Using A Grassroots Approach To Reduce Pediatric and Neonatal Pressure Ulcers

Title: Using Grassroots Approach To Reduce Pediatric and Neonatal Pressure Ulcers

Purpose

The purpose of this evidence-based practice project was to implement an assessment and intervention strategy that reduces pediatric and neonatal pressure ulcers below NDNQI benchmarks and is maintained and monitored by the unit based S.T.A.R. (Skin Team Advocate and Resource) members.

Objective/Relevance/Significance

In September of 2009, we began participation in NDNQI quarterly skin survey to assess patients for pressure ulcers. During our first skin survey, we discovered that 17% of our pediatric and neonatal patients had a pressure ulcer which demonstrated that we had significant opportunity for improvement.

Strategy and Implementation

After a review of the literature we found little published on hospital wide evidence based pressure ulcer prevention programing in the neonate and pediatric population so we felt a unified program approach on protocols and education, with a core group of trained staff nurses would elicit the best success.

            1. Selected and implemented risk assessment tools and interventions

            2. Full time skin, wound, ostomy nurse clinician

            3. Developed Standards of Care

            4. Unit based staff nurse S.T.A.R. members were recruited, educated and began leading the unit-based skin care quarterly audits.

Evaluation

Eighteen months after our first skin survey we celebrated zero pressure ulcers in all children and neonates in our hospital. Significant decrease from 42 (9.6% of patients) pressure ulcers during 2010 audits to 5 (1.2% of patients) pressure ulcers in 2013 and two quarters with zero incidence of pressures ulcers. In 2014 we have had three surveys in which two quarters had zero pressure ulcers and one quarter survey with one pressure ulcer out of 126 pediatric patients surveyed. We have 2 STARs on each unit and 7 nurses who have graduated from the WTA program.