title: Clinical Nurse Specialist Collaboration to Recognize, Prevent, and Treat Pediatric Pressure Ulcers.
abstract: OBJECTIVE
  The purpose of this quality improvement project was to reduce the incidence of pressure ulcers in a 232-bed, freestanding children's hospital in Western United States.
  
  
  BACKGROUND
  Pressure ulcers have been an underappreciated hospital-acquired condition in children. Children have distinct anatomic, physiologic, and developmental factors that alter how pressure ulcers occur, but nurses may not recognize the pediatric patient as at risk because of lack of knowledge and tools to assess skin, identify risk factors, and recognize or stage pressure ulcers. Our initial efforts to develop organizational tools to reduce pediatric pressure ulcers were not sufficient, despite improvements in care. Interprofessional and intraprofessional collaboration, led by clinical nurse specialists, focused on documentation, tracheostomies, respiratory devices, and hemodynamically unstable or extracorporeal life support patients.
  
  
  BACKGROUND
  Stage 3 and 4 and unstageable pressure ulcers are also "never events" in children. The unique factors involved with infant and pediatric pressure ulcers demand unique solutions.
  
  
  RESULTS
  Our collaborative efforts led to a significant and sustained reduction in pressure ulcer incidence, from 3.3 per 1000 patient days in the first quarter of 2010 to 1.7 per 1000 patient days in the second quarter of 2014. Reportable pressure ulcers were reduced by 60%. Improved awareness and prevention strategies also led to significant reductions in extracorporeal life support patient pressure ulcers and respiratory device-related pressure ulcers.
  
  
  CONCLUSIONS
  Through intraprofessional and interprofessional collaboration, the clinical nurse specialists were able to implement sustained organizational change and improve care for infants and children.
  
  
  CONCLUSIONS
  Reduction in pressure ulcers is achievable but requires collaboration and creative solutions that involve multiple disciplines.
authors.affiliation: Author Affiliations: Clinical Nurse Specialist, Cardiovascular Intensive Care Unit (Ms Peterson); Clinical Nurse Specialist, Oncology (Ms Adlard); Clinical Nurse Specialist, Neonatal Intensive Care Unit (Ms Walti); Clinical Nurse Specialist, Pediatric Intensive Care Unit (Dr Hayakawa); Clinical Nurse Specialist, Medical/Surgical (Ms McClean); and Quality Analyst (Ms Feidner), CHOC Children's Hospital, Orange, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Peterson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adlard
authors.forename: Beverly Inge
authors.initials: BI
authors.lastname: Walti
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hayakawa
authors.forename: Elyse
authors.initials: E
authors.lastname: McClean
authors.forename: Susan Carroll
authors.initials: SC
authors.lastname: Feidner
mesh_terms: D002648:Child; D003299:Cooperative Behavior; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D009720:Nurse Clinicians / Q000523:psychology*; D009733:Nursing Diagnosis; D015403:Nursing Evaluation Research; D010371:Pediatric Nursing; D003668:Pressure Ulcer / Q000451:nursing* / Q000517:prevention & control*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States