Neonatal Skin Care with a Focus on Diaper Dermatitis: Creating and Implementing a Successful Policy Revision

Media Esser MSN, RN, NNP-BC, APNP Children’s Hospital of Wisconsin

Aims •  Analyze strategies to assist in

successfully implementing a skin care policy/guideline.

•  Revise a policy that is personalized to the population and incorporate the most current research and literature.

•  Focus on updating information and for diaper dermatitis identified as the most common skin issue.

•  Incorporate nursing expertise and experience into utilizing the new policy.

•  Incorporate strategies to sustain compliance with revised policy.

Introduction •  Neonatal skin care is an important part of

caring for neonates in the NICU.

•  Staff surveys showed a lack of reference to the policy, but found diaper dermatitis to be the most frequently encountered skin issue.

•  Lack of consistency in diaper dermatitis prevention and care was prominent in this unit.

•  Current policy lacked clear instruction for diaper dermatitis care.

•  A revision process including an update of current evidence with a focus on diaper dermatitis was found necessary upon survey and review of current policy.

Discussion

•  The AWHONN/NANN skin care guidelines have set the standard for skin care in neonates, now it is up to each institution to adopt these practices.

•  The use of an algorithm in the development or revision of a skin care policy can be helpful in long lasting implementation.

•  Revision of policies require educational support and staff development related to focused changes.

•  Continued assessment for the need for revision can provide consistent evidence-based care with the goal of outcome improvement.

Next Steps

Next steps: Continual auditing of consistency in usage of policy and maintaining support through skin care champions. Consider follow up survey to demonstrate effectiveness of policy revision.

Resources Baker, S. F., Smith, B. J., Donohue, P. K., & Gleason, C. A. (1999). Skin Care Management Practices for Premature Infants. Journal of Perinatology , 19 (6), 426-431. Bakewell-Sachs, S., & Blackburn, S. (2003). State of science: Achievements and challenges across the spectrum of care for the preterm infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing , 32 (5), 683-695. Beal, J. A. (2005). Evidence for Best Practices in the Neonatal Period. MCN , 30 (6), 397-403. Ciliska, D. K., Pinelli, J., DiCenso, A., & Cullum, N. (2001). Resources to Enhance Evidence-based Nursing Practice. AACN Clinical Issues , 12 (4), 520-528. Gennaro, S., Hodnett, E., & Kearney, M. (2001). Making Evidence-Based Practice a Reality in Your Institution. MCN , 26 (5), 236-244. Johnson, F. E., & Maikler, V. E. (2001). Nurses' adoption of the AWHONN/NANN neonatal skin care project. Newborn and Infant Nursing Reviews , 1 (1), 59-67. Lund, C. H., Kuller, J., Lane, A. T., Raines, D. A., & Thomas, K. K. (2001). Neonatal Skin Care: Evaluation of the AWHONN/NANN Reasearch-Based Practice Project on Knowledge and Skin Care Practices. JOGNN , 30 (1), 30-40. Lund, C. H., Kuller, J., Lane, A., Lott, J., & Raines, D. (1999). Neonatal Skin Care: The scientific basis for practice. JOGNN , 28, 241-254. Lund, C. H., Kuller, J., Raines, D. A., Ecklund S, Archambault, M. E., O’Flaherty, P. Neonatal Skin Care. 2nd Ed. Evidence-Based Clinical Practice Guideline. Washington, DC: Association of Women’s Health, Obstetric and Neonatal Nurses; 2007 Lund, C. H., Osborne, J. W., Kuller, J., Lane, A. T., Lott, J. W., & Raines, D. A. (2001). Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline. JOGNN , 30, 41-51. Oman, K. S., Duran, C., & Fink, R. (2008). Evidence-Based Policy and Procedures. JONA , 38 (1), 47-51. Samaniego, I. (2002). Developing a Skin Care Pathway for Pediatrics. Dermatology Nursing , 14 (6), 393-396. Trotter, S. (2004). Care of the Newborn: Proposed new guidelines. British Journal of Midwifery , 12 (3), 152-157. Turrill, S. (2003). A Focus of Care for Neonatal Nursing: The relationship between neonatal nursing practice and outcomes. Part 1. Paediatric Nursing , 15 (4), 13-17. Wallin, L., Bostrom, A.-M., Harvey, G., Wikblad, K., & Ewald, U. (2000). National guidelines for Swedish neonatal nursing care: evaluation of clinical application. International J

Acknowledgements The author wishes to thank Christine Schindler and Carolyn Lund for their support.

Process for Implementing Revision to Skin Care Policy

Iden%fy  a  policy  or  guideline  for  Revision  (2009)

Prepara%on  (2009-­‐10)

!!

Implementa%on  (2013) Educa&on  and  rollout    at  educa&on  days,  staff  mee&ngs,  etc.  

Identify Policy for Revision (2009)

Preparation for Policy Revision (2009-2010)

Implementation of Policy (2013-2014)

Sustaining Implementation (2014+)