{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:11:56Z","timestamp":1790115116387,"version":"4.0.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Noninvasive ventilation (NIV) has become the preferable modality of respiratory support for spontaneously breathing premature infants in the neonatal ICU (NICU). Whereas NIV support contributes to the prevention of long-term respiratory sequelae from mechanical ventilation, the nasal interfaces used are well known for placing patients at risk for development of NIV device-related pressure injuries (PIs). After implementing clinical practice guidelines promoting the use of sealing NIV interfaces for respiratory support in a level IV NICU, an increase in the frequency of stage 2 or worse and deep tissue injury (DTI) PI was observed. We hypothesized that the implementation of a multifaceted skin care bundle (SCB) would reduce the incidence of NIV device-related PI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Quality improvement methodology was used to evaluate the impact of implementing an SCB for patients supported with NIV via a nasal interface. Incidence rate of stage 2 or worse and DTI PI was reported per 100 NIV days over 4 distinct time periods: (1) pre-NIV guideline, (2) post-NIV guideline, (3) post SCB, and (4) sustainability phase. Incidence comparisons were made using one-sided\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      values from the Farrington-Manning test of equal risks with a significance level of 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The NICU experienced a notable rise in NIV device-related PI after implementation of NIV guidelines (0.01 vs 0.34 per 100 NIV days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01). After application of an SCB, a decrease in NIV device-related skin PI was achieved (0.34 vs 0.07 per 100 NIV days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04), representing a 79% reduction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A collaborative and multidisciplinary team approach was used to promote engagement with clinical staff to address a preventable harm. The implementation of a multifaceted PI prevention bundle contributed to reducing harm while permitting the continued use of appropriate respiratory support to a highly vulnerable patient population in the NICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.08850","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T12:45:10Z","timestamp":1635252310000},"page":"24-33","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Reducing Device-Related Pressure Injuries Associated With Noninvasive Ventilation in the Neonatal Intensive Care Unit"],"prefix":"10.1177","volume":"67","author":[{"given":"J Julia","family":"Krzyzewski","sequence":"first","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine K","family":"Rogers","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M","family":"Ritchey","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie R","family":"Farmer","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April S","family":"Harman","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana S","family":"Machry","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, Saint Petersburg, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3442"},{"issue":"6","key":"e_1_3_3_3_2","article-title":"Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants","author":"Subramaniam P","year":"2016","unstructured":"Subramaniam P, , Ho J, , Davis P. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants. 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Nasal complications related with CPAP treatment. Ent Updates 2018; 8(3):133-138.","journal-title":"Ent Updates 2018"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/ANC.0000000000000348"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000604"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-019-03146-5"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199408000-00018"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/fn.75.3.F209"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603694"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0738"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1101"},{"key":"e_1_3_3_25_2","volume-title":"In: Heifetz R, Grashow A, Linsky M, The Theory Behind the Practice: A Brief Introduction to the Adaptive Leadership Framework","author":"Heifetz R","year":"2009","unstructured":"Heifetz R, , Grashow A, , Linsky M. The theory behind the practice. In: Heifetz R, Grashow A, Linsky M, The Theory Behind the Practice: A Brief Introduction to the Adaptive Leadership Framework. 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