Implementation of an evidence-based non-invasive respiratory support (NIRS) bundle in the NICU to decrease nasal injury complications

Background Nasal skin breakdown is a common complication of non-invasive respiratory support (NIRS) therapy. The objective of this quality improvement project was to improve assessments and standardize care to infants receiving NIRS to reduce iatrogenic nasal injury complications. Methods Nursing staff NIRS knowledge and action were assessed using a self-report survey created for the project. A NIRS bundle was implemented to standardized care provided to all infants receiving NIRS. Infant chart reviews were conducted to determine incidence and severity of nasal injury before and after NIRS bundle implementation. Results Twenty-six nurses completed pre and post survey assessments. Combined NIRS care scores improved from an average of 16.81 (SD = 1.569) to 17.57 (SD = 1.287, p = 0.058). NIRS knowledge scores slightly improved from an average of 6.76 (SD = 2.016) to 6.88 (SD = 1.495, p = 0.833). The incidence of nasal injuries from NIRS use was reduced by 15.8% (34.7% compared to 18.9%; p = 0.086). Conclusion Improving staff NIRS knowledge and standardizing NIRS care is associated with decreased incidence of nasal injury. Implementing feasible evidence-based interventions impact neonatal care by decreasing unintended treatment complications and increasing NIRS success.