Pressure Redistribution Crib Mattress: A Quality Improvement Project.

BACKGROUND: Selective use of pressure-redistributing support surfaces is considered an essential component of a pressure injury prevention bundle. Critically ill children who are too big for an isolette but too little for a bed are usually placed in critical care cribs that have unique features such as moveable side rails and a built-in scale for weighing the patient, but they do not have a mattress designed to redistribute pressure. The primary aim of this quality improvement project was to evaluate a pressure redistribution mattress designed for use in critical care cribs. CASES: We retrospectively reviewed 22 charts of critically ill pediatric patients who participated in a product trial completed over a 12-week period in a stand-alone children's hospital in the Western United States. We reviewed demographic data, skin assessments, Braden Q Scale score, and support surface use. Our review revealed no pressure injury occurrences over the 12-week data collection period. CONCLUSIONS: Findings from this quality improvement project suggest that the pressure-redistributing mattress, when used as part of an intervention bundle, prevents pressure injuries in critically ill pediatric patients.

The Impact of Pediatric Pressure Injury Prevention Bundle on Pediatric Pressure Injury Rates: A Secondary Analysis.

PURPOSE: The primary aim of this study was to explore the relationship between a pediatric pressure injury prevention bundle (PPIPB) implemented by pediatric hospitals across the nation and pressure injury (PI) rates over a 6-year period. A secondary aim of this study was to identify whether any one risk factor addressed in the PPIPB had a greater effect on PI occurrences than any other factor. DESIGN: Nonexperimental, retrospective correlation analysis of secondary data. SUBJECTS AND SETTING: Analysis of data from 99 pediatric hospitals participating in the national initiative Solutions for Patient Safety (SPS). METHODS: Data were extracted from the SPS, an initiative designed to reduce PI rates in pediatric hospitals. We analyzed data related to nursing interventions implemented to ameliorate 5 factors associated with PI development. They were presence of medical devices, moisture, immobility, skin integrity, and absence of pressure redistribution with some support surfaces. Paired t test and correlation analysis were used to determine the relationship between the use of a PPIPB and PI incidence per 1000 patient-days. RESULTS: Findings indicated a 57% reduction in PI incidence when the PPIPB was used. A significant inverse relationship between the PPIPB and PI incidence was found. None of the 5 risk factors addressed by the PPIPB had a stronger correlation with PI occurrences than any other factor. CONCLUSIONS: Study findings strongly suggest the use of a PPIPB decreases PI incidence in pediatric hospitals and should be considered when implementing a PI prevention program.

Use of a Moisture Wicking Fabric for Prevention of Skin Damage Around Drains and Parenteral Access Lines.

BACKGROUND: Skin damage under various drainage tubes and parenteral access lines occurs frequently in pediatric patients. Our team sought an alternative to the use of gauze or foam for prevention and management of peritubular skin damage. CASES: We used a moisture wicking fabric in select patients in a tertiary children's hospital in Northern California. The fabric was placed under tracheostomy ties and around gastrostomy tubes and Penrose drains. CONCLUSION: The moisture wicking fabric was effective in absorbing moisture and maintaining skin integrity. This new approach has been incorporated into our facility policy.