Learning Objective 1: identify risks involved in the development of occipital pressure ulcers in neonates.
Learning Objective 2: identify at least two different interventions that can be used for the prevention of occipital pressure ulcers in neonates.
Problem: Immobilized acutely ill pediatric patients are at risk for developing pressure ulcers. Open heart surgery patients are at greater risk due to the inability to establish a routine turning schedule due to internal and external jugular catheters. The most common area for neonates to develop pressure ulcers is on the occipital area due to weight distributions of neonates. This University teaching hospital had eight hospital acquired occipital pressure ulcers in 2009. Most evidenced based research in pressure ulcer development in the pediatric population has been based on adult studies.
Intervention: A multidisciplinary team approach which consisted of a Plastic Surgeon, Registered Nurses, Physical Therapist, and a Dietician met weekly to develop plans and interventions specific for patient needs. Pressure redistribution surfaces and silicone foam padding were stocked on the pediatric peri-operative carts and in the Pediatric Intensive Care Units (PICU) for immediate use in immobilized patients. A nurse champion for pressure ulcer prevention was selected for the PICU who educated nurses and physicians, promoted the interventions, and monitored the patients for pressure ulcer development along with the quarterly pressure ulcer surveys.
Comparison: The previous practice for the prevention of pressure ulcers in the PICU consisted of the use of a gel mattress. These patients were difficult to reposition and thus repositioning was sporadic at best.
Outcome: Eighteen months after the intervention there have been no hospital acquired pressure ulcers in the PICU despite the high risk nature of this patient population. Evidenced-based clinical practice guidelines for prevention of pressure ulcers in the pediatric population are needed.