Prevention of Skin Breakdown in Pediatric Electroencephalography Studies
Abstract number :
3.388
Submission category :
15. Practice Resources
Year :
2023
Submission ID :
985
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Sara Batson, R. EEG / EP T. CLTM CNIM – Joe DiMaggio Children's Hospital
Mary Kay Silverman, DNP RN CEN NEA-BC – Director of Nursing, Outpatient Services, Joe DiMaggio Children's Hospital
Rationale: Skin breakdown is an adverse event associated with performing prolonged electroencephalogram (EEG) studies on pediatric patients. Adverse events are associated with patient and staff dissatisfaction and increased pediatric morbidity. This study evaluated the impact of a multidisciplinary team and implementation of a protocol on the incidence and severity of skin interactions associated with prolonged pediatric EEG studies.
Methods: This was a retrospective review of medical records and skin breakdown logs from 2020 to 2022 within the Neurodiagnostic department of this quintenary pediatric, Level I Florida hospital. Tracking of significant adverse skin events began in 2020. The wound team assessed each event and graded using the NPIAP pressure injury scale. In 2022, the institution created a protocol and formed a multidisciplinary team to address skin breakdown associated with prolonged EEG studies. The multidisciplinary team included nursing, wound care, Neurodiagnostics staff and physicians. The inclusion criteria was inpatient EEG studies greater than two hours performed from January 1, 2020 to December 31, 2022. This included the Epilepsy Monitoring Unit (EMU) studies. All outpatient EEG studies, and all studies less than two hours were excluded. Protocol included types of electrodes, EEG products, application and wrapping techniques. The Neurodiagnostic team developed, educated, and implemented a protocol for the multidisciplinary team to utilize. The protocol included EEG application of leads, nurses monitoring leads when changing patient position, and nursing checking the head wrap every two hours to prevent pressure injury. A protocol to give periods of skin rest was also included.
Results: The total number of prolonged pediatric EEG studies performed were 1,938 in 2020, 2,369 in 2021, and 2,312 in 2022. Total prolonged inpatient studies were 36% in 2020 (289 EMU + 417 IP/ICU), 35% in 2021 (379 EMU + 446 IP/ICU), and 35% in 2022 (393 EMU + 414 IP/ICU). (See Table 1.) There was one skin reaction in 2020 in the cardiac ICU. This was a stage 1 wound with a one day study. In 2021, there were two reported severe skin reactions, both stage 2 and both were pediatric ICU patients. Both patients had multiple prolonged EEGs during their hospitalization. One child had four, with study duration up to five days, and the other child had three with a duration lasting up to six days. After implementation of the protocol and multidisciplinary team in 2022, there were two reported adverse reactions. Both were cardiac ICU patients and had stage 2 wounds associated with a one day EEG study. All wounds reported were on the forehead/scalp areas.
Conclusions: Skin breakdown associated with prolonged inpatient pediatric EEG studies is rare, but not always preventable. Healing in critically ill patients is diminished. Awareness, education, and planning to avoid adverse events leads to increased recognition and reporting. Implementation of a protocol and a multidisciplinary team led to decreased risk factors for skin breakdown and possible decreased severity of events. The increased communication and awareness improved neurodiagnostic patient care.
Funding: None
Practice Resources