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Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit

BACKGROUND: Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress. We classify PUs by the level of tissue injury: stage I–IV, unstageable, suspected deep tissue injury. This quality project was aimed to reduce the incidence of PUs > st...

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Autores principales: Simsic, Janet M., Dolan, Kevin, Howitz, Sarah, Peters, Stephanie, Gajarski, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594780/
https://www.ncbi.nlm.nih.gov/pubmed/31579864
http://dx.doi.org/10.1097/pq9.0000000000000162
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author Simsic, Janet M.
Dolan, Kevin
Howitz, Sarah
Peters, Stephanie
Gajarski, Robert
author_facet Simsic, Janet M.
Dolan, Kevin
Howitz, Sarah
Peters, Stephanie
Gajarski, Robert
author_sort Simsic, Janet M.
collection PubMed
description BACKGROUND: Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress. We classify PUs by the level of tissue injury: stage I–IV, unstageable, suspected deep tissue injury. This quality project was aimed to reduce the incidence of PUs > stage II in the cardiothoracic intensive care unit. METHODS: We reviewed PUs > stage II from March 2010 to December 2017. Interventions included: PU bundle (April 2010, revised January 2013); multidisciplinary huddles for PUs > stage II (October 2011); multidisciplinary weekly skin rounds (March 2010, revised August 2012); unit specific workgroup (October 2012); caregiver input form (December 2012). The PU bundle included diaper barrier cream, pulse oximeter probe rotation, turning schedule, pressure reduction surfaces, heel pressure release, head of the bed elevation. RESULTS: Between 2010 and 2014, PUs decreased from 15.7 events per 1,000 patient days to a new baseline of 2.9 events per 1,000 patient days. We have sustained this rate for 3 years. PUs related to immobility decreased from 35 in 2010–2011 to 4 in 2016–2017. PU related to medical devices decreased from 34 in 2010–2011 to 15 in 2016–2017. CONCLUSIONS: Institution of PU bundle, multidisciplinary weekly skin rounds, and huddles for PUs > stage II reduced PUs related to immobility, allowed for earlier identification of stage II PUs and reduced stage III PUs. Challenges remain in reducing PUs related to medical devices. Importantly, we sustained this improvement over the past 3 years.
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spelling pubmed-65947802019-10-02 Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit Simsic, Janet M. Dolan, Kevin Howitz, Sarah Peters, Stephanie Gajarski, Robert Pediatr Qual Saf Individual QI projects from single institutions BACKGROUND: Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress. We classify PUs by the level of tissue injury: stage I–IV, unstageable, suspected deep tissue injury. This quality project was aimed to reduce the incidence of PUs > stage II in the cardiothoracic intensive care unit. METHODS: We reviewed PUs > stage II from March 2010 to December 2017. Interventions included: PU bundle (April 2010, revised January 2013); multidisciplinary huddles for PUs > stage II (October 2011); multidisciplinary weekly skin rounds (March 2010, revised August 2012); unit specific workgroup (October 2012); caregiver input form (December 2012). The PU bundle included diaper barrier cream, pulse oximeter probe rotation, turning schedule, pressure reduction surfaces, heel pressure release, head of the bed elevation. RESULTS: Between 2010 and 2014, PUs decreased from 15.7 events per 1,000 patient days to a new baseline of 2.9 events per 1,000 patient days. We have sustained this rate for 3 years. PUs related to immobility decreased from 35 in 2010–2011 to 4 in 2016–2017. PU related to medical devices decreased from 34 in 2010–2011 to 15 in 2016–2017. CONCLUSIONS: Institution of PU bundle, multidisciplinary weekly skin rounds, and huddles for PUs > stage II reduced PUs related to immobility, allowed for earlier identification of stage II PUs and reduced stage III PUs. Challenges remain in reducing PUs related to medical devices. Importantly, we sustained this improvement over the past 3 years. Wolters Kluwer Health 2019-04-02 /pmc/articles/PMC6594780/ /pubmed/31579864 http://dx.doi.org/10.1097/pq9.0000000000000162 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI projects from single institutions
Simsic, Janet M.
Dolan, Kevin
Howitz, Sarah
Peters, Stephanie
Gajarski, Robert
Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title_full Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title_fullStr Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title_full_unstemmed Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title_short Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit
title_sort prevention of pressure ulcers in a pediatric cardiac intensive care unit
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594780/
https://www.ncbi.nlm.nih.gov/pubmed/31579864
http://dx.doi.org/10.1097/pq9.0000000000000162
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