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Ciprandi G, Crucianelli S, Zama M, Antonielli G, Armani R, Aureli S, Barra G, Beetham CJC, Bernardini G, Cancani F, Carai A, Cajozzo M, Carlesi L, Cialdella A, Ciaralli I, Ciliento G, Corsetti T, De Chirico B, Di Corato P, Dotta A, Filippelli S, Franci M, Frattaroli J, Grussu F, Lico S, Losani P, Giergji M, Magli S, Marino SF, Mongelli A, Nazzarri M, Pace M, Palmieri G, Pannacci I, Paparozzi F, Pomponi M, Portanova A, Preziosi A, Ragni A, Raponi M, Renzetti T, Rizzo M, Roberti M, Sasso E, Savarese I, Secci S, Selvaggio D, Serafini L, Spuntarelli G, Urbani U, Vanzi V, Permatunga R, Santamaria N. The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study. Int Wound J 2022; 19:1887-1900. [PMID: 36250520 PMCID: PMC9615277 DOI: 10.1111/iwj.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022] Open
Abstract
The prevention of hospital‐acquired pressure injuries (HAPIs) in children undergoing long‐duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long‐duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi‐modal, multi‐disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long‐duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long‐duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence‐based, multi‐modal, multidisciplinary HAPI prevention strategy.
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Affiliation(s)
- Guido Ciprandi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Serena Crucianelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mario Zama
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Antonielli
- Operative Unit of Odontostomatology, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Riccarda Armani
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Stefano Aureli
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gianmarco Barra
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | | | - Giulio Bernardini
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Federica Cancani
- Emergency Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Carai
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marta Cajozzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Carlesi
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Cialdella
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Italo Ciaralli
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gaetano Ciliento
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tiziana Corsetti
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Benedetta De Chirico
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Paolo Di Corato
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Sergio Filippelli
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marina Franci
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Jacopo Frