Reducing Serious Hospital-acquired Pressure Injuries in Pediatric Intensive Care Units through Proactive Interdisciplinary Rounding

Hospital-acquired pressure injuries (HAPIs) contribute to significant morbidity, prolonged hospitalization, and increased healthcare costs in pediatric intensive care units (PICUs). Critically ill children are at increased risk due to immobility, complex comorbidities, and frequent use of medical devices. Despite stable rates of adherence to prevention bundles, an increase in serious HAPIs (sHAPIs)-defined as stage 3, stage 4, or unstageable injuries-was observed at our institution. This quality improvement initiative aimed to reduce the rate of sHAPIs by 10% through the implementation of proactive interdisciplinary rounding.

Weekly interdisciplinary pressure injury rounds were implemented across the cardiac intensive care unit, neonatal intensive care unit, and PICU at a freestanding 364-bed children's hospital. Rounding teams included physicians, nurses, certified wound ostomy nurses, clinical quality coordinator nurses, and rehabilitation therapists. High-risk patients were identified using the Braden QD Scale and unit-specific criteria. During rounds, teams discussed prevention strategies and implemented targeted interventions, including device optimization, mobility promotion, nutrition assessment, skin protection measures, and bedside education. Outcome, process, and balancing metrics were tracked.

Within 1 year of implementation, the ICU sHAPI rate was reduced by 39% from 0.564 to 0.343 per 1,000 patient-days. The time between events increased in the PICU and cardiac intensive care unit. More than 1,400 proactive interventions were implemented. Rates of non-sHAPI hospital-acquired conditions decreased from 4.8 to 2.8 events per month.

Proactive interdisciplinary rounding was feasible, reproducible across ICUs, and associated with fewer sHAPIs.