Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit

Area of Science:

• Critical Care Medicine
• Patient Safety
• Quality Improvement

Background:

• Pressure ulcers (PUs) are injuries to skin/tissue from pressure or shear stress.
• PUs are staged I-IV, unstageable, or suspected deep tissue injury.
• This project aimed to decrease PUs exceeding stage II in a cardiothoracic intensive care unit (ICU).

Purpose of the Study:

• To reduce the incidence of pressure ulcers (PUs) greater than stage II.
• To implement and evaluate the effectiveness of a comprehensive PU prevention strategy.
• To sustain improvements in PU reduction over time within a critical care setting.

Main Methods:

• A quality improvement project reviewed PUs greater than stage II from March 2010 to December 2017.
• Interventions included a PU bundle, multidisciplinary huddles, weekly skin rounds, a unit workgroup, and caregiver input.
• The PU bundle comprised barrier cream, probe rotation, turning schedules, pressure reduction surfaces, heel pressure release, and bed elevation.

Main Results:

• Pressure ulcer incidence decreased from 15.7 to 2.9 events per 1,000 patient days between 2010-2014.
• This reduced rate was sustained for three years.
• PUs related to immobility dropped from 35 (2010-2011) to 4 (2016-2017); device-related PUs decreased from 34 to 15.

Conclusions:

• The PU bundle, skin rounds, and huddles effectively reduced immobility-related PUs and stage III PUs.
• Early identification of stage II PUs was facilitated by the interventions.
• Reducing device-related PUs presents an ongoing challenge, but significant improvements were sustained.