Pressure Ulcers Tamika johnson April 18, 2013

Pressure ulcers An injury to the skin and underlying tissue Range from mild reddening to severe tissue damage Four stages of pressure ulcers: Stage I, Stage II, Stage III, Stage IV, Unstageable

Pressure Ulcer statistics 26% hospitalized patients, 39% spinal cord injuries, 43% nursing home, 50% pediatrics

Pressure Ulcer statistics continued Estimated cost of hospital acquired pressure ulcers range between $1119-$70,000 depending on the stage and ensuing length of stay Estimated cost of a stage IV hospital acquired pressure ulcer $129,248 Estimated 60,000 deaths a year related to hospital acquired pressure ulcers

Prevalence study

Established tools Braden Q Scale Cushion and Protect

Issues on unit Breakdown in communication Noncompliance due to product availability

Plan of action Spoke to various nurses Met with Director of Nursing Safety and Patient Satisfaction Assessed unit inventory Reviewed protect and cushion resource manual Made list of materials needed Conference call with Children’s Hospital of Pennsylvania Met with Director of Nursing Safety and Patient Satisfaction and the Director of Central Supplies Rearranged and restocked pyxis machines with central supply technician

Goals Nurses in the Pediatric Intensive Care Unit will have resources and materials readily available to help in the prevention of pressure ulcers The Pediatric Intensive Care Unit’s percentage of unit based pressure ulcers will fall below the national benchmark for two consecutive quarters

Objectives Obtain proper padding and protection to aid in ulcer prevention Attend in-services for new skin products Demonstrate competency of the Braden Q Scale Identify patients at risk for impaired skin integrity

rationale Having a designated area for skin/wound products will help nurses identify proper materials needed to protect patient’s skin Placing a barrier between skin and medical devices will decrease pressure ulcers Applying extra padding to boney areas will decrease the pressure maintained on a specific area (ex: occiput) Knowing how to apply the Braden Q scale will identify more at risk patients

Follow-up Satisfaction Poll Perform inventory

Conclusion

references Brem, H., Maggi, J., Nierman, D., Rolnitzky, L., Bell, D., Rennert, R., Golinko, M., Yan, A., Lyder, C., & Vladeck, B. (2010). High cost of stage IV pressure ulcers. American Journal of Surgery. 200(4) :473-477. doi: 10.1016/j.amjsurg.2009.12.021. Pressure ulcers. (2013). Retrieved on March 13, 2013 from http://www.nursingcenter.com/prodev/ce_article.asp?tid=1439028 Pressure ulcers. (2013). Retrieved on March 13, 2013 from http://www.webmd.com/skin-problems-and- treatments/four-stages-of-pressure-sores Pressure ulcers. (2013). Retrieved on April 17, 2013 from http://www.jcrinc.com/pressure-ulcers Schober-Flores, C. (2012). Pressure ulcers in the pediatric population. Journal of the Dermatology Nurses Association. 4(5): 295-306.