Improved Neonatal Skin Care after Development of Neonatal Skin Guidelines and Skin Team

Purpose:
Knowledge and consistent execution of best practices in skin care for neonates is variable and lags behind its adult counterpart. The goal of strategies employed is to decrease prevalence of four skin conditions: Epidural stripping, diaper dermatitis, pressure ulcers and extravasations injuries.

Significance:
Neonatal skin structural differences predispose this population to various types of skin injuries. Neonates present a challenge as percutaneous absorption is increased and prevalence of injuries from adhesive is high due to weaker adherence between the dermis and epidermis skin layers.

Strategy and Implementation:
The innovation employed was to develop a dedicated Neonatal skin team along with consistent preventative product use and procedures to treat skin conditions. Nurses were solicited to conduct a literature search on best practice and to implement the use of skin care products in the neonatal unit. The team developed a consistent method for documenting skin risk assessment and documentation as it pertained to skin conditions/pressure ulcers as well as uniform treatment methods for all skin conditions. The skin team educated all staff on the skin guidelines/products and their use, proper documentation and the newly developed unit policy and procedures for treating skin conditions. The team also developed a dressing check list and visual aid for any neonate that developed a skin condition requiring a dressing. All staff was required to complete the NDNQI pressure ulcer staging module. A monthly skin audit of patient charts for consistency in documentation and treatment was developed

Evaluation:
Six months after implementation an increase in documented skin conditions were present. This was expected since documentation prior to education was lacking. The incidence of moderate to severe diaper dermatitis has decreased from 7% to 2% and healing time has been shortened.

Implications for Practice:
All hospital units should develop age appropriate skin care guidelines and a skin care tam. Consistent use of products, education and documentation leads to improved recognition and treatment of various skin conditions which decreases morbidity and cost associated with skin injuries.