Document Detail

Prevention of tracheostomy-related pressure ulcers in children.
MedLine Citation:
PMID:  22351895     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Pressure ulcers are commonly acquired in pediatric institutions, and they are a key indicator of the standard and effectiveness of care. We recognized a high rate of tracheostomy-related pressure ulcers (TRPUs) in our ventilator unit and instituted a quality improvement program to develop and test potential interventions for TRPU prevention, condensed them into a clinical bundle, and then implemented the bundle into our standard practice.
METHODS: The intervention model used a rapid-cycle, Plan-Do-Study-Act (PDSA), framework for improvement research. All tracheostomy-dependent patients admitted to our 18-bed ventilator unit from July 2008 through December 2010 were included. TRPU stage and description, number of days each TRPU persisted, and bundle compliance were recorded in real time. All TRPUs were staged by a wound-care expert within 24 hours. The interventions incorporated into the TRPU-prevention bundle included frequent skin and device assessments, moisture-reducing device interface, and pressure-free device interface.
RESULTS: There was a significant decrease in the rate of patients who developed a TRPU from 8.1% during the preintervention period, to 2.6% during bundle development, to 0.3% after bundle implementation. There was a marked difference between standard and extended tracheostomy tubes in TRPU occurrence (3.4% vs 0%, P = .007) and days affected by a TRPU (5.2% vs 0.1%, P < .0001).
CONCLUSIONS: Education and ongoing assessment of skin integrity and the use of devices that minimize pressure at the tracheostomy-skin interface effectively reduce TRPU even among a population of children at high risk. These interventions can be integrated into daily workflow and result in sustained effect.
R Paul Boesch; Christine Myers; Tonia Garrett; AnnMarie Nie; Natalie Thomas; Amrita Chima; Gary L McPhail; Mathew Ednick; Michael J Rutter; Kathy Dressman
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Publication Detail:
Type:  Journal Article     Date:  2012-02-20
Journal Detail:
Title:  Pediatrics     Volume:  129     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-02     Completed Date:  2012-04-25     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e792-7     Citation Subset:  AIM; IM    
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MeSH Terms
Child, Preschool
Critical Illness / therapy
Health Services Research
Intensive Care Units, Pediatric
Intervention Studies
Logistic Models
Multivariate Analysis
Pressure Ulcer / etiology,  prevention & control*
Primary Prevention / methods*
Quality Improvement*
Respiration, Artificial / methods
Risk Assessment
Safety Management / methods
Tracheostomy / adverse effects*,  methods
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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