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Objective: Develop a standardized clinical assessment and management plan (SCAMP™) to describe pressure injury development in pediatric cardiac surgical patients and evaluate prevention strategies.
Methods: Using a novel quality improvement initiative1, and consensus approach, a nurse-driven pressure injury prevention SCAMP™ was developed with implementation upon patient admission. Data were recorded targeting specific nursing assessments and management based on pre-defined data statements and algorithms. Diversions from algorithms were recorded and analyzed.
Results: Data on 674 cardiac surgical patients were collected between May 2011-June 2012. In 5,918 patient days, 4,603 nursing skin assessments were completed in the Cardiac Intensive Care Unit (CICU) and Cardiac Inpatient Unit, representing 77% of expected assessments. Twenty-nine patients developed 30 pressure injuries: 70%, (21/30) device-related and 30% (9/30) immobility-related. Total pressure injury incidence was 4.4%: device-related 3.1% and immobility-related 1.3%. Most (62%) device-related pressure injury were airway-related: oral endotracheal tubes (9/21) and nasal endotracheal tubes (4/21). The occiput was the most common location for immobility-related injury. Most (40%) pressure injury was Stage 1, Stage 2 (26.7%), mucosal membrane pressure injury (26.7%), and deep tissue injury (6.7%). Majority (80%) of pressure injury occurred within 7 days of cardiac surgery with 90% identified in the CICU. The most common reported nursing diversion was frequency of repositioning, related to concern of the patient’s early postoperative status.
Conclusion: A nurse-driven SCAMP™ informed a program-based evaluation of nursing practice and patient outcomes. Review of practices highlighted opportunities to standardize and focus pressure injury prevention practices through program guidelines and ensure communication of patient vulnerabilities.