Development of a Pressure Ulcer Trigger Tool for the Neonatal Population

Purpose:
Although all NICU infants are considered to be at risk for pressure ulcer development, a means to sort out those at most risk requiring additional assessment and intervention was needed. This project developed, tested and implemented a trigger tool for this purpose to meet this need.

Significance:
Immature skin is fragile and may break down with contact with usual hospital devices, such as CPAP or IV tubing. Pressure ulcers in the neonatal population are painful and can increase cost of care. A means to determine highest risk would assist the bedside nurse provide appropriate care.

Strategy and Implementation:
The Iowa model guided the project. The PICO question was posed,"For infants in the NICU, does the use of a pressure ulcer trigger tool perform equally as well as the Braden Q to identify infants at risk?" A team was developed to appraise the evidence. Team members were: clinical nurse specialist, wound ostomy continence nurses, Nursing Councils members,librians and a electronic medical record specialist. A three item trigger tool was developed based on the questions proposed by the Institute for Clinical Sytems Improvement. The three questions coorespond to the constructs of the Braden Q pressure ulcer assessment tool. A pilot using a paper and pen tool was done. Revisions were made to the questions to coincide with the documentation standard. To ensure usage, the questions were imbedded into the electronic flow sheets. Education and feedback was provided to bedside side staff through Education council members through a one to one format, and through poster displays in key areas.

Evaluation:
The tool was evaluated when a random selection of 15 infants were assessed using the Braden Q by a WOCN, and the results were compared to the results of the trigger tool assessments. The tool identified those at risk. The NDNQI pravalence audits continue with a low to zero pressure rate.

Implications for Practice:
A three question pressure ulcer trigger tool is helpful for the NICU population to quickly identify those at highest risk. The tool is an efficient screening tool and prompted consultation in selected cases that were high risk.