Outcomes of a Quality Improvement Program to Reduce Hospital-acquired Pressure Ulcers in Pediatric Patients.

Abstract

Hospital-acquired pressure injuries (PIs) present a significant challenge to pediatric providers. PURPOSE The purpose of this quality improvement program was to develop and implement a debrief protocol and to evaluate compliance with and the implementation of a comprehensive prevention bundle to decrease the overall incidence and severity of pediatric pressure ulcers (PUs)/PIs in a free-standing children's hospital. METHODS As a member of the Children's Hospitals Solution for Patients Safety national network, a PU Hospital Acquired Conditions (HAC) team was created in 2013, followed by the development and implementation of a PU occurrence debrief tool and discussion guide and implementation of multiple staff educational strategies and a comprehensive prevention bundle. The PU occurrence debriefing occurred within 24 to 48 hours of a PU. Incidence data were collected annually from 2014 until 2017. RESULTS Compliance on implementation and documentation of bundle elements ranged from 88% to 94%, and PU/PI incidence decreased by 30% from 2014 to 2016 and by 40% in 2017. The overall PU rate was 0.0057 in 2014, 0.0050 in 2015, 0.0036 in 2016, and 0.0023 in 2017; 65% of all PUs were device-related. Of those, >50% were related to respiratory devices, 25% to peripheral intravenous catheters/central lines, 10% to tracheostomies, and 15% to other devices. Respiratory device-related PUs decreased by 50% in the pediatric intensive care unit, by 80% in the neonatal unit, and eliminated completely in extracorporeal membrane oxygenation patients. CONCLUSION The debriefing process, debriefing tool, educational programs, and prevention bundle reduced the rate of hospital-acquired PIs in pediatric patients and propagated a culture of safety.