A Quality Improvement Initiative to Reduce Nasal Injuries Secondary to Nasal Mask Application for Non-Invasive Ventilation

Introduction: Nasal injury is an important concern with the use of non-invasive ventilation delivered by masks or prongs. Despite regular skin integrity assessment and close monitoring, we found a high incidence rate of nasal skin injuries in nearly 70% of neonates receiving non-invasive ventilation admitted into our neonatal intensive care unit (NICU). Methods: A quality improvement (QI) initiative to reduce the incidence of nasal injuries secondary to nasal mask application in inborn neonates admitted to our NICU by 50% from baseline over 8 weeks. We performed fishbone analysis and multiple Plan-Do-Study-Act (PDSA) cycles targeted to reduce nasal injury following nasal mask application for non-invasive ventilation. A QI team comprising resident doctors, nurses and staff neonatologists was formed to drive change. Key interventions were strengthening the protocol-based application of nasal masks and consistent monitoring and documenting injuries. Data were collected weekly and plotted on run charts. Results: The successive implementation of interventions led to the reduction of injury by 46% (71%–25%) at the end of 5 weeks of intervention. The interventions have been incorporated into our unit policy and have sustained at 45% for 3 months following the QI initiative. Conclusion: QI methods involving training and educating healthcare workers about the step-by-step application of nasal masks and frequent assessment for nasal injury helped reduce the nasal injury rate in our unit. Incorporation into the NICU policies was crucial for the sustenance of culture change.