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Care of patients’ skin is a nurse-sensitive outcome measure established by the American Nurses Association (Young & Clark, 2009). Maintaining skin integrity in the critical-care environment is difficult because of patient acuity and the highly invasive interventions and therapies they receive (Galvin & Curley, 2012). The prevalence, prevention, and treatment of skin breakdown have been studied in adults, but research is lacking for children (Groeneveld et al., 2003). Pediatric patients have different anatomic, physiologic and developmental factors that alter their risk of obtaining and presentation of hospital acquired pressure ulcers (HAPUs), (Noonan, Quigley & Curley, 2013). Medical devices monitoring has become standard of practice for the acute care environment and clinicians have recognized that medical devices placed against the skin or mucosal membranes can lead to pressure ulcer development (Noonan et al., 2013). Medical Device Related (MDR) pressure ulcers are different then pressure ulcers derived on bony prominences because they are produced from unrelieved tissue compression on the site where the medical device is in contact with skin or mucosal membranes (Noonan et al., 2013). Due to the acute nature of the patients in critical care settings, nursing interventions focus on support of vital functions; and skin breakdown is generally not the main concern during admission (Smitt, Woensel, & Bos, 2011). Ensuring that nurses in the critical care area regard preventive skin care as a priority is critical for success in skin-breakdown interventions (Drake, Wendi, Sherburne, Nugent, & Simpson, 2012). Current work is being done by Martha Curley to create a risk prediction tool for MDR HAPUs that will inform and optimize prevention and treatment (Noonan et al, 2013). With this new knowledge, and in the absence of any current national standards it was identified, through a pilot project in a pediatric Cardiac Intensive Care Unit (PCICU) in a large hospital in Upstate New York, that there was a lack of standardization in device related skin care for patients. For the pilot project a practice guideline was created that guided PCICU nurses on the interventions for potential skin-breakdown issues in their patients. The patients had a significant change in skin breakdown with a one-sided Fishers Exact Test (P=.0422). A logistic regression model showed intervention as a significant factor in reducing incidence of pressure ulcers, skin breakdown, and length of stay (P=.0389). The current study is looking at the effects of an educational intervention with nurses, and implementation of the skin care practice guideline across all pediatric care areas. Disseminating the results and tools to replicate the practice guideline is essential for implementing current evidence based best practice across pediatrics, and is timely with the anticipation of the release of risk prediction tool for MDR HAPUs.


Presented at the American Association of Critical-Care Nurses National Teaching Institute in San Diego, California, May 2015.

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