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Factors Associated With Pediatric Hospital-Acquired Pressure Injuries
1Ivy Razmus, PhD, RN, CWOCN, University of Detroit Mercy at Aquinas, Grand Rapids, Michigan.
Insights
Pediatric patients at risk for pressure injuries face over 9 times higher odds of hospital-acquired pressure injuries (HAPIs). Specific pediatric units and children-only hospitals showed increased HAPI likelihood, with no prevention interventions proving effective.
Area of Science:
- Nursing Quality Indicators
- Patient Safety
- Pediatric Healthcare
Background:
- Hospital-acquired pressure injuries (HAPIs) are a significant concern in pediatric patient care.
- Understanding risk factors and associated characteristics is crucial for effective prevention strategies.
- Previous research has primarily focused on adult populations, leaving a gap in pediatric-specific data.
Purpose of the Study:
- To identify associations between pediatric patient characteristics, hospital factors, and HAPIs.
- To examine risk factors for HAPIs in pediatric patients, including those identified as high-risk.
- To explore the relationship between unit type, nurse staffing, and HAPI occurrence in pediatric units.
Main Methods:
- A descriptive, correlational analysis was performed on a large dataset from the National Database of Nursing Quality Indicators (NDNQI).
- Data included 39,984 pediatric patients (1 day to 18 years) across 678 units in 271 US hospitals collected in 2012.
- Hierarchical logistic regression was used to analyze patient demographics, unit type, risk status, prevention practices, staffing, and hospital characteristics related to HAPI.
Main Results:
- Patients identified as at risk for pressure injuries had over 9 times higher odds of developing HAPIs (OR: 9.42).
- HAPIs were more likely in pediatric critical care units (OR: 2.59) and rehabilitation units (OR: 4.05).
- Hospitals exclusively serving children had higher HAPI rates (OR: 2.6), and no specific prevention interventions were associated with reduced HAPI occurrence.
Conclusions:
- Supports the routine use of pressure injury risk assessment in pediatric patients.
- Highlights specific pediatric unit types and hospital characteristics associated with increased HAPI risk.
- Indicates a need for further research into effective HAPI prevention strategies tailored for pediatric populations.
Purpose:
The purpose of this study was to identify associations among pediatric patient characteristics (age and gender), hospital characteristics, inpatient unit characteristics (unit type, pressure injury prevention practices, and nurse staffing measures), and hospital-acquired pressure injuries (HAPIs) in a group of pediatric patients and in those determined to be at risk for pressure injury.
Design:
A descriptive, correlational analysis of data from a large dataset.
Subjects And Setting:
The sample comprised 39,984 children aged 1 day to 18 years of age from 678 pediatric units in 271 participating hospitals across the United States.
Methods:
Data related to pressure injuries and prevention among pediatric patients from the National Database of Nursing Quality Indicators (NDNQI) were analyzed. All data were collected during the year 2012. Descriptive statistics were used to summarize the study sample. Hierarchical logistic regression analysis was used to analyze patient age and gender, unit type, pressure injury risk, prevention and staffing measures, and hospital characteristics associated with HAPI.
Results:
The likelihood of a HAPI was more than 9 times higher among patients who were determined to be at risk for pressure injuries (odds ratio [OR]: 9.42, 95% confidence interval [CI]: 7.28-12.17, P < .001) compared to patients deemed not at risk. Hospital-acquired pressure injury was more likely to occur on pediatric critical care units (OR: 2.59, 95% CI: 1.28-5.26, P = .009) and rehabilitation units (OR: 4.05, 95% CI: 1.21-13.55, P = .02). Patients from hospitals that only provided care for children (OR: 2.6, 95% CI: 1.42-4.78, P = .002) were also more likely to be associated with HAPI compared to hospitals that provided care for adults and children. Among the 11,203 pediatric patients deemed at risk for pressure injuries, 95.8% received one or more prevention interventions. There were no prevention interventions associated with a lower occurrence of HAPI.
Conclusions:
Study findings support pressure injury risk assessment among pediatric patients and elucidates important information regarding pediatric unit and hospital characteristics associated with HAPI.
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