Harm Range: Minimal temporary harm to moderate permanent harm.
Pressure injuries occur in 10% to 27% of pediatric cases and frequently progress to a more serious stage of injury after initial detection. Once an injury reaches stage 3, it may become a sentinel event. Risk and location of pressure injuries in children differ from adults due to varying skin maturity and body proportions. By ages 6 to 10, injury locations resemble those of adults, and by age 8 skin formation is comparable to adults. Pressure injuries commonly occur on the head and are often caused by pressure from braids and extensions or devices such as cervical collars, respiratory equipment (i.e., CPAP/BiPAP masks), EEG leads, restraints, and immobilization gear.
Contributing factors may include:
- Lack of clarity around pressure injury guidelines, orders, and care expectations — particularly in medically complex patients.
- Unclear processes for wound team consultation, documentation, and ordering.
- Inadequate and varied cadence of full skin assessments each shift and upon admission.
- Failing to include the family in the patient’s care, specifically during transitions of care.
- Deficient documentation of skin assessments.
- Using equipment and devices without adequate rotation, training, or skin assessment of the underlying site.
Development and progression of pressure injuries have resulted in adverse outcomes, including need for surgical intervention, temporary loss of function or injury, and increased length of recovery.
Recommendations
- Include order sets, consultations, and utilization of the Braden QD scale to identify notification of high-risk patients in the EHR to ensure best practices and decrease human factors.
- Standardize communication between disciplines by using note templates and nurse rounding tools during handoff and multidisciplinary huddles.
- Consider taking a daily photo of the skin concern that includes the location, laterality, measurements, and patient identification as a point of reference.
- Develop clear and direct guidelines, roles, and expectations within teams, particularly related to high-risk patients, wound care consultations, standard skin protection and padding, and authorization of patient mobility and device removal.
- Complete an assessment of equipment, resources, and tools, as well as viable alternatives.
- Integrate patients and families into the care plan and in the identification of high-risk patients.
- Consider developing a care team in collaboration with leadership to review high-risk patients at a designated interval.
Resources
- Solutions for Patient Safety, Pressure Injuries (PI) Operational Definition and Bundle
- National Pressure Injury Advisory Panel, Resources
References
- Journal of Tissue Viability, Prevention of pressure injuries in critically ill children: A preliminary evaluation, 2020
- Journal of Tissue Viability, Analysis of the prevalence and risk factors of pressure injuries in the hospitalized pediatric population: A retrospective study, 2023
- The Joint Commission, Quick safety 25: Preventing pressure injuries, Updated March 2022
This safety watch is approved for general distribution to improve pediatric safety and reduce patient harm. This safety watch meets the standards of non-identification in accordance with 3.212 of the Patient Safety Quality Improvement Act (PSQIA) and is a permissible disclosure by Child Health PSO. In accordance with our Terms of Use and Code of Conduct, this material cannot be used for any commercial transactions that are unrelated to the original intent of Child Health PSO Patient Safety Action watch.
