Bringing pressure ulcer rates to zero in the Pediatric CVICU

The average profile for the cardiac patient in the pediatric cardiovascular intensive care unit (CVICU) includes decreased perfusion, hemodynamic instability, and inability to reposition. These factors are compounded by extended operating times, need for vasopressors and fluid volume restriction.  These factors have been identified as risk factors for developing pressure ulcers in the pediatric population. 

            This unit at one-point experienced pressure ulcer rates as high as 25%.  The unit made a dedicated effort to examine the issues related to skin integrity and developed a skin integrity plan for all patients that are on the unit.  The plan of care utilized new theory and evidenced based practice from the literature on pediatric pressure ulcers.  Despite the limited information for pediatric pressure ulcer prevention, through the collaboration amongst nursing and allied health care providers a model of care has been developed and implemented.  

            The standard of care for the pediatric CVICU incorporates an all-encompassing approach to maintaining skin integrity to prevent pressure ulcers.  This model has four main concepts:  education of the nurses, availability of products, policy and effective communication. Education of nurses utilized the adult learning theory. The learning needs of the staff nurses were assessed and then the information was customized. Education was given out in the format of emails, posters, handouts and an online learning model. Cognitive information was supplemented with hands on teaching and then brought to life with the available products on the unit.  A policy for the standard of care has been developed and communication regarding skin integrity is stressed.

            Since the implementation of the model there has been one incidence of occipital pressure ulcer and zero sacral pressure ulcers. Challenges still exist for maintaining rates of zero alterations in skin integrity with the use of mask ventilation.