Journal Logo

Learning Session Abstract

A Systems Approach to Reducing the Rate of Pediatric Pressure Injury and Preventing Harm

Eizyk, Shelly RN, MSN, PCCN, CCRN, WCC; Ferdon, Kandice R. MSN, RN; Schaffer, Patricia L. MSN, RN; Gronauer, Jennifer M. MS, RRT-NPS; Chitkara, Rachelle A. RN-NIC; McGuane, Kristina A. BSN, RN, WCC, CWON; White, Cynthia C. MS, RRT-NPS, FAARC

Author Information
Pediatric Quality and Safety: March/April 2020 - Volume 5 - Issue - p e275
doi: 10.1097/pq9.0000000000000275
  • Open


Hospital-acquired pressure injuries (HAPIs) result in harm that impacts patients, families, and caregivers. The physical, emotional, and financial burden are significant, costing $9.1–$11.6 billion annually. The HAPI rate is a national measure of quality and is reported and benchmarked internally as well as externally


To decrease the overall rate of stage 2, pressure injuries per 1,000 patient days from 1.17 to 0.77 by July 31, 2019.


Utilizing the model for improvement, we determined smart aims, developed a key driver diagram, mapped failure modes, and tested interventions using Plan, Do, Study, Act (PDSA) cycles. Interdisciplinary subteams were formed, consisting of Registered Nurses (RNs) and Registered Respiratory Therapists (RRTs) from critical care and medical-surgical units. The teams focused on respiratory devices, Electroencephalogram (EEG) leads, tubing, and staff education and coaching to reduce pressure injuries. Using multiple PDSA cycles, teams tested the following interventions: (1) RNs and RRTs conducted multidisciplinary skin rounds; (2) frontline teams used weekly pressure injury data to identify trends and practices that needed coaching. Learnings were shared organically across unit boundaries; (3) skin champions and wound teams actively coached at the bedside to empower front line staff to identify barriers to care and mitigation strategies; and (4) skin champions engaged patients and families during rounds.


A 48% reduction in stage II pressure injuries from 0.96 to 0.5 per 1,000 patient days was achieved in Q2. For the same period, we achieved an 81% reduction in serious pressure injuries (stage 3, 4, and unstageable) from 0.16 to 0.03 per 1,000 patient days. Interdisciplinary collaboration across the system with an intentional focus and application of a differentiated practice model resulted in significantly reduced serious harm and stage II pressure injuries.

Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.