Quality Improvement Team Approach to Detect Pressure Ulcers in a Pediatric Hospital

The increased incidence of pressure ulcers during consecutive annual skin prevalence surveys in our Pediatric Hospital lead to development of a quality improvement initiative to increase the detection of pressure ulcers. A multidisciplinary skin team was formed on the following units: Pediatric Intensive care, Cardiothoracic Intensive care, Rehabilitation, Pulmonary and Neuroscience, as these are the units where the majority of the pressure ulcers were discovered. 

We also created a Pressure Ulcer Reduction Team to allow the staff from each of the units the opportunity to meet monthly to address the number, cause and prevention of pressure ulcers. This hospital wide team provides a forum in which we can spread best practices we have implemented on a unit level to the entire hospital. The goal of this project is to decrease both the incidence and severity of pressure ulcers across our pediatric hospital.

The hospital wide team has created a Pressure Ulcer Prevention Bundle for both pediatric and neonatal patients.  The team has also worked to increase knowledge of the Braden Q and Braden to determine skin risk for developing these injuries. Our cause analysis led the team to focus on decreasing pressure ulcers related to immobility and respiratory devices.  The recent standardization of our turning/repositioning schedule will enable staff to hold one another accountable.  Related to respiratory devices it was beneficial to modify existing assessment standards, application techniques as well as careful review of new products available to utilize new technology to relieve or redistribute pressure.  The team meets monthly and reviews all data from the previous month and determines bundle element focus for the next month

Having a multidisciplinary team has been critical to the overall success of this project.  The real-time identification of injuries and prevention opportunities, along with staff feedback, was valuable in engaging the bedside staff.