P0525 / #423: REPOSITIONING GUIDELINES TO DECREASE PRESSURE INJURIES IN THE PEDIATRIC INTENSIVE CARE UNIT

Abstract

Aims & Objectives: Objectives: Critically ill patients in the PICU are at risk of pressure injury (PI), particularly when hemodynamic instability is a barrier to repositioning. The objective of this project was to create evidence-based repositioning guidelines for hemodynamically unstable PICU patients and test the effectiveness of guideline implementation on PI incidence. Methods: Methods: A pre-post observational design was used for the QI project, comparing the at risk population for 21 weeks before guideline implementation (August 2018-January 2019) and for 21 weeks post-implementation (August 2019-January 2020). PICU nurses completed surveys to identify barriers to intervention and an interdisciplinary consensus panel developed guidelines for repositioning hemodynamically unstable patients. All PICU patients age 0 to 36 months sedated for invasive mechanical ventilation with a Braden Q score ≤ 18 were eligible for inclusion. Repositioning was measured every 2 hours; full turn (300), partial turn (150), unable to turn due to hemodynamic instability or noncompliance. The primary outcome was incidence of Stage II or higher PI. Results: Results: Pre-implementation survey data revealed 16.4% of nurses (n=68 respondents) identified confidence in identification of hemodynamic instability parameters. In the pre-implementation period, 19 of 116 (15%) patients developed PI compared to 2 of 100 (2%) patients after implementation of the repositioning guidelines (p<0.001). The anatomical location of PI pre-implementation was occipital (68%), device related (27%) and heel (5%). Post-implementation identified occipital (50%) and device related (50%). Conclusions: Conclusions: A standard methodology for repositioning hemodynamically unstable PICU patients reduces pressure injury. New measurement of compliance provides an accurate and specific description of repositioning.