PRESSURE ULCERS AND PREVENTION AMONG PEDIATRIC PATIENTS AND FACTORS ASSOCIATED WITH THEIR OOCCURENCE IN ACUTE CARE HOSPITALS

Abstract

Abstract Introduction: Pressure ulcers are a health-care concern for all patient populations; however, younger patients, including infants, have different etiologies associated with pressure ulcer development. The influence of hospital, unit, and nursing factors on hospital-acquired pressure ulcers (HAPU) rates have not been evaluated in pediatric patients. Comparative data for pediatric patients is necessary for hospitals to improve the care related to prevention and treatment of pediatric pressure ulcers. Purpose: The purpose of this study was to describe (a) the pressure ulcer prevalence rate and the rate of HAPU in pediatric patients; (b) the frequency of patient pressure ulcer risk assessment and prevention interventions; and (c) patient pressure ulcer risk and prevention interventions, microsystem factors, and mesosystem factors associated with HAPU among pediatric patients in U.S. hospitals. Method: A descriptive correlational secondary analysis was performed on National Database for Nursing Quality Indicators® (NDNQI®) pressure ulcer data for 2012. Results: This study found a pressure ulcer prevalence of 1.4% and a 1.1% rate of HAPU among pediatric patients 1 day to 18 years of age. HAPU rates were highest among children ages 9 to18 years (1.6%) and ages 5 to 8 years (1.4%) and among patients in the pediatric critical care units (3.7%) and pediatric rehabilitation units (4.6%). Most of the HAPU were Stage I and Stage II pressure ulcers (65.6%); 14.3% were suspected Deep Tissue Injury and 10.1% were unstageable pressure ulcers. The odds for a HAPU were 9.42 times higher among patients who were determined to be at risk for pressure ulcers (OR = 9.42, 95% CI [7.28, 12.17], p <.001) compared to those patients not at risk for pressure ulcers. Patients from pediatric hospitals had 2.67 higher odds for a HAPU compared to patients from nonpediatric hospitals (OR = 2.67, 95% CI [1.5, 4.76, p = .001). Among the 11,203 pediatric patients at risk for pressure ulcers, 95.8% received one or more prevention interventions. There were no prevention interventions associated with lower HAPU. Conclusions: Acutely ill children develop pressure ulcers. Study findings provide baseline data on HAPU among hospitalized children and microsystem and mesosystem factors associated with their HAPU.