Development of a Pediatric Pressure Ulcer Prevention Program

Today, pediatric pressure ulcer programs are developing in numerous pediatric hospitals across the country. Programs are developing due to: increased acuity of hospitalized pediatric patients, reimbursement for pressure ulcer wound care, as well as adherance to nursing quality indicators for quality improvement in patient care. At our not-for-profit quadenary pediatric teaching hospital, we began initiation of a pressure ulcer prevention program in mid-2007. Our goal was to reduce our ICU prevalence rate below 4% and to do that, we needed to implement a pressure ulcer risk assessment tool, and program while collecting prevalence data for two national pressure ulcer prevention test pilots. Program initiation required senior nursing leadership's support and a multi-disciplinary pressure ulcer task force. The first step was to educate ICU nursing staff about the pressure ulcer risk assessment tool, evidence-based pressure ulcer interventions, and we placed our highest risk patients, the ICU patients, on a 4 in foam overlay on admission. We reevaluated the tool and interventions in one month and received positive feedback from nurses, and had positive patient outcomes, so we moved on to the second second phase.  In the next phase we formalized and educated the data collection team for prevalence studies. In 2008 and early 2009, overall hospital prevalence rate and ICU rate continued to stay well below 4%. In June of 2009, the 3rd phase required the pressure ulcer committee to meet frequently and discuss roll-out of the pressure ulcer risk assessment tool to the other units, and at our other hospital campus. Thru online nursing education, posters, storyboards, a Skin Care/Pressure Ulcer policy with a bed algorithm, bedside prevention interventions for pressure ulcers, nursing leadership support, and support from clinical education, the pressure ulcer risk assessment tools and intervention selection lists were incorporated into the new electronic documentation record. Documentation of the patient's pressure ulcer risk score and nursing prevention interventions are documented every twelve hours by the nurse. Heightend awareness of pressure ulcer prevention across the hospital, nursing staff edcuation, and improved national nursing standards have made a difference in prevention of pressure ulcers at our hospital. We will continue on to the fourth phase of the program development with goals being: 1) detemining the best means of identifying the patient at risk for pressure ulcer development in the ER, 2) improve nurse to nurse communication for the " at risk " patient going to the OR and prevention measures 3) continued education of nursing staff annually, 4) improve patient and family education, 5) and develop physician education surrounding early documentation and reimbursment of pressure ulcer treatment.