Reducing pressure ulcers in pediatric and neonatal patients

Purpose:
Pediatric and neonatal pressure ulcers (PU) were discovered to be a significant issue in our patients as a result of participation in the NDNQI quarterly skin survey beginning in 2009. We did not utilize a pressure ulcer risk assessment, nor recognize that we had opportunity for improvement.

Significance:
During our first skin survey, we discovered that 17% of our pediatric and neonatal patients had a pressure ulcer. Many of them were Stage I and device related, however this indicated that we had many practices which put our patients at risk for disruption in skin integrity.

Strategy and Implementation:
In September 2009, after our initial survey results were known, we began focused work on device related PU elimination, including changing our peripheral IV (PIV) securement method; implementation of a skin barrier under PIV hubs; increasing frequency of temperature probe repositioning in the NICU; revision of NP and other tube securement methods; and improvement in NICU oximeter product for extremely low birth weight infants. We implemented numerous new products including positioning devices, sacral foam border dressings with silicone tact, off-loading boots sized for kids, and silver impregnated cloth under blood pressure cuffs. A thorough process for selection and implementation of a PU risk assessment for kids and neonates was undertaken and in December of 2010, fully implemented. Numerous educational offerings were provided to nursing staff and a core group of staff nurse skin champions, STARS, led each unit with skin care improvement endeavors.

Evaluation:
Within eighteen months of focused work, we celebrated our first skin survey in which there were zero pressure ulcers in all children and neonates in our hospital. Since then, we have had several quarters with zero and maintain an overall very low incidence of pressure ulcers in our patients.

Implications for Practice:
Working with frontline nurses, we determined effective solutions for prevention of pressure ulcers. They were engaged and dynamic in the process for elimination of PU. Frontline caregivers who lead improvement efforts is an effective method to gain staff buy-in for process improvement.