Collecting the Data- Now What?

Purpose:
Driscoll Children's Hospital identified a high rate of pressure ulcers in the NICU and PICU. The Quality Practice Council wanted to assure a higher quality of care. A goal was set to decrease pressure ulcers by one-half 18 months after implementing a pressure ulcer prevention program.

Significance:
According to the 2012 NDNQI results, DCH had 51 hospital acquired pressure ulcers of different stages. Out of the 51 identified pressure ulcers, the hospital had seven total reportable pressure ulcers. Six pressure ulcers were located in the PICU while one was located on a pediatric floor.

Strategy and Implementation:
The first action was to recruit a skin care and wound prevention specialist. This wound care nurse would help create a pressure ulcer prevention program. An adult Pressure Ulcer Prevention (PUP) program was utilized as a guideline and model in order to translate the care to include the neonatal and pediatric patient. This model would then be written as our hospital guidelines for the neonatal and pediatric pressure ulcer prevention program (NP PUPP). The NP PUPP includes a bundle of components that are found to be correlated with the success of reducing pressure ulcers in the adult population. The bundle includes, staff nurse and nurse tech education, a skin care regimen, appropriate support surfaces, moisture management, positioning plans and guidelines for implementing care. A SKIN team was created to assist in disseminating the information required to having a successful program and achieving the desired results.

Evaluation:
The 2012 NDNQI first quarter resulted twelve hospital acquired pressure ulcers. Even though the NP PUPP is not fully implemented, 2013 NDNQI first quarter revealed four hospital acquired pressure ulcers. Pressure ulcers have decreased with implementation of practice changes and increase awareness.

Implications for Practice:
Recommendations for practice in our own facility are to continue completing each component of the bundle to fully implement the NP PUPP. On a larger scale, the pediatric community of hospitals must come together to help create a standard pediatric pressure ulcer prevention bundle.