Reducing hospital-acquired pressure injuries among pediatric patients receiving ecmo: A retrospective study examining quality improvement outcomes

Jordan E. Jackson, Holly Kirkland-Kyhn, Laura Kenny, Alana L. Beres, Stephanie Mateev

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, includ-ing the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider edu-cation, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018. t Duplicate.

Original languageEnglish (US)
Pages (from-to)14-24
Number of pages11
JournalWound management & prevention
Volume67
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • Extracor-poreal membrane oxygenation
  • Hospital-acquired pressure injury
  • Intensive care unit
  • Pediatric patients
  • Pressure injury
  • Pressure ulcer
  • Quality improvement

ASJC Scopus subject areas

  • Medicine(all)

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