Pediatric Skin Integrity and the Use of a Postoperative Reporting Tool: A Summary of Evidence for Best Practice

Purpose:
In 2011,18-27% of children had a hospital acquired pressure ulcer(HAPU)(Schindler,et al.2011).5.6% of all surgical patients develop HAPU(Wadlund, 2010).Wei et al,(2012) suggests a skin integrity tool specific to perioperative patients is needed.

Significance:
The mean cost to treat a stage 4 pressure ulcer in the United States is $70,000(Schindler et al.,2011)and, in 2008,CMS announced they will no longer reimburse for stage 3/4 HAPUs (Department of Health and Human,2009).The impact of HAPUs make prevention essential for all health care professionals.

Strategy and Implementation:
A skin integrity task force was formed in August, 2011 at a pediatric hospital.The goal of the team was to ensure staff education and competency validation skin integrity best practice. A skin integrity reporting tool (SIRT) was created in September 2011.The SIRT was used to aide in report of skin risks between the operating room and the pediatric intensive care unit (PICU). Input was sought from the skin team and staff. The literature supports the need for such a tool since patients who have general, cardiac, spine or neurological operative procedures are at high risk for developing a HAPU (Wei et al., 2012). Surgeries which exceed 3 hours, also pose a risk skin integrity (Wadlund, 2010).The SIRT was first piloted in November 2011 with cardiac, spine and neurology procedures which exceeded 3 hours who were returning to the PICU post op. The pilot proved successful and the SIRT was implemented for all in-patient surgeries which exceeded 3 hours. Data was tracked to determine outcomes.

Evaluation:
Pre- implementation data demonstrated a mean number of days between HAPU occurrences as 27.2. Post SIRT implementation, the mean occurrence between HAPU occurrences was 99 days.

Implications for Practice:
Using the SIRT improved patient outcomes as evidence by decrease in the number of HAPU in pediatric patients. In some instances, the SIRT helped to identify further preventative measures and increased staff awareness and collaboration to actions needed to prevent HAPU.