Working Under Pressure: Evidence-Based Risk Assessment and Pressure Injury Prevention in the Pediatric Intensive Care Unit

Background: The hospital-acquired pressure injury (HAPI) can have physiologic, psychologic, and financial sequelae. Children are at increased risk secondary to immature physiology, developmental differences, and severity of illness. Evidence suggests presence of medical devices exponentiates HAPI risk.

Local Problem: Upward trends in HAPIs revealed nearly 50% are device related in the project setting, an urban Pediatric Intensive Care Unit. The Braden QD Scale was identified as best evidence for HAPI risk assessment. This initiative aimed to observe the ability of the Braden QD Scale as a predictor of HAPI risk as compared to current practice utilizing the Braden Q Scale.

Methods: The Evidence-Based Practice Improvement Model served as the framework, yielding evidence supporting utilization of the Braden QD Scale. Patients from birth through age 21 were included. Plan-Do-Study-Act (PDSA) cycles guided the project with feedback from stakeholders. Aggregate data were captured over 90 days including Braden Q Score, Braden QD Score, and characteristics of any identified HAPI. The cut-off point of the Braden QD Scale was the primary outcome measure with statistical analysis to determine its ability to predict HAPI risk in comparison to the Braden Q Scale.

Intervention: Stakeholders were educated on project parameters. Three RN champions were deployed to promote familiarization of the Braden QD Scale, which was integrated into workflow in a side-by-side comparison of HAPI risk with the Braden Q Scale.

Results: Sixty patients were screened over a 90-day period. The Braden Q cut-off point was met in 6 patients and the Braden QD cut-off point was met in 24 patients in 162 side-by-side comparisons.

Conclusions: The results support the Braden QD Scale as the best evidenced tool for HAPI risk assessment in critically ill children. Its integration into practice should be coupled with interdisciplinary and evidence-based mitigation strategies aligning with facility priorities to improve patient outcomes and decrease cost.