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A quality-improvement collaborative project to reduce pressure ulcers in PICUs

Marty Visscher1, Alice King, Ann Marie Nie

  • 1Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. marty.visscher@cchmc.org

Pediatrics
|May 8, 2013
PubMed

Insights

A quality improvement intervention successfully reduced pressure ulcers (PUs) by 50% in a pediatric intensive care unit (PICU). Further strategies are needed to address device-related injuries in neonates.

Area of Science:

  • Pediatric critical care medicine
  • Quality improvement science
  • Patient safety

Background:

  • Pediatric patients in intensive care units (ICUs) face risks of pressure ulcers (PUs), leading to pain, infection, and extended hospital stays.
  • Stage III and IV pressure ulcers are serious, reportable events in pediatric care.
  • Reducing PU incidence is a critical patient safety goal in pediatric ICUs.

Purpose of the Study:

  • To develop and implement a quality improvement (QI) intervention aimed at reducing pressure ulcers (PUs) by 50% in pediatric ICUs.
  • To evaluate the effectiveness of a collaborative QI model in decreasing PU rates.
  • To identify specific challenges and patient populations at higher risk for PUs.

Main Methods:

  • Established a QI collaborative leadership team to guide the intervention.
  • Measured baseline PU rates and conducted rapid-cycle tests of change.
  • Developed and implemented a comprehensive QI bundle in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).

Main Results:

  • Achieved a 50% reduction in PU rates in the PICU, decreasing from 14.3 to 3.7 per 1000 patient-days (P < .05).
  • Observed decreases in all stages of conventional and device-related PUs in the PICU post-intervention.
  • No significant change in PU rates in the NICU; however, device-related PUs (pulse oximeters, cannulas) increased post-implementation.

Conclusions:

  • The collaborative QI model effectively reduced pressure ulcers in the pediatric intensive care unit.
  • Pediatric patients, especially neonates, are susceptible to device-related pressure ulcers.
  • Enhanced awareness, early detection, and mitigation strategies for device-related injuries are crucial for further PU reduction.
Abstract

Keywords:
ICUbundledeviceinterventionneonatalpressure ulcerquality improvementskinwound

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