tracked compliance and outcomes.
Process Measures
Balance Measures
Results: Injury rates in cooled infants decreased from 72% to 33%. Overall EEG-related skin injury dropped from 58% to 11% in the most recent quarter. Improvements are largely attributed to use of gold electrodes and Mepitel.
Conclusions: Deviations from the bundle are monitored and addressed with leadership. Compliance continues to improve, supported by consistent protocols and leadership oversight. This initiative has significantly reduced injury rates and will continue with ongoing monitoring, staff engagement, and potential regional expansion.
Funding: No external funding