Rowe Angela D, McCarty Karen, Huett Amy
Arkansas Children's Hospital, Little Rock, AR, United States.
University of Alabama Capstone College of Nursing, Tuscaloosa, AL, United States.
J Pediatr Nurs. 2018 Jul-Aug;41:104-109. doi: 10.1016/j.pedn.2018.03.001. Epub 2018 Mar 13.
A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention. The aim of this quality improvement project had two aims. First, to reduce HAPI incidence in the PICU by 10%. Second, to increase consistent usage of pressure injury prevention strategies as evidenced by a 10% increase in pressure injury bundle compliance. The third aim was to identify if there are differences in percentage of interventions implemented between two different groups of patients. Donabedian's model of Structure, Process, and Outcomes guided the development and implementation of this quality improvement project. Interventions focused on risk assessment subscale scores have the opportunity to mitigate specific risk factors and improve pressure injury prevention.
Through implementation of the nurse driven pathway there was as 57% decrease in reported HAPIs in the PICU as well as a 66% increase in pressure ulcer prevention bundle compliance.
Implementation of the nurse driven pressure injury prevention pathway was successful. There was a significant increase in bundle compliance for pressure ulcer prevention and a decrease in reported HAPIs.
The pathway developed and implemented for this quality improvement project could be adapted to other populations and care settings to provide guidance across the continuum.
美国南部一家大型独立儿科医院报告称，2013年至2015年间医院获得性压力性损伤（HAPI）增加了117%，重症监护病房是发生率最高的科室。设计与方法：设计并实施了一项质量改进项目，以协助预防压力性损伤。文献综述证实，儿科HAPI是一项挑战，使用集束干预措施和用户友好型指南/路径有助于消除预防障碍。该质量改进项目有两个目标。第一，将儿科重症监护病房（PICU）的HAPI发生率降低10%。第二，提高压力性损伤预防策略的一致使用率，压力性损伤集束干预措施依从性提高10%即为证据。第三个目标是确定两组不同患者之间实施的干预措施百分比是否存在差异。Donabedian的结构、过程和结果模型指导了该质量改进项目的开发和实施。针对风险评估子量表评分的干预措施有机会减轻特定风险因素并改善压力性损伤预防。
通过实施护士主导的路径，PICU报告的HAPI减少了57%，压力性溃疡预防集束干预措施的依从性提高了66%。
护士主导的压力性损伤预防路径的实施是成功的。压力性溃疡预防集束干预措施的依从性显著提高，报告的HAPI减少。
为该质量改进项目开发和实施的路径可适用于其他人群和护理环境，以提供全程指导。
