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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Quality Report

A Quality-Improvement Collaborative Project to Reduce Pressure Ulcers in PICUs

Marty Visscher, Alice King, Ann Marie Nie, Pat Schaffer, Teresa Taylor, David Pruitt, Mary Jo Giaccone, Marshall Ashby and Sundeep Keswani
Pediatrics June 2013, 131 (6) e1950-e1960; DOI: https://doi.org/10.1542/peds.2012-1626
Marty Visscher
aSkin Sciences Program, Plastic Surgery,
fSurgery, and
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Alice King
bPediatric Advanced Wound Care and Skin Service,
fSurgery, and
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Ann Marie Nie
bPediatric Advanced Wound Care and Skin Service,
fSurgery, and
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Pat Schaffer
cPatient Services,
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Teresa Taylor
cPatient Services,
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David Pruitt
dPhysical Medicine and Rehabilitation,
gPediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Mary Jo Giaccone
cPatient Services,
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Marshall Ashby
eJames M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and Departments of
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Sundeep Keswani
bPediatric Advanced Wound Care and Skin Service,
fSurgery, and
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Abstract

BACKGROUND AND OBJECTIVE: Pediatric patients are at risk for developing pressure ulcers (PUs) and associated pain, infection risk, and prolonged hospitalization. Stage III and IV ulcers are serious, reportable events. The objective of this study was to develop and implement a quality-improvement (QI) intervention to reduce PUs by 50% in our ICUs.

METHODS: We established a QI collaborative leadership team, measured PU rates during an initial period of rapid-cycle tests of change, developed a QI bundle, and evaluated the PU rates after the QI implementation. The prospective study encompassed 1425 patients over 54 351 patient-days in the PICU and NICU.

RESULTS: The PU rate in the PICU was 14.3/1000 patient-days during the QI development and 3.7/1000 patient-days after QI implementation (P < .05), achieving the aim of 50% reduction. The PICU rates of stages I, II, and III conventional and device-related PUs decreased after the QI intervention. The PU rate in the NICU did not change significantly over time but remained at a mean of 0.9/1000 patient-days. In the postimplementation period, 3 points were outside the control limits, primarily due to an increase in PUs associated with pulse oximeters and cannulas.

CONCLUSIONS: The collaborative QI model was effective at reducing PUs in the PICU. Pediatric patients, particularly neonates, are at risk for device-related ulcers. Heightened awareness, early detection, and identification of strategies to mitigate device-related injury are necessary to further reduce PU rates.

  • pressure ulcer
  • skin
  • wound
  • device
  • quality improvement
  • bundle
  • intervention
  • neonatal
  • ICU
  • Abbreviations:
    CWOCN —
    certified wound ostomy and continence nurse
    DTI —
    deep tissue injury
    NIPPV —
    noninvasive positive pressure ventilation
    PU —
    pressure ulcer
    QI —
    quality improvement
    QIC —
    quality improvement collaborative
    TOC —
    test of change
    • Accepted February 13, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 6
    1 Jun 2013
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    A Quality-Improvement Collaborative Project to Reduce Pressure Ulcers in PICUs
    Marty Visscher, Alice King, Ann Marie Nie, Pat Schaffer, Teresa Taylor, David Pruitt, Mary Jo Giaccone, Marshall Ashby, Sundeep Keswani
    Pediatrics Jun 2013, 131 (6) e1950-e1960; DOI: 10.1542/peds.2012-1626

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    A Quality-Improvement Collaborative Project to Reduce Pressure Ulcers in PICUs
    Marty Visscher, Alice King, Ann Marie Nie, Pat Schaffer, Teresa Taylor, David Pruitt, Mary Jo Giaccone, Marshall Ashby, Sundeep Keswani
    Pediatrics Jun 2013, 131 (6) e1950-e1960; DOI: 10.1542/peds.2012-1626
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    Cited By...

    • Pediatric NIV Pressure Injury: Honing the Cause and Progress to Solutions
    • Reducing pressure ulcers across multiple care settings using a collaborative approach
    • Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers
    • Pressure Ulcer Incidence in Patients Wearing Nasal-Oral Versus Full-Face Noninvasive Ventilation Masks
    • Neonatal Pressure Ulcer Prevention
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