Abstracts

Rationale: Neonates with Hypoxic Ischemic Encephalopathy (HIE) are at a high risk for progressive seizures. Rapid intervention with therapeutic hypothermia assists in improved neurological outcomes. In 2013, an increase in Hospital Acquired Pressure Ulcers (HAPU) was observed in this patient population while undergoing long term monitoring of EEG.Methods: Between January 2014 through September 2014, 30 total newborns with a diagnosis of HIE underwent the therapeutic hypothermia protocol in the Neonatal Intensive Care Unit (NICU) for an average length of 72 hours. A comprehensive team consisting of neurodiagnostic leadership, technologists, NICU nursing and wound care team collaborated to establish a quality improvement approach during long term monitoring of EEG. The following were the key components of our quality improvement approach: - Collect historical data with therapeutic hypothermia showing the prevalence/incidence of HAPU’s related to EEG patients in the NICU - Reduce the electrode array per ACNS guidlelines - Changed to disposable gold-plated electrodes - Eliminate circumferential head wrapping - Standardized use of adhesive to breathable cloth tape, which allows skin to breathe. - Technologists rounded twice daily to do skin observations with NICU nurses: - During skin assesments, presence of redness or blanching was identified as a ""near miss"". Tracking began in April 2014. - Electrodes were repostioned when redness or blanching was noted - Documentation of assessments and interventions - Re-education for all technologist staff - Weekly meetings with all key stakeholdersResults: Historical trending data accumulated for one year from Jan 2013 – Dec 2013 listed the total number of HAPU as a numerator compared to the total number of infants undergoing therapeutic hypothermia protocol as the denominator.The twelve month data revealed 6 documented HAPU on 34 hypothermia infants, 4 of which occurred in the last six months.This data was benchmarked by analyzing and illustrating trends monthly starting in Jan 2014 using the same numerator and denominator, but with the implemented quality improvement changes. Our results show a 100% decrease in HAPU beginning in Jan 2014 with the implementation of the quality improvement protocol. 30 total neonates with HIE were monitored with the therapeutic hypothermia protocol. During the protocol implementation period, none of the infants were staged with HAPU. There were 26 documented near misses that were caught during obervations that resulted in the technlogist repositioning the electrode and ultimately pre-emptively avoiding incidences of HAPU.Conclusions: Over the course of the nine month quality improvement trial, the incidence of Hospital Acquired Pressure Ulcers (HAPU) on neonates undergoing therapeutic hypothermia protocol was reduced by 100% as benchmarked with baseline data from the previous one year period. The use of a mutlidisaplinary approach to the reduction in HAPU resulted in significantly improved quality and supported our mission of excellence in patient care.