A Quality Improvement Project to Reduce Peristomal Skin Injuries in a Surgical Neonatal Intensive Care Unit.

BACKGROUND

Ostomy formation is often a necessary surgical intervention in neonates with congenital gastrointestinal or genitourinary conditions or related to a disease process; however, it poses significant challenges in Neonatal Intensive Care Unit (NICU) patients, particularly with stoma care and associated skin breakdown.

PURPOSE: The aim of this project was to achieve a 60% reduction in peristomal skin injuries within 6 months of project implementation.

METHODS

Evidence-based Practice for Improving Quality methodology and Plan-Do-Study-Act cycles were used in developing the project in the NICU. A preproject survey identified gaps in nurses' confidence and knowledge guiding the interventions. Following consensus, a bedside stoma care plan template was implemented, supported by 6 weeks of bedside education and practical demonstrations. Incident Management System (ims + ) data and a postproject survey evaluated the project's impact.

RESULTS

Over 6 weeks, 63% (n = 66/105) of nurses received bedside education, and 15% (n = 16/105) received stoma care demonstrations. Data analysis showed a 62% reduction in peristomal skin injuries within 6 months, from 37.5% (n = 6/16) to 14.3% (n = 2/14). Improvements were sustained over 12 months, with a further reduction to 8.3% (n = 1/12). Postproject survey results demonstrated increased nurse confidence and greater consistency in stoma care practices.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The project found and addressed a need for an individualized bedside stoma care plan template. By improving nurses' knowledge, confidence, and standardizing clinical practice, stoma-related injuries were reduced. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population.