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Since the pediatric population has a greater likelihood of decreased tissue perfusion, hospitalized children are at increased risk for the development of pressure ulcers. So, we developed an intervention to identify children at risk for pressure ulcers, in order to reduce the incidence rate.
Significance:
An audit in 2008 revealed an increased incidence of pressure ulcers. In compromised patients, pressure ulcers increase the risk for infection and can threaten health. But associated concerns that can also affect a child's life include disfigurement and even permanent occipital hair loss.
Strategy and Implementation:
The Pressure Ulcer Prevention Pediatric Interdisciplinary Committee (PUPPI-C) was created to determine how best to evaluate risk in order to intervene and prevent hospital-acquired pressure ulcers (HPU). The committee reviewed the audit cases in order to isolate specific risk factors (e.g. diagnosis, ventilator status, medications, CVC), which provided a problem-focused trigger to which the University of Iowa Model for Evidence-Based Practice was applied. The Braden Scale being utilized in the EMR (EPIC) did not meet our needs because it does not take into account tissue perfusion, which affects pediatric care. After a literature review, PUPPI-C identified the Modified Braden Q Pressure Ulcer Risk Assessment Scale (Braden Q). The scale was piloted, implemented and incorporated into EPIC. Since PUPPI-C found no established pediatric intervention protocol, we adopted and are currently utilizing the Loyola Pediatric Skin Intervention Tool for low, moderate and high risk patients.
Evaluation:
The audit found 7 HPUs in the first 8 months of 2009, 3 after the Braden Q pilot implementation. Since 8/2009, there were 0 pressure ulcers on the pediatric floor. Since 6/2010, there were 0 pressure ulcers in the PICU. We participate in NDNQI quarterly skin surveys for pediatric data collection.
Implications for Practice:
PUPPI-C will audit the use of the Braden Q and assess the intervention protocol monthly. Modifications will be made and tested. PUPPI-C is developing a Pediatric Occipital Preservation program to address our goal of improved care of hospitalized kids. We will continue quarterly NDNQI participation.