Cincinnati Children’s Finds Higher Than Expected Numbers of Pressure Ulcers in Children

Quality Improvement Efforts Reduces Them by 50 Percent

Tuesday, June 18, 2013

A survey taken at Cincinnati Children’s Hospital Medical Center revealed a problem thought to be a major issue only in adult medicine: pressure ulcers. The survey revealed a rate of pressure ulcers in children of at least 10 percent, more than twice as high as was thought to occur in pediatrics.

When Cincinnati Children’s assembled a patient safety collaborative to investigate the problem, the medical center also discovered that the cause of pressure ulcers in children differed from the cause in adults. While more than 70 percent of pressure ulcers in adults occur due to pressure over bony parts of the body, researchers at Cincinnati Children’s discovered that most pressure ulcers in children occur due to medical devices.

These devices include ill-fitting facemasks used in delivering mechanical ventilation to the sickest patients, tracheotomy tubes, pulse oximeters (used to measure oxygen saturation in the blood), and orthopedic casts. While often life-saving, these devices can cause pressure ulcers that can be quite serious. Their incidence is higher in critically ill patients, with increased infection, pain and prolonged hospitalization.

Cincinnati Children’s established a quality improvement collaborative leadership that developed a quality improvement bundle of solutions, resulting in a 50 percent reduction in pressure ulcers in patients in the pediatric intensive care unit just one year after implementation. The results of the project are published online in Pediatrics and can be adopted by other hospitals wanting to reduce the incidence of pressure ulcers in their patients.

Pressure ulcers aren’t always serious, but even when they are not, they often serve as the “final straw” for families with sick children. These pressure ulcers are often the most visible signs of illness and can be an emotional tipping point. That’s why pressure ulcer prevention has become a key part of providing family-centered care.

The importance of early detection of skin injury prompted the implementation on each inpatient unit of “skin champions.” These staff members, each of whom has an interest in skin and wound care, undergo training in early detection of injury and serve as resources to staff members on the unit, including rounds and bedside skin assessments.

Moreover, Cincinnati Children’s has established a Pediatric Advanced Wound and Skin Service that includes wound treatment throughout the medical center as well as academic research on skin and wound healing. Many current skin and wound products have little science behind them, but scientists at Cincinnati Children’s are working to make new discoveries, some still at the basic science level, that they hope translate into new products in the coming years.

Lead author of the Pediatrics study was Marty Visscher, PhD, director of the Skin Sciences Program at Cincinnati Children’s. The Pediatric Advanced Wound and Skin Service is directed by Sundeep Keswani, MD, who co-authored the study.

About Cincinnati Children's

Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report’s 2013 Best Children’s Hospitals ranking. It is ranked #1 for cancer and in the top 10 for nine of 10 pediatric specialties. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org. Connect on the Cincinnati Children’s blog, via Facebook and on Twitter.