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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.

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|July 22, 2024
PubMed
Summary
This summary is machine-generated.

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.

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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.