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The Pediatric Pressure Ulcer Prevention Bundle
Topic: Interventions for pressure ulcer prevention in the adult population are based on a risk assessment score. Many children do not score high risk on the assessment tool but are at risk for pressure ulcer development related to devices. A pediatric “bundle” was developed that includes a medical device assessment, head to toe skin assessment and a pediatric pressure ulcer risk assessment tool.
Purpose: To reduce pressure ulcers in all hospitalized pediatric patients.
Methodology: The investigators reviewed the NPUAP’s Pressure Ulcer Prevention Points and the Wound Ostomy and Continence Nurses Society’s Guideline for Prevention and Management of Pressure Ulcers and used these guidelines as a starting point for developing strategies specific to the pediatric population. A prevention team was formed consisting of a nurse manger; physician; project managers; CWOCN, and staff RN’s from the four units with the highest prevalence rates in a Midwestern pediatric tertiary care hospital. The team used improvement science to guide them in testing each component of the bundle separately and as a whole.
Statistics: The investigators have performed quarterly pressure ulcer prevalence surveys. The prevalence rates were calculated by dividing the number of children with pressure ulcers by the number of children in the sample multiplied by 100. A run chart was annotated to show when components of the bundle were implemented house wide and the subsequent changes in the prevalence rates.
Results: The quarterly prevalence rates decreased within the institution whenever a component of the bundle was instituted.
Conclusion: The investigators have shown that when parts of the pediatric pressure ulcer prevention bundle were put into daily nursing practice, the prevalence rates of pressure ulcers in the Midwestern pediatric facility showed a decrease. The final testing on the bundle will be performed in January and April 2009.