Skin injury prevention in an Irish neonatal unit: An action research study

Abstract

Aim: This study aimed to improve skin assessment and skincare practices for neonates in a regional neonatal setting in Ireland by the implementation of the Neonatal Tissue Viability Risk Assessment Tool.Method: A qualitative participatory action design was used. Following the introduction of the Neonatal Tissue Viability Risk Assessment Tool into the neonatal unit, three focus groups with nurses (n=17) were held. The focus group data was analysed using thematic analysis.Results: Neonatal nurses acknowledged the need for change regarding the prevention of neonatal skin injuries. Variations in skincare practices were found and a need for standardised care was highlighted. Implementation of the skin risk assessment tool helped to raise awareness, standardise practice and improve documentation and communication. Conclusion:Implementing a skin risk assessment tool into neonatal units in Ireland together with evidence-based skincare guidelines and staff education could result in the reduction of skin injuries in these infants.

Prevention of neonatal pressure injuries

“…A number of neonatal units in the UK, Ireland, the United States and Canada are implementing neonatal risk assessment tools into clinical practice as a quality improvement intervention (Ashworth and Briggs, 2011;Schumacher et al 2013;August et al 2014;Vance et al 2015;Grosvenor et al 2016). A literature search retrieved 9 published paediatric pressure ulcer risk assessment tools with the BradenQ scale and the Glamorgan Scale being the only tools that have been tested for sensitivity and specificity (Baharestani and Ratliff, 2007).…”

“…Only 6 published skin risk assessment tools are available for the neonatal population and of these tools few measures have been validated (Noonan et al, 2011;Vance et al, 2015). From the literature it is evident that a further 3 tools are currently being developed as a result of research but these have not yet been published (August et al 2014;Vance et al 2015;Grosvenor et al 2016). Most neonatal tools have been based on the BradenQ scale which is an adaptation of the Braden Scale used for adults (Vance et al, 2015).…”

“…Skin risk assessment tools together with tissue viability/skincare guidelines can ensure 'safer better healthcare' that improves clinical practice and patient outcomes (Health Information and Quality Authority, 2012). Recent evidence suggests that skin risk assessment tools help to identify infants that are at risk of skin breakdown and ensures preventative measures are in place before skin breakdown occurs (Ashworth and Briggs, 2011;Grosvenor et al 2016). Risk assessment tools also help nurses provide a comprehensive skin assessment, improve documentation and accountability and help to standardise clinical practice (Grosvenor et al 2016).…”

“…More trials on this topic is clearly needed. Nonetheless, the absence of a standardised skin assessment tool and the lack of best practice guidelines to assist decision making can lead to widespread variations in practice amongst hospitals and within individual neonatal units (Grosvenor et al 2016). Moreover, evidence suggests that the use of a validated reliable risk assessment tool in conjunction with a nurse's intuition and clinical judgement can complement skin assessment and provide evidence-based accountable nursing care (Kottner et al 2013).…”

Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale

“…Few scales are used in neonate populations, and some were developed in children not neonates (Noonan, Quigley, & Curley, 2011), some are free adaptations (Grosvenor, O'Hara, & Dowling, 2016), and others have not been validated (Fujii et al, 2010). Some authors said that these current neonatal scales present major limitations (García-Fernández et al, 2011;Kottner et al, 2013).…”