Frank Gary, Walsh Kathleen E, Wooton Sharyl, Bost Jim, Dong Wei, Keller Leah, Miller Michelle, Zieker Karen, Brilli Richard J
Children's Healthcare of Atlanta Children's Hospital of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Liberty Mutual Insurance, Boston, Mass.; Hospital Administration, Department of Quality Improvement, Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; and The Ohio State University College of Medicine, Columbus, Ohio.
Pediatr Qual Saf. 2017 Feb 16;2(2):e013. doi: 10.1097/pq9.0000000000000013. eCollection 2017 Mar-Apr.
Our objective was to describe changes in pressure injury (PI) rates in pediatric hospitals after implementation of an active surveillance and prevention bundle and to assess the impact of bundle elements.
The Children's Hospitals Solutions for Patient Safety (SPS) Network is a learning collaborative working together to eliminate harm to hospitalized children. SPS used a 3-pronged approach to prevent pressure injuries: (1) active surveillance, (2) implementing and measuring compliance with the prevention bundle, and (3) deploying a wound ostomy team. Among hospitals participating since 2011 (phase 1), we used negative binomial analyses to assess change in PI rates. Only phase 1 hospitals had a baseline period before any prevention bundle intervention. Among all hospitals participating in 2013 (phases 1 and 2), we used funnel charts to assess the association between reliable bundle implementation and PI rates.
Among the 33 hospitals that participated in SPS from 2011 to 2013 (phase 1), the rate of stage 3 pressure injuries declined from 0.06 to 0.03 per 1,000 patient-days ( < 0.001). Stage 4 pressure injuries declined from 0.01 to 0.004 per 1,000 patient-days ( = 0.02). Among all 78 hospitals in phases 1 and 2, the cohort that adopted each bundle element, measured compliance, and achieved 80% prevention bundle compliance had significantly lower PI rates compared with all hospitals.
SPS hospitals saw a significant reduction in stage 3 and 4 PIs over a 2-year period. Reliable implementation of each element of a prevention bundle was associated with lower PI rates.
我们的目标是描述实施主动监测与预防集束干预措施后儿科医院压力性损伤（PI）发生率的变化，并评估集束干预措施各要素的影响。
儿童医院患者安全解决方案（SPS）网络是一个致力于消除住院儿童伤害的学习协作组织。SPS采用三管齐下的方法预防压力性损伤：（1）主动监测；（2）实施并衡量对预防集束干预措施的依从性；（3）部署伤口造口团队。在2011年起参与的医院（第1阶段）中，我们使用负二项式分析评估PI发生率的变化。只有第1阶段的医院在任何预防集束干预措施实施前有一个基线期。在2013年参与的所有医院（第1阶段和第2阶段）中，我们使用漏斗图评估可靠的集束干预措施实施与PI发生率之间的关联。
在2011年至2013年参与SPS的33家医院（第1阶段）中，3期压力性损伤发生率从每1000患者日0.06降至0.03（<0.001）。4期压力性损伤发生率从每1000患者日0.01降至0.004（P = 0.02）。在第1阶段和第2阶段的所有78家医院中，采用每个集束干预措施要素、衡量依从性并实现80%预防集束干预措施依从性的队列与所有医院相比，PI发生率显著更低。
SPS医院在2年期间3期和4期PI显著减少。预防集束干预措施各要素的可靠实施与较低的PI发生率相关。
