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Prevention and Management of Skin Damage Related to COVID-19 in Patients and Staff

New Knowledge, Innovations, and Improvements

The University of Miami Hospital and Clinics UHealth Tower nursing staff led in assuring visible contributions to nursing science, knowledge development and implementation, and quality improvement. Evidence-based practice approaches are at the center of the Nursing Professional Practice Model which offers a blueprint for patient care delivery and aligns practice to support the highest quality patient care, within a framework of shared governance, and the professional values of caring, compassion, respect, excellence, and discovery. The relationship-based nursing care delivery system builds on the pillars of excellence of the Magnet model and is infused in expert care for patients, families, communities—and extends to care of our professional nursing staff. As SARS-CoV-2, also known as COVID-19 emerged in 2019, the Wound Healing, Ostomy, and Hyperbaric Nursing Team developed cutting edge guidelines for the care of patients with COVID-19 [insert photo of guidelines for supine and prone positioning]. These guidelines were critical to optimal care for patients—particularly the patient population in intensive care. As Monica Perez, RN, director of the UM Wound Healing, Ostomy, and Hyperbaric Nursing Team and Ana Restrepo RN, inpatient director noted: “We wanted to assure that our efforts in patient care were evidence-based in collaboration with our nursing staff colleagues.” With the leadership of Nancy Johnson, MSHCA, BSN, RN, Associate Vice President for Clinical Operations, these transformational leaders described that the entire team focused on another critical element related to protection of skin integrity—providing evidence-based guidelines for nursing staff wearing N95 protection during patient care. Perez and Restrepo added: “We followed the guidelines of the National Pressure Injury Advisory Panel to assure an evidence-based, quality-focused approach not only for patient care, but also for the health and safety of our staff nurse, nursing support staff, and interprofessional colleagues.” For Nurses’ Week, these UHealth leaders developed an evidence-based video [insert video link] aimed at assuring communication for all staff regarding key COVID-19 patient care and N-95 guidelines for nurses’ skin integrity and utilization of N-95 protective equipment. The team worked in partnership with nursing staff and infectious disease colleagues to develop, test, and evaluate the guidelines and recommendations for N-95 skin integrity for nursing staff. From a wound, ostomy, and skin care perspective, the guidelines are framed based on levels of tissue damage from Level 1 (intact skin with no redness), Level 2 (Stage 1 pressure injury) to Level 3 (Stage 2 pressure injury) [insert photo of chart]. From a quality improvement perspective noted Perez and Restrepo, forging these guidelines offered cutting edge protection for patients and new guidelines/recommendations for optimal protection of staff wearing personal protective equipment (PPE). Thus, these nursing innovations offered a vibrant contribution to pay it forward for their nursing, nursing support, and interprofessional colleagues.

Insert Posters from Monica Perez Regarding Prevention and Management of Skin Damage Related to Personal Protective Equipment (PPE) for Patients and Staff