Implementation of a practice guideline to reduce pressure injuries in hospitalised children: a quality improvement project

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Abstract Background Children are at high risk of developing pressure injuries. Studies have already shown that the implementation of evidence-based guidelines prevents up to 95% of pressure injuries (PI). These demonstrate the high relevance of implementing prevention strategies to achieve a zero incidence of PI in pediatric inpatient care. Hypothesis/Aim To reduce pressure injuries in hospitalised children through a multi-step quality improvement project Methods This project was conducted as a single-center study at a mixed neonatal and pediatric intensive care unit in Germany. The implementation process followed the seven steps of evidence-based practice described by Melnyck et al. Patient data were collected retrospectively from medical records before (n=185) and after (n=218) the implementation process. Statistical analyses using SPSS version 29.0 included multiple-response analyses, Pearson chi-square test, and phi coefficient. Results/findings There was a significant increase in PIs when respiratory support (p<0.001), parenteral nutrition (p<0.001), or inotropic drugs (p<0.001) were necessary. In addition, more PIs were recorded in patients diagnosed with prematurity, and the incidence of PI increased with longer ICU stay. After the education of nurses, a significant increase in risk assessments performed was achieved (p<0.001). After the quality improvement project, grade 2 PIs were completely avoided. Conclusions Preventing pressure injuries offers numerous benefits. Our study demonstrates that implementing various measures and training nursing staff results in a higher frequency of PI-risk screenings, a zero incidence of grade 2 PIs, and better documentation.

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