Objective: To establish a valid and reliable method to conduct a one-day skin prevalence survey in a tertiary-care university-affiliated children's hospital.

Methods: Once the survey was approved by the institution's nursing leadership in 2005, an audit tool was developed using established terminology and national guidelines. The tool queried 12 data elements related to alterations in skin integrity: (1) use of pulse oximetry, (2) peripheral intravenous catheters, (3) nasally inserted tubes, and/or (4) any other invasive tubes (excluding urethral catheters and oral endotracheal tubes). Also, skin integrity was assessed in relation to (5) incontinence, (6) tracheostomies, and/or other (7) ostomies. Patients were also assessed for (8) presence of incisions/wounds, (9) epidermal stripping, (10) skin abrasions, (11) pressure ulcers, and/or (12) any other alterations in skin integrity. A detailed manual of operations with color photographs was created. At least one nurse auditor from each nursing unit attended a 2-hour training program. Inter-rater reliability regarding skin assessments and Braden Q use was established via a post-test and staff nurse follow-up after the class. Experts in pressure ulcer staging and intravenous infiltrate staging were used to decreased variation in the description of these problems. Patients and families were informed of the audit, using interpreters as needed.

Outcomes: Working in teams, 36 nurses collected data, spending a median 7 hours per unit. 100% of all eligible patients were assessed. A variety of skin alterations were found. The methodology has been successfully replicated in 2 separate pediatric hospitals.

Conclusions: After months of planning, our skin prevalence survey successfully described alterations in skin integrity in a tertiary-care university-affiliated children's hospital. The methodology was easily replicated, allowing for external benchmarking.