Neonatal Quality Improvement
Neonatal Quality Improvement 4
Sharadha Polam, MD
Childrens Hospital of Philadelphia
MONMOUTH JUNCTION, New Jersey, United States
Diaper Dermatitis (DD) is one of the most common skin conditions suffered by neonates and infants, which causes discomfort and stress to both neonates and their caregivers.
Approximately 50 – 65% of babies will suffer from DD(1). Mid rash – 58%, Moderate rash – 34%, Severe rash – 8%(2).
Our SMART aim is to decrease the percentage of babies with diaper dermatitis in our NICU from 42% (baseline period from Nov 2019 to Nov 2020) to less than 10% by Feb 2022 and sustain.
A multi-disciplinary team composed of Neonatologists, Wound Care Consultant, Nurses, and Pharmacist developed an evidence-based skin care policy for NICU at PMPMC as:
Use pamper-sensitive wipes for all babies and apply Hydraguard cream prophylactically starting from the first and with every diaper change to all babies who have intact skin. For babies who are less than 36 weeks, they are to be cleaned by using dry wipes moistened with plain water followed by Hydraguard. For any babies who have redness or breakdown, switch to plain dry wipes moistened with plain water and start using Z-guard regardless of gestational age. For any babies with a breakdown or severe rash, start using Triad cream.
The new skincare policy hand-outs were distributed to NICU nurses, Neonatologists, and parents, and attached to nurses’ clipboards as reminders during each shift. Data and feedback were collected from EHR and recorded in the logbook.
Outcome and process measures were diaper dermatitis rate and the number of wound care consults, respectively. These metrics were ascertained using a retrospective chart review extending one year prior to implementing the new skincare policy, followed by a prospective data collection process after implementing the new skincare policy. Pharmacist and Wound Care Consultant provided wound care consults data. Data was visualized in a control I-chart to identify special cause signals.
The pre-intervention period from Nov 2019 to Nov 2020 consisted of 246 NICU admissions and had an average diaper dermatitis percentage of 42.0%. The wound care consults count was 30. Extending this centerline in an I-chart (we obtained single percentage values), a special cause signal happened starting in December 2020, allowing for a downward shift in diaper dermatitis percentage to 7.5%. The wound care consults count dropped to zero during this period.
The diaper dermatitis percentage at PMPMC NICU from Nov 2020 to Feb 2022 decreased by 34.5% accompanied by a reduction of wound consultation to zero. This improvement was sustained for another 7 months.