Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T00:14:05.164Z Has data issue: false hasContentIssue false
  • English
  • Français

Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan

Published online by Cambridge University Press:  06 July 2018

Lindyce A. Kulik ,
Jean A. Connor ,
Dionne A. Graham  and
Patricia A. Hickey
Lindyce A. Kulik*
Affiliation:
Cardiovascular & Critical Care Services, Department of Nursing Patient Services, Boston Children’s Hospital, Boston, MA, USA
Jean A. Connor
Affiliation:
Cardiovascular & Critical Care Services, Boston Children’s Hospital Harvard Medical School, Boston, MA, USA
Dionne A. Graham
Affiliation:
Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, MA, USA
Patricia A. Hickey
Affiliation:
Cardiovascular & Critical Care Services, Boston Children’s Hospital Harvard Medical School, Boston, MA, USA
*
Author for correspondence: L. Kulik, Boston Children’s Hospital, 300 Longwood Ave, 8 South, Boston, MA 02115, USA. Tel: 617 355 9860; Fax: 617 730 1909; E-mail: Lindyce.Kulik@childrens.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The description of pressure injury development is limited in children with CHD. Children who develop pressure injuries experience pain and suffering and are at risk for additional morbidity.

Objectives

The objective of this study was to develop a standardized clinical assessment and management plan to describe the development of pressure injury in paediatric cardiac surgical patients and evaluate prevention strategies.

Methods

Using a novel quality improvement initiative, postoperative paediatric cardiac surgical patients were started on a nurse-driven pressure injury prevention standardized clinical assessment and management plan on admission. Data were recorded relevant to nursing assessments and management based on pre-defined targeted data statements and algorithm. Nursing feedback regarding diversions was recorded and analysed.

Results

Data on 674 congenital paediatric cardiac surgical patients who met criteria were collected between May, 2011 and June, 2012. In 5918 patient days, a total of 4603 skin assessments were completed by nurses from the cardiac ICU and the cardiac inpatient unit, representing 77% of the expected assessments. The majority (70%, 21/30) of the 30 pressure injuries were medical-device-related and 30% (9/30) were immobility-related. The overall incidence of pressure injury was 4.4%: device-related was 3.1% and immobility-related was 1.3%. Most pressure injuries were Stage 1 (40%), followed by Stage 2 (26.7%), mucosal membrane injury (26.7%), and suspected deep tissue injuries (6.7%).

Conclusion

A nurse-driven pressure injury prevention standardized clinical assessment and management plan supported a programme-based evaluation of nursing practice and patient outcomes. Review of practices highlighted opportunities to standardise and focus prevention practices and ensure communication of patient vulnerabilities.

Keywords

CHDpressure injurypressure injury preventionstandardised care
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 9 , September 2018 , pp. 1151 - 1162
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Kulik LA, Connor JA, Graham DA, Hickey PA. (2018) Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan. Cardiology in the Young 28: 1151–1162. doi: 10.1017/S1047951118000975

