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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
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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
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Copyright
© Cambridge University Press 2018 

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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

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