Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit

Abstract

Background: Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress. We classify PUs by the level of tissue injury: stage I–IV, unstageable, suspected deep tissue injury. This quality project was aimed to reduce the incidence of PUs > stage II in the cardiothoracic intensive care unit. Methods: We reviewed PUs > stage II from March 2010 to December 2017. Interventions included: PU bundle (April 2010, revised January 2013); multidisciplinary huddles for PUs > stage II (October 2011); multidisciplinary weekly skin rounds (March 2010, revised August 2012); unit specific workgroup (October 2012); caregiver input form (December 2012). The PU bundle included diaper barrier cream, pulse oximeter probe rotation, turning schedule, pressure reduction surfaces, heel pressure release, head of the bed elevation. Results: Between 2010 and 2014, PUs decreased from 15.7 events per 1,000 patient days to a new baseline of 2.9 events per 1,000 patient days. We have sustained this rate for 3 years. PUs related to immobility decreased from 35 in 2010–2011 to 4 in 2016–2017. PU related to medical devices decreased from 34 in 2010–2011 to 15 in 2016–2017. Conclusions: Institution of PU bundle, multidisciplinary weekly skin rounds, and huddles for PUs > stage II reduced PUs related to immobility, allowed for earlier identification of stage II PUs and reduced stage III PUs. Challenges remain in reducing PUs related to medical devices. Importantly, we sustained this improvement over the past 3 years.

Development and Validation of a Checklist for the Safety of Hospitalized Children

“…A study carried out in a Pediatric Cardiac Intensive Care Unit implemented interventions to reduce the pressure ulcer (PU) rates, such as a package of measures, multidisciplinary meetings, multidisciplinary weekly rounds, unit-specific work group and a form for recording information about the cause and prevention of each PU. The results of the study showed a reduction in the incidence of PU from 15.7 to 2.9 events per 1,000 patient-days, a reduction in the PUs related to immobility from 35 to 4, and a reduction in the PUs related to medical devices from 34 to 15 events 30 .…”

“…The use of support surfaces for pressure redistribution such as mattresses, cushions and pillows, as well as to protect bony prominences, helps to reduce the risk and incidence of pressure ulcers in critically-ill patients at high risk for their development, as well as the implementation of prevention protocols to promoting improvements in care quality [29][30] .…”

Dekubitus: eine Herausforderung

“…In dieser Gruppe dominieren die männlichen Patienten im Verhältnis von 3 : 1 [2]. Jedoch können auch bei kindlichen Patienten Druckulzera auftreten, wobei es sich zumeist um intensivmedizinisch therapierte Kinder handelt [3].…”

Effect of Preventive Bundle Guidelines on Nurses’ Knowledge and Compliance Regarding Pressure Ulcer Among Critically Ill Children at Pediatric Intensive Care Unit

“…Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress [1]. Pressure ulcer is localized damage to the skin or underlying soft tissue, usually over a bony prominence or related to a medical device or other equipment.…”

“…Furthermore, children at greatest risk are those requiring mechanical ventilation or inotropic support; those who suffer a cardiac arrest following cardiac surgery; those with nutritional deficits and children with longer hospital lengths of stay. Medical device-associated pressure ulcers are frequent among pediatric patients with reported prevalence rates ranging from 50% to 69% [1].…”