References

1. Kiss, E, Heiler, M. Pediatric skin integrity practice guideline for institutional use: a quality improvement project. J Pediatr Nurs 2014; 29: 362–367.CrossRefGoogle ScholarPubMed
2. Schindler, C, Mikhailov, T, Kuhn, E, et al. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care. Am J Crit Care 2011; 20: 26–34.CrossRefGoogle ScholarPubMed
3. Visscher, M, King, A, Nie, A, et al. A quality-improvement collaborative project to reduce pressure ulcers in PICUs. Pediatrics 2013; 131: e1950–e1960.CrossRefGoogle ScholarPubMed
4. National Pressure Ulcer Advisory Panel. National Pressure Ulcer Advisory panel announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury, 2016. Retrieved September 27, 2017, from http://www.npuap.org/national-pressure- ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to- pressure-injury-and-updates-the-stages-of-pressure-injury.Google Scholar
5. Allman, R, Goode, P, Burst, N, Bartolucci, A, Thomas, D. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care 1999; 12: 22–30.Google ScholarPubMed
6. Reddy, M, Gill, S, Rochon, P. Preventing pressure ulcers: a systematic review. JAMA 2006; 296: 974–984.CrossRefGoogle ScholarPubMed
7. Curley, MAQ, Razmus, I, Roberts, K, Wypij, D. Predicting pressure ulcer risk in pediatric patients: the Braden Q scale. Nurs Res 2003; 52: 22–32.CrossRefGoogle Scholar
8. Centers for Disease Control and Prevention. Congenital heart defects: data & statistics, 2016. Retrieved September 27, 2017, from https://www.cdc.gov/ncbddd/heartdefects/data.html.Google Scholar
9. Gilboa, S, Devine, O, Kucik, J, et al. Congenital heart defects in the United States - estimating the magnitude of the affected population in 2010. Circulation 2016; 134: 101–109.CrossRefGoogle ScholarPubMed
10. Hickey, PA, Gauvreau, K, Tong, E, Schiffer, N, Connor, JA. Pediatric cardiovascular critical care in the United States: nursing and organizational characteristics. Am J Crit Care 2012; 21: 242–250.CrossRefGoogle ScholarPubMed
11. Black, J, Edsberg, L, Baharestani, M, et al. Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel consensus conference. Ostomy Wound Manage 2011; 57: 24–37.Google ScholarPubMed
12. Coleman, S, Gorecki, C, Nelson, E, et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud 2013; 50: 974–1003.CrossRefGoogle ScholarPubMed
13. Schoonhoven, L, Defloor, T, van der Tweet, I, Buskens, E, Grypdonck, M. Risk indicators for pressure ulcers during surgery. Appl Nurs Res 2002; 15: 163–173.CrossRefGoogle ScholarPubMed
14. Swafford, K, Culpepper, R, Dunn, C. Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. Am J Crit Care 2016; 25: 152–164.CrossRefGoogle Scholar
15. Aronovitch, S. Intraoperatively acquired pressure ulcers: are there common risk factors? Ostomy Wound Manage 2007; 53: 57–69.Google ScholarPubMed
16. O’Connell, M. Positioning impact on the surgical patient. Nurs Clin North Am 2006; 41: 173–192.CrossRefGoogle ScholarPubMed
17. Rao, A, Preston, A, Strauss, R, Stamm, R, Zalman, D. Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients: a systematic review. J Wound Ostomy Continence Nurs 2016; 43: 242–247.CrossRefGoogle ScholarPubMed
18. Ahern, J, Hickey, PA. Implementation of a pressure ulcer prevention program in a pediatric hospital. Chinese Nurs Manage 2011; 2: 26–28.Google Scholar
19. Galvin, P, Curley, MAQ. The Braden Q + P: a pediatric perioperative pressure ulcer risk assessment and intervention tool. AORN J 2012; 96: 261–270.CrossRefGoogle Scholar
20. Centers for Medicare and Medicaid Services. Eliminating serious, preventable and costly medical errors-never events, 2006. Retrieved September 27, 2017, from http://www.cms.hhs.gov/apps/media/press/releaseasp?Counter=1863.Google Scholar
21. Massachusetts Legislature. Chapter 305 of the Acts of 2008, an act to promote cost containment, transparency, and efficiency in the delivery of quality health care, 2008. Retrieved September 27, 2017, from https://malegislature.gov/Laws/SessionLaws/Acts/2008/Chapter305.Google Scholar
22. Connor, JA, Gauvreau, K, Jenkins, K. Factors associated with increased resource utilization for congenital heart disease. Pediatrics 2005; 116: 689–695.CrossRefGoogle ScholarPubMed
23. Hickey, PA, Gauvreau, K, Jenkins, K, Fawcett, J, Hayman, L. Statewide and national impact of California’s staffing law on pediatric cardiac surgery outcomes. J Nurs Adm 2011; 41: 218–225.CrossRefGoogle Scholar
24. Schindler, C, Mikhailov, T, Cashin, S, Malin, S, Christensen, M, Winters, J. Under pressure: preventing pressure ulcers in critically ill infants. J Spec Pediatr Nurs 2013; 18: 329–341.CrossRefGoogle ScholarPubMed
25. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and Treatment of Pressure Ulcers. Clinical Practice Guideline. National Pressure Ulcer Advisory Panel, Washington, DC, 2009.Google Scholar
26. Baharestani, M, Ratliff, C. Pressure ulcers in neonates and children: a NPUAP white paper. Adv Skin Wound Care 2007; 20: 208–220.CrossRefGoogle ScholarPubMed
27. Neidig, J, Kleiber, C, Oppliger, R. Risk factors associated with pressure ulcers in the pediatric patient following open-heart surgery. Prog Cardiovasc Nurs 1989; 4: 99–106.Google ScholarPubMed
28. Rathod, R, Farias, M, Friedman, K, et al. A novel approach to gathering and acting on relevant clinical information: SCAMPs. Congenit Heart Dis 2010; 5: 343–353.CrossRefGoogle ScholarPubMed
29. Curley, MAQ, Hickey, PA. The Nightingale metrics. Am J Nurs 2006; 106: 66–70.CrossRefGoogle ScholarPubMed
30. Agency for Health Care Policy and Research. Pressure Ulcer in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3. Public Health Service, US Department of Health and Human Services, Rockville, MD, 1992.Google Scholar
31. Institute for Healthcare Improvement. 5 million lives getting started kit: prevent pressure ulcers, how to guide, 2007. Retrieved September 27, 2017, from http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventPressureUlcers.aspx.Google Scholar
32. Institute for Healthcare Improvement. How to guide: pediatric supplement. Preventing pressure ulcers: 5 million lives campaign, 2011. Retrieved from http://www.ihi.org/ resources/Pages/Tools/HowtoGuidePreventPressureUlcersPediatricSupplement.aspx.Google Scholar
33. National Pressure Ulcer Advisory Panel. Mucosal pressure ulcers - An NPUAP position statement, 2008. Retrieved September 27, 2017, from http://www.npuap.org/wp- content/uploads/2012/01/Mucosal_Pressure_Ulcer_Position_Statement_final.pdf.Google Scholar
34. Fischer, C, Bertelle, V, Hohlfeld, J, Forcada-Guex, M, Stadelmann-Diaw, C, Tolsa, J. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed 2010; 95: F447–F451.CrossRefGoogle ScholarPubMed