STOP: Skin assessment in Transition of care from the OR to the PICU
Melissa R. Bennetts, DNP, RN, CPNP-AC
Children’s Hospital of Wisconsin; Milwaukee, WI; Critical Care Pediatric Nurse Practitioner
Phone: 414-266-4978; Email:
Anne Hedger, DNP, ACNP-BC, ANP-BC, CPNP-AC
University of South Alabama; Mobile, AL; Associate Professor
Christine Schindler, PhD, RN, CPNP-PC/AC
Marquette University College of Nursing; Milwaukee, WI; Assistant Professor
Children’s Hospital of Wisconsin; Milwaukee, WI; Critical Care Pediatric Nurse Practitioner
Bixiang Ren, M.S.
Children’s Hospital of Wisconsin, Milwaukee, WI; Statistical Analyst
Background. Patients that are in the pediatric intensive care unit (PICU), and have a procedure in the operating room (OR) are at increased risk for skin breakdown and pressure ulcer formation.
Purpose. This quality improvement project had specific aims to: 1) implement the Braden Q+P pressure ulcer risk assessment tool, 2) standardize handoff communication between the pediatric intensive care unit (PICU) and operating room (OR) teams in relation to patient's skin integrity, and 3) create a system for tracking skin breakdown and pressure ulcers in post-operative cardiac patients that transfer from the OR to the cardiac PICU.
Design and Methods. This project implemented the Braden Q+P risk assessment tool and compared pressure ulcer incidence and preventative measures before and after implementation of the tool at a large tertiary care pediatric hospital in the Midwest. Patients were obtained by a convenience sample and inclusion criteria included cardiac patients with a procedure in the OR who recovered in the cardiac PICU. A chart review was completed and compared the post-implementation time period of a 90 day time frame in February 2015-May 2015. This information was compared to the same 90 day time period in 2014 and results were compared to the 2015 information. Data was collected from the electronic health record including pressure ulcer incidence, any skin injury, and preventative strategies taken to prevent progression of pressure ulcers in patients that fit the inclusion criteria.
Results/Discussion. It was found that there was a significant increase in pressure ulcer preventative strategies used in the post-intervention group in 2015 compared to the 2014 group. The preventative strategies were used as a result of the use of the Braden Q+P tool. There was not a statistically significant decrease in the incidence of pressure ulcers. The 2014 group had 4 pressure ulcers and the 2015 had only one pressure ulcer. The implementation of the Braden Q+P tool did show improved communication between the OR and the cardiac PICU teams and created a standardized method to communication information about the patient’s skin in the handoff. There were barriers identified to completing the Braden Q+P form completely, however when there was a charted concern of the patient’s skin integrity, these forms were found to be fully completed.
Conclusion/Clinical Implications. The use of a skin assessment tool was found to improve handoff communication between the OR and cardiac PICU teams. Implementation of the tool was also shown to increase use of preventative interventions to help decrease the incidence or progression of pressure ulcers. This tool could be used in the future for all pediatric post-operative patients to prevent the progression and incidence of pressure ulcers. Implementing the Braden Q+P tool into the electronic health record and making it visible to all care teams would be recommended.