Quality improvement for reducing nasal continuous positive airway pressure related nasal injury in neonatal intensive care unit

Abstract

To reduce the incidence and severity of nasal injury in nasal continuous positive airway pressure ventilated neonates through a quality improvement project, a quality improvement project has been impleted in a neonatal intensive care unit (NICU) in a Level III hospital. Newborns requiring nasal continuous positive airway pressure (NCPAP) ventilation admitted to the NICU were included in this quality improvement project. A quality improvement team was established and developed guidance applicable to our unit on a standard method for nasal prong wear. Then, all the NICU nurses received a 15-minute uniform training session on nasal prong/mask-wearing standards. In addition, daily clinical inspections were made to give targeted 1-on-1 instruction to those who did not implement the method correctly. The primary outcome measures were the rate of correct nasal prong/mask wear and the incidence rate of neonatal NCPAP-related nasal injury. The secondary outcome measure was the prevalence rate of nasal injury. The quality improvement project was conducted in April 2020 and April 2021. The rate of correct nasal prong/mask wear (78.17% vs. 83.29%, χ2 = 18.660, p < 0.001), the incidence rate of neonatal NCPAP-related nasal injury (18.26% vs. 8.36%, χ2 = 19.674, p < 0.001), and the prevalence rate of nasal injury (27.52% vs. 13.85%, χ2 = 166.299, p < 0.001) all showed statistically significant differences before and after the quality improvement. Standardizing the way in which nasal prongs/masks are worn can reduce the incidence of nasal injury with low costs and relatively high benefits; thus, this approach is worth promoting.