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Repositioning Guidelines to Decrease Pressure Injury in the Pediatric Intensive Care Unit: A Quality Improvement
Margaret T Birdsong1,2,3,4, Judy Ascenzi1,2,3,4, Carla Aquino1,2,3,4
1Margaret T. Birdsong, DNP, MSN, CPNP, CWOCN , Department of Pediatric Surgery, Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland, and Department of Pediatric Nursing, Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Implementing repositioning guidelines significantly reduced pressure injuries (PI) in hemodynamically unstable pediatric intensive care unit (PICU) patients. This quality improvement project demonstrated a substantial decrease in PI incidence, improving patient outcomes.
Area of Science:
- Pediatric Intensive Care
- Quality Improvement Science
- Patient Safety
Background:
- Pediatric intensive care unit (PICU) patients requiring mechanical ventilation are at high risk for pressure injuries (PI).
- Hemodynamic instability complicates standard PI prevention protocols in this vulnerable population.
- Existing guidelines may not adequately address the unique challenges of repositioning unstable pediatric patients.
Purpose of the Study:
- To develop and implement evidence-based repositioning guidelines for hemodynamically unstable PICU patients.
- To decrease the incidence of Stage II or higher pressure injuries in this specific patient group.
- To evaluate the effectiveness of a structured repositioning intervention through a quality improvement initiative.
Main Methods:
- A pre-post observational design was employed in an academic hospital PICU.
- Repositioning guidelines were implemented, with attempts every 2 hours, including full, partial, or noting inability due to instability.
- The study included 116 patients pre-implementation and 100 post-implementation, focusing on those aged 0-36 months with a Braden Q score ≤ 18.
Main Results:
- A significant reduction in pressure injury incidence was observed post-intervention (16.4% pre-implementation vs. 2.0% post-implementation).
- The P-value of .0003 indicates a statistically significant improvement in PI rates.
- The intervention proved effective in lowering PI rates in the studied pediatric population.
Conclusions:
- A structured repositioning intervention is effective in reducing pressure injuries in hemodynamically unstable PICU patients.
- These findings support the implementation of targeted repositioning protocols to enhance patient safety in critical care settings.
- This quality improvement project highlights the potential for significant PI reduction through guideline implementation in pediatric critical care.
Purpose:
The purpose of this quality improvement (QI) project was to develop and implement repositioning guidelines that reduce pressure injury (PI) in hemodynamically unstable pediatric intensive care unit (PICU) patients.
Participants And Setting:
All PICU patient ages 0 to 36 months who required sedation for invasive mechanical ventilation and had a Braden Q score ≤ 18 were eligible for inclusion. The project was implemented in 116 patients preimplementation and 100 postimplementation. Their median t age was 5 months (interquartile range 2-13 months). The QI project setting was an academic hospital PICU with a Level I trauma center located in the Mid-Atlantic Region of the United States.
Approach:
A pre-post observational design was used to compare the at-risk population for 21 weeks before (August-December 2018) and after (August-December 2019) implementing repositioning guidelines. Turn attempts were undertaken every 2 hours. Repositioning attempts were defined as (1) full (30°); (2) partial (15°); (3) unable to turn owing to hemodynamic instability; or (4) noncompliance. The primary outcome was incidence of Stage II or higher PI.
Outcomes:
We found a significant reduction in the incidence of PI before and after implementation of the repositioning intervention (16.4% vs 2.0%, P = .0003).
Implications For Practice:
A structured intervention for repositioning hemodynamically unstable PICU patients has the potential to significantly lower PI incidence in a group of hemodynamically unstable children.
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