Sandy Quigley, RN, MSN, CWOCN, CPNP, Children's Hospital Boston, Boston Children's Hospital, Boston, MA, Lindyce Kulik, RN, MS, CWON, CPNP, CCRN, Cardiovascular Critical Care, Boston Children’s Hospital, Boston, MA, Margaret McCabe, PhD, RN, PNP, Nursing, Boston Children's Hospital, Boston, MA, Catherine Noonan Caillouette, RN, MS, CPNP, CWOCN, Plastic Surgery, Boston Children’s Hospital, Boston, MA, Rosella Micalizzi, MSN, RN, CPNP-PC, Pediatric Surgery, Boston Childrens' Hospital, Boston, MA, Susan Hamilton, RN, MS, CCRN, CWOCN, Nursing Critical Care, Boston Children's Hospital, Boston, MA, Sarah Wells, MSN, RN, CPN, CWOCN, Complex Care Service, Boston Children's Hospital, Boston, MA, Caroline Costello, MBA, BSN, RN, CPON, BMTCN, Hematopoietic Stem Cell Transplant Program, Boston Children's Hospital, Boston, MA, Jane Murphy, MS, RN, PPCNP-BC, CPHQ, Pediatric Surgery, Boston Children's Hospital, Boston, MA, Janelle Nobrega, MSN, RN, CPNP, Inpatient Cardiovascular Program, Boston Children's Hospital, Boston, MA, Natalie Hasbani, MPH, Cardiology, Boston Children's Hospital, Boston, MA and Martha A.Q. Curley, RN, PhD, FAAN, School of Nursing, University Of Pennsylvania, Philadelphia, PA
Purpose: Hospital acquired pressure ulcers (HAPUs) from immobility and medical devices represent serious iatrogenic injury in acute care environments. The first step in pressure ulcer (PU) prevention is accurate risk assessment. A free standing academic medical center in the northeast collected comprehensive prospective data to describe pediatric patients at risk to develop PUs. Our data will be combined with seven other pediatric hospitals to complete a multicenter study testing the predictive validity of the 1) Braden Q Scale for development of immobility-related pressure ulcers and 2) Braden Q+D Scale for development of medical device-related pressure ulcers in pediatric patients.
Methodology: Nursing units were screened using a randomization sequence. To ensure an adequate sampling of at-risk groups across the organization subject enrollment was stratified by age group and patient type (medical/surgical and cardiac). After obtaining informed consent two separate teams of nurses, blinded to each other’s assessments, worked in tandem to assess risk and presence of PUs. All PUs were staged by a CWOC nurse and photographed. Inter-rater reliability between the two teams of nurses was established prior to the start of data collection and rechecked regularly during data collection.
Results: From 04/09/2013 thru 07/24/2015 our site screened 2974 subjects to enroll a stratified sample of 123 subjects, 24 developed 49 PUs, 34 were medical device-related and 15 immobility-related. Ten patients had more than one ulcer. Median Braden Q score on admission was 20 (18-24). The majority of PUs were Stage I (24) and II (16). The three devices most frequently associated with PUs at our center were O2 Sat probe, OTT, BiPAP/CPAP.
Conclusion: These descriptive findings contribute new knowledge about PU development in acute care pediatrics and will make an important contribution to the science of predicting device and immobility related risk for PUs in acute care pediatric populations.
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