BACKGROUND AND OBJECTIVE: Pediatric patients are at risk for developing pressure ulcers (PUs) and associated pain, infection risk, and prolonged hospitalization. Stage III and IV ulcers are serious, reportable events. The objective of this study was to develop and implement a quality-improvement (QI) intervention to reduce PUs by 50% in our ICUs. METHODS:We established a QI collaborative leadership team, measured PU rates during an initial period of rapid-cycle tests of change, developed a QI bundle, and evaluated the PU rates after the QI implementation. The prospective study encompassed 1425 patients over 54 351 patient-days in the PICU and NICU. RESULTS:The PU rate in the PICU was 14.3/1000 patient-days during the QI development and 3.7/1000 patient-days after QI implementation (P , .05), achieving the aim of 50% reduction. The PICU rates of stages I, II, and III conventional and device-related PUs decreased after the QI intervention. The PU rate in the NICU did not change significantly over time but remained at a mean of 0.9/1000 patient-days. In the postimplementation period, 3 points were outside the control limits, primarily due to an increase in PUs associated with pulse oximeters and cannulas. CONCLUSIONS:The collaborative QI model was effective at reducing PUs in the PICU. Pediatric patients, particularly neonates, are at risk for device-related ulcers. Heightened awareness, early detection, and identification of strategies to mitigate device-related injury are necessary to further reduce PU rates. Pediatrics 2013;131:e1950-e1960 Dr Visscher made a substantial contribution to the conception and design, acquisition of data, and analysis and interpretation of data and in drafting the article with critical revision for important intellectual content; Dr Leung made a substantial contribution to the design, analysis, and interpretation of data and in drafting the article with critical revision for important intellectual content; Mss Nie, Schaffer, and Taylor, Dr Pruitt, and Ms Giaccone made substantial contributions to the conception and design, acquisition of data, and interpretation of data; Mr Ashby made a substantial contribution to the conception and design, analysis of data, and interpretation and in drafting of article with critical revision for important intellectual content; Dr Keswani made a substantial contribution to conception and design, analysis and interpretation of data and in drafting the article with critical revision for important intellectual content; and all authors had final approval of the version to be published. Stage III and IV PUs are serious reportable events, considered "never events" by several national benchmarking organizations. 5 PU incidence is higher in critically ill patients, 6 with increased pain, infection, and prolonged hospitalization. 7 Reductions in reimbursement for health care-acquired PUs have been implemented by the Centers for Medicare & Medicaid Services for adult institutions. 8 They extend to Medicaid recipients, including pediatrics, as of July 2...

Pediatric patients, especially neonates and infants, are vulnerable to pressure injury formation. Clinicians are steadily realizing that, compared with adults and other specific populations, pediatric patients require special consideration, protocols, guidelines, and standardized approaches to pressure injury prevention. This National Pressure Advisory Panel white paper reviews this history and the science of why pediatric patients are vulnerable to pressure injury formation. Successful pediatric pressure injury prevention and treatment can be achieved through the standardized and concentrated efforts of interprofessional teams. GENERAL PURPOSE To review what is known about pediatric pressure injuries (PIs) and the specific factors that make neonates and children vulnerable. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to: 1. Identify the scope of the problem and recall pediatric anatomy and physiology as it relates to PI formation. 2. Differentiate currently available PI risk assessment instruments. 3. Outline current recommendations for pediatric PI prevention and treatment.