Preventing and mitigating pressure ulcers in pediatric critical care: A collaborative effort in evidence-based practice implementation

Purpose: Millions of pressure ulcers (PU) develop each year and billions of dollars are spent treating them. Myths and unchallenged ideologies can hinder quality patient care.  Pressure ulcer development in pediatric patients occurs at similar rates to adult patients yet many caregivers believe PUs are rare in children. This presentation discusses the changes made in our Critical Care Department to decrease the risk of PU development. Our state’s Department of Public Health requires all stage III, IV, and unstageable wounds be reported.

Methods: A reportable wound developed in 2010 and brought the reality of this issue to the attention of the quality department. Initial steps to address this previously under-recognized problem include: hiring a wound care specialist (CWON), instituting a skin risk assessment tool, forming a Skin Wound Assessment Team (SWAT), and working toward buy-in from surgical and respiratory therapy departments. These interventions proved helpful but insufficient. Occurrence rates remained high despite improvement efforts. A multidisciplinary skin integrity task force was formed in 2011, quality improvement goals were established and defined outcome measures implemented to track progress. We began benchmarking our performance against NDNQI data in 2010 and are consistently close to the median.

Results: Wound prevention goals were not met in the first few months. The skin integrity task force widened its efforts.  After initial struggles, all of the task force goals were reached by December 2011; however, diligent attention to detail is maintained to help ensure the goals continue to be reached and outcomes remain optimal.

Conclusions: Pressure ulcer development is a significant problem in pediatric patients. Strategies to prevent wound development require dedicated inter-professional collaboration and a critical evaluation of all products and devises used on patients. Understanding where system failures occur and developing sound evidence-based interventions are crucial to a successful pressure ulcer prevention bundle.