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Quality-improvement plan reduced pediatric pressure ulcers

Pressure ulcers in children, primarily caused by medical devices, were reduced by 50% in a pediatric ICU after development of a quality-improvement program, according to study results.

Researchers at Cincinnati Children’s Hospital Medical Center established a quality-improvement (QI) leadership team in August 2007 to assess pressure ulcer (PU) incidence and developed initiatives to reduce PUs among pediatric patients at the center’s ICUs. The prospective study included 1,425 patients across 54,351 patient-days in the PICU and NICU. PUs per 1,000 patient-days taken from biweekly head-to-toe skin assessments were the primary outcome.

 

Marty O. Visscher

“Pressure ulcers occur in the pediatric population and may be underappreciated, ie, perceived as a problem only for people who cannot move,” researcher Marty O. Visscher, PhD, director of the Skin Sciences Program and associate professor of pediatric plastic surgery at Cincinnati Children’s Hospital Medical Center, told Healio.com. “They represent serious harm (more severe stages III, IV and deep tissue injury).”

The QI team’s 50% reduction goal was achieved in the PICU population, which had a PU rate of 14.3 per 1,000 patient-days (100 PUs; 7,979 days) during the QI development and 3.7 per 1,000 patient-days (51 PUs; 14,729 days) after 1 year of implementation (P<.05). There was a decrease in the rates of stages I, II and III conventional and device-related PUs in the PICU. Rate in the NICU (mean, 0.9 per 1,000 patient-days) did not change significantly.

Researchers wrote that focusing on heightened awareness and early detection and targeting strategies to mitigate device-related wounds could further reduce PU rates.

“The majority of pressure ulcers in this group, about 60% to 90%, come from pressure caused by medical devices such as face masks for noninvasive ventilation, pulse oximeter probes, tracheostomy tubes, casts, etc.,” Visscher said. “When pressure is relieved, the reperfusion causes tissue injury. This is in great contrast to the adult population where about 30% of pressure ulcers are caused by devices.”

Disclosure: Marty O. Visscher has provided CareFusion with education regarding skin damage from respiratory devices.