Skin: Our Largest Organ -- Where do we begin?

Florence Nightingale observed the importance of skincare in 1859, “Poisoning by the skin is no less certain than poisoning by the mouth – only it is slower in its operation.” Skincare has taken center stage in many arenas. Skin breakdown is a nurse sensitive indicator for the Nursing Database for Nursing Quality Indicators (NDNQI).  Pressure ulcer prevention is considered Ohio Children’s Hospital Solutions for Patient Safety (OCHSPS) Collaborative as a patient safety improvement goal. Our skin is the first defense.  It covers our bodies to protect us from pathogens.  When a patient is critically ill, skin must be cared for or it cannot protect.  At Children’s Hospital of The King’s Daughters (CHKD) the care of children is our priority.  In the pediatric intensive care unit (PICU) at CHKD, several nurses saw an opportunity to take the responsibility for protecting children a step further.  This was accomplished with the development of a PICU skin protocol.  The goal was to guide every bedside nurse in the PICU to identify a patient’s skin breakdown risk and the interventions needed to prevent skin injury.  The team assembled evaluated current PICU and best practices as well as the products available to the unit. The PICU specific skin intervention protocol was developed.  The protocol is based on the nurse’s risk assessment, patient’s condition and history, and product availability.  The development of this protocol allowed the nurses to take ownership of their patient’s treatment, and improve the overall skin care in the CHKD PICU.