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

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.