Evidence-Based Practice Guideline: Neonatal Skin Care NUR 608-821 Evidence-Based Practice and Quality Improvement in Healthcare Systems

Newborns enter this world with a physical barrier to protect them from the harsh conditions outside the womb. The skin serves as the first line of defense to protect the newborn. Proper skin care from the start for the ill newborn and preterm will help this susceptible population survive and thrive. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) worked together to develop the Neonatal Skin Care: Evidence-Based Clinical Practice Guideline Fourth Edition in 2018 to guide healthcare workers. Using this evidence-based practice guideline daily, APRNs, RNs, and parents at Utah Valley Hospital’s (UVH) Level III NICU will reduce neonatal skin injury and sepsis and increase parent satisfaction scores. POI Significance Advancements in medical interventions that save ill newborns have yielded unintended consequences such as neonatal skin injury. A skin injury can lead to neonatal sepsis. According to Fleischmann et al., neonatal sepsis occurs in 2824 for every 100,000 live births worldwide, with a mortality of 17.6% (2021). Parents experience increased distress when their baby has a visible injury, sepsis resulting from injury, and the separation created by the NICU environment. The APRN has a role in reducing skin injury and complications through evidence-based practice (EBP) and involves the RN and parents in the daily skin care tasks. The Neonatal Skin Care: Evidence-Based Clinical Practice Guideline Fourth Edition provides a template to implement EBP. To evaluate outcomes, there are three types of healthcare quality measures. They are structural, practice, and outcome measures (AHRQ, 2015). Structural measure refers to how well the hospital, clinic, or agency delivers excellent care. For example, are there proper staffing

3 ratios to allow APRNs to do a complete skin assessment every day on every baby? A practice measure looks at the results of implementing best practices. For example, how many NICU babies that qualify for swaddling bathing received a swaddle bath in the past month? The outcome measure looks at how the implementation affects the patient’s condition. For example, did implementing the Neonatal Skin Risk Assessment Scale reduce the number of skin injuries in the NICU in the past three months? While each measure could gauge the effectiveness of EBP skin care for neonates, the outcome option is the best quality measure. PICO/Clinical Question P= sick/preterm newborns in the NICU at UVH I= complete implementation of the neonatal skin care guideline C= current practice that does not include preserving vernix caseosa, using a skin assessment and risk assessment tool every shift, regular emollient application, and diaper dermatitis guideline O= reduced numbers of neonatal skin injury and sepsis cases and improved satisfaction scores over the next three months