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CS369
An Initiative To Diminish The Occurrence Of Pressure Ulcer Development In The Pediatric Cardiac Surgery Patient
By: P. Lincoln, D. Beke, N. Braudis, S. Quigley; Children's Hospital Boston; MA
For further information, please contact: plincoln@rcn.com
Purpose: Pediatric cardiac patients are vulnerable to pressure ulcers due to decreased oxygen saturation and limited cardiac output. The focus of this project was to identify patients at increased risk for pressure ulcer development and to institute nursing interventions to maintain tissue integrity.
Description: Pediatric cardiac nurses from the preoperative clinic, operating room, cardiac intensive care unit (CICU), and step-down unit developed guidelines for pressure ulcer prevention in the cardiac surgery patient. Preoperative risk assessment included patient age and placement on growth curve, anticipated length of surgery, and degree of pre-existing cyanosis. Intra-operative guidelines involved documentation of pre and post procedure skin assessments to detect potential areas of concern, application of transparent film dressings over bony prominences to decrease friction effects, the use of gel padding for protection to common problem areas such as occiput, heels, and elbows, and the placement of an air mattress overlay for pressure redistribution on the postoperative bed. Education was conducted with CICU staff concerning pressure ulcer development and prevention strategies. Clinical nurse specialists from the CICU underwent comprehensive training in skin assessment, pressure ulcer prevention, pressure ulcer staging guidelines, documentation, and wound care. Communication of skin concerns and continuation of interventions followed the patient through transfer to the step-down unit.
Evaluation and Outcomes: Quarterly skin integrity data is collected utilizing the Braden Q pediatric risk assessment tool on the CICU patient population. Incident reports are filed on all alterations in patient skin integrity to detect trends and assure follow-up. The need for a standardized approach to all skin issues was realized including identification, notification, documentation, treatment and follow-up across the continuum.
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