Gibran Merali
University Hospital Southampton, United Kingdom
Abstract Title:
Improving skin barrier protection in critically Ill patients through standardised emollient prescribing: A quality improvement project
Research Interests:
Introduction: Critically ill patients are vulnerable to skin dryness, irritation and skin barrier impairment due to critical illness and prolonged intensive care admission. Consistent skin care and use of a standardised emollient may support a uniform approach to skin barrier protection. This quality improvement project aimed to improve skin barrier protection through standardised emollient prescribing in a tertiary hospital in the United Kingdom.
Materials and Methods: A quality improvement project was undertaken in a general intensive care unit (ICU). A baseline audit of 30 inpatients in March 2026 assessed documented skin assessment, potentially preventable skin damage, emollient prescribing, application and use of the locally recommended emollient. An anonymous nursing staff survey identified knowledge gaps and barriers to consistent emollient use. Findings informed a Plan-Do-Study-Act (PDSA) intervention comprising staff education and visual prompts encouraging clinicians to prescribe an emollient according to local guidance. Repeat data were collected from a further 30 inpatients in August 2026 using the same measures.
Results: Baseline data demonstrated inconsistent standardised emollient use. Skin assessments were documented in 83.3% of patients and 70.0% received a moisturising product; however, only 3.3% received the locally recommended emollient. Survey responses identified variation in knowledge and practice, including use of non-standardised moisturisers, uncertainty regarding the recommended product and lack of prescribing. Following the intervention, emollient prescribing increased to 70.0% and use of the recommended emollient to 63.3%. Documented skin assessment increased to 86.7%, while documented emollient application was 66.7%.
Conclusion: Baseline assessment identified substantial variation in skin barrier protection practices, particularly between emollient application and appropriate prescribing. Standardising emollient prescribing represents a simple, low-cost intervention that may improve preventive skin care while reducing unnecessary exposure to non-standardised topical products that may complicate assessment of cutaneous reactions.
