Ulcer prevention in high risk infants in the PICU

Background and Significance:  Immobilized acutely ill pediatric patients are at risk for developing pressure ulcers (PU’s). The most common area for infants to develop PU’s is on the occipital area due to weight distributions. Open heart surgery patients are at greater risk due to the inability to establish a routine turning schedule. The average incidence rate for PU’s in the pediatric population is 0.25% to 27%.  This PICU only had two PU’s over the last two years however they were stage III and IV ulcers.  The current practice for the prevention of PU’s in the pediatric population includes the use of a standard gel pad in the radiant warmer. 

Method/Objective: A multidisciplinary Skin Care team, which consisted of the PICU CNS, unit nurses, ECLS Coordinator, Pediatric Heart Center CNS and the PICU Medical Director met to develop and implement interventions specifically for high risk infants in the PICU.  New pressure redistribution surfaces were pressure mapped and two custom gel mattresses were purchased and stocked in the PICU for immediate use in high risk, immobilized patients. An algorithm was created for bedside nurses to reference. The Skin Care team provided education to nurses and physicians, promoted the interventions, and monitored the patients for PU development.

Results: One year after the implementation of the new protocol and algorithm, there have been no hospital acquired PU’s in those highest at risk. This includes 28 neonates undergoing cardiac surgery that are less than 5kg and 4 neonates undergoing ECLS.   Given the average cost of an ulcer can be as high as $70,000, the initial prevention savings for care in the PICU was $140,000.