Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project.

Abstract

Burn injuries to the face and neck are very common. Once vital structures such as the mouth, ears, nose and eyes are damaged by burn injury, there will be pain, swelling, deformity and the potential for contractures to develop. This can lead to a lifetime of physical and psychological issues. It is very important to deliver evidence-based recommended practice in order to achieve the best outcome as these structures heal. The aim of this project was to ensure the compliance of face care procedures with JBI evidence-based recommended practice. This evidence implementation project employed the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Design and implementation of strategies to improve practice involved identification of barriers and outlining strategies to overcome barriers, resources utilized and outcomes of this process. This project retrospectively surveyed the case notes of ten patients who sustained facial burns, based on both baseline and follow-up audits. Compliance with best practice audit criteria in the baseline audit was moderate to high (70-100%) in four out of 10 criteria. These criteria reflect appropriate administration of analgesia prior to wound care, attendance at education sessions on facial burns, ophthalmic testing being performed, assessment for inhalation injuries and mouth care. Poor compliance rates (10-40%) were seen in the criteria representing nasal care, explanation of the procedure to the client and eye and ear care. Documentation for these criteria was almost non-existent resulting in the outcome of poor compliance. Education sessions were held across both the Adult Burn Service and Intensive Care Unit settings with particular emphasis on the importance of complete documentation. The results of the follow-up audit showed significant improvement (67-100% compliance) in documentation for the performed procedures. The aims of the project were partially achieved. Future plans to undertake another project and look into the compliance rate of face care procedures with the face care protocol across both Adult Burn Service and Intensive Care Units have been discussed with current stakeholders. This will involve auditing a further ten cases of actual face care procedures performed by nursing staff in both settings.