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Cohort study to determine the risk of pressure ulcers and developing a care bundle within a paediatric intensive care
Hazel A Smith1, Zena Moore2, Mong Hoi Tan3
1Paediatric Intensive Care Unit, Children's Health Ireland, Crumlin, Dublin 12, Ireland; Paediatrics, Trinity College Dublin, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
Insights
Pressure ulcers affect 11.7% of pediatric intensive care patients, primarily males, with lack of physical activity a key risk factor. Medical devices, especially for airway support, are the main cause, often on the face and scalp.
Area of Science:
- Pediatric critical care medicine
- Nursing research
- Wound prevention
Background:
- Pressure ulcers (PUs) are a significant concern in pediatric intensive care units (PICUs).
- Identifying incidence and risk factors is crucial for developing effective prevention strategies.
Purpose of the Study:
- To determine the incidence and risk factors for pressure ulcers in a PICU.
- To develop evidence-based preventive pressure ulcer care bundles.
Main Methods:
- Prospective cohort study conducted in a general PICU.
- Utilized the Braden Q Scale for risk assessment and the European Pressure Ulcer Advisory Panel tool for staging.
Main Results:
- Seventy-seven children were recruited; 11.7% developed pressure ulcers, all male.
- Lack of physical activity was the primary risk factor.
- Most pressure ulcers were grade one, located on the face/scalp, often associated with airway support devices.
Conclusions:
- Pressure ulcer incidence in this PICU was 11.7%, with facial/scalp areas most affected.
- Medical devices, particularly those for airway support, were identified as the prime causative factor.
- The SSKIN care bundle was modified and implemented for PU prevention in the PICU.
Objective:
Determine the incidence and risk factors for pressure ulcers in a paediatric intensive care unit. Use the information gathered to develop preventive pressure ulcer care bundles.
Research Methodology:
Prospective cohort study using Braden Q Scale for Predicting Pressure Sore Risk and European Pressure Ulcer Advisory Panel Pressure Ulcer Staging tool.
Setting:
General paediatric intensive care unit in a tertiary level hospital between May and October 2017.
Results:
Seventy-seven children were recruited. Most children were male (n = 42, 54.5%) and all nine children (11.7%) that developed a pressure ulcer were male. The main risk factor for developing a pressure ulcer was lack of physical activity. None of the children assessed as high or severe risk developed a pressure ulcer. Eight (89%) pressure ulcers were assessed as grade one. Seven pressure ulcers (77.8%) were on the facial and scalp area and all seven children were receiving airway support at the time the pressure ulcers developed.
Conclusion:
Incidence of pressure ulcers was 11.7%, with the facial and scalp area the most common anatomical areas affected. Medical devices appeared to be the prime causative factor. Based on our data we have modified and launched the SSKIN care bundle for the paediatric intensive care unit setting.
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