title: A quality-improvement collaborative project to reduce pressure ulcers in PICUs.
abstract: 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.
authors: Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. marty.visscher@cchmc.org
authors: Marty
authors: M
authors: Visscher
authors: Alice
authors: A
authors: King
authors: Ann Marie
authors: AM
authors: Nie
authors: Pat
authors: P
authors: Schaffer
authors: Teresa
authors: T
authors: Taylor
authors: David
authors: D
authors: Pruitt
authors: Mary Jo
authors: MJ
authors: Giaccone
authors: Marshall
authors: M
authors: Ashby
authors: Sundeep
authors: S
authors: Keswani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D018570:Risk Assessment; D055815:Young Adult
keywords: ICU; bundle; device; intervention; neonatal; pressure ulcer; quality improvement; skin; wound
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