Having the Right Pieces in Place to Prevent Pressure Ulcers the Pediatric Intensive Care Unit (PICU)

Title: Having the Right Pieces in Place to Prevent Pressure Ulcers the Pediatric Intensive   Care Unit (PICU) 

Purpose:

The purpose of this evidence-based practice project was to implement assessment and interventions strategies to reduce pediatric pressure ulcers below NDNQI benchmarks in the PICU. 

Objective/Relevance/Significance: 

House-wide quarterly pressure ulcer prevalence audits are completed. There has been an increase in pressure ulcers in the PICU since January 2014. 

Strategy and Implementation 

• Skin Team Advocate Resource (S.T.A.R.) members on the unit were encouraged and supported to complete the Wound Treatment Associate Program. .
• Collaboration with ECMO team to develop and incorporate enhanced education and protocols for skin care.  Started in Summer 2014 and Development of order sets
• Additional education with PICU staff
• Improved handoff report between PICU and OR regarding positioning devices and protective positioning devices. 
• Including pressure ulcer prevention interventions in the nursing comments of the bedside nursing handoff section.
• Pediatric Wound and Skin Specialty Nurse attending Division Bed Huddles 
• Adaptation to routine nursing practices through nursing skin care protocols that could be instituted without orders Heel protection developed 
• Updating and distribution of unit specific tool kits for skin care and pressure ulcer prevention
• Online yearly inservice on pressure ulcer and moisture related skin damage prevention.
• Inservicing on new products for skin care
• Implement Consult to the Pediatric Wound and Skin Specialty Nurse when ECMO is started
• Developed skin care algorithms for bedside staff. Skin Tear Algorithm, Dressing Care,  IAD Algorithms
• Monthly “mini-audits for the PICU
• Encourage the STARs who have completed the WTA Program to become certified when the test is available.        

Evaluation: 

With increased education and implementation of the current strategies we are reducing the number of pressure ulcers and increasing the overall awareness of pressure ulcer prevention among the PICU staff.