Medical Devices, The Double-Edged Sword: A Quality Improvement Project to Reduce the Number of Medical Device-Related Pressure Injuries in the Pediatric Population Using the Braden QD Scale

BACKGROUND: Hospital-acquired pressure injuries in pediatric patients have a prevalence rate of 0.47% to 31.2%, which extend hospital stay by up to 14.1 days and cost over $26.8 billion annually in the United States. Medical device-related pressure injuries have an incidence rate of 70%. It is recommended to use the Braden QD scale to evaluate pediatric patients for both immobility and the risk of pressure injuries related to medical devices.

LOCAL PROBLEM: A children’s hospital in the northeastern United States was found to be using a pressure injury risk assessment tool that only evaluates immobility-related pressure injury risk. The purpose of this project was to implement a pressure injury risk assessment tool that also considers medical devices in its overall scoring.

METHODS: The Evidence-Based Practice Improvement Model (EBPI) was the guiding framework for this project. The Braden QD scale was used to assess pediatric patients for both immobility and pressure injuries related to medical devices during their stay. PDSA cycles were used to evaluate the effectiveness of education and weather if using the Braden QD helped to reduce the number of pressure injuries.

INTERVENTIONS: Education was provided to the nursing staff on the use of the Braden QD. The Braden QD was created into a Qualtrics survey and a QR code was placed at nursing stations.

RESULTS: A total of 93 patients were assessed using both scales. The Braden QD identified 10 patients at-risk compared to 5 with the Braden Q. Of the three documented pressure injuries, the Braden QD identified 2 of those patients ‘at-risk’, and the Braden Q found none.

CONCLUSIONS: The Braden QD scale identified more ‘at-risk’ patients, which can lead to increased adoption of pressure injury prevention strategies. It is currently being integrated into the EHR at the project site.