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Solutions for Patient Safety Fall 2020 Learning Session Abstracts

Utilizing Skin Rounds and Kamishibai Cards to Prevent DTPIs in Hospitalized Children: Hassenfeld Children’s Hospital at NYU Langone Health

Fuller, Jacquelyn MSN, RN; Angert, Robert MD; Fisher, Jason C. MD; Kerns, Rebecca MPP; Jones, Koren MPH; Haines, Elizabeth DO

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Pediatric Quality and Safety: March/April 2021 - Volume 6 - Issue - p e448
doi: 10.1097/pq9.0000000000000448
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In FY2018, Hassenfeld Children’s Hospital (HCH) deep tissue injury (DTPI) rate was 0.55 DTPIs per 1,000 patient days compared to the SPS centerline of 0.179 DTPIs per 1,000 patient days.


We aimed to decrease our DTPI rate by 50% by August 31, 2019. Our objectives were to increase opportunities to observe practice and provide real-time education to frontline staff utilizing Kamishibai Cards and develop local interdisciplinary champions to lead prevention efforts. We hypothesized that shifting the focus to observation of practice and real-time education rather than PI bundle element documentation would empower bedside nurses to drive prevention efforts and decrease our DTPI rate.


Twice weekly, pediatric units participate in interdisciplinary skin rounds led by a unit-based nursing champion and a physical or occupational therapist. This team observes the bedside nurse perform offloading of heels, offloading and rotating of devices, and turning and positioning of the patient and performs a K-Card observation to deliver real-time feedback. K-Card observations reveal opportunities for improvement that are acted upon immediately rather than retrospectively based on EMR documentation review. Our work is sustained through monthly multidisciplinary meetings that promote sharing best practices and unit PI prevention binders that include important protocols and reference materials.


The HCH DTPI rate decreased by 79%, from 0.55 DTPIs per 1,000 patient days in FY2018 to 0.117 DTPIs per 1,000 patient days in FY2019. In FY2020, we further reduced our rate to 0.061 DTPIs per 1,000 patient days (Figure 1). Our safety culture has matured to proactive PI prevention at the bedside, quick identification of high-risk patients, and escalation of concerns.


Observational skin rounds and bedside nurse engagement have been foundational to DTPI prevention efforts. An emphasis on observation of practice reveals opportunities for improvement and real-time education. Skin Rounds empower staff to share concerns that are acted upon immediately to provide safe care for the patient.

Fig. 1.
Fig. 1.:
Deep tissue injury rate. © Copyright 2020, Solutions for Patient Safety (SPS). All rights reserved. This document was created as part of the quality assessment and peer review activities of SPS Learning Network, and the underlying information used to create this document is not subject to discovery pursuant to ORC Section 2305.25, 2305.251, 2305.252, and 2305.253. Any disclosure, copying, distribution or use of this information is prohibited without the express permission of SPS.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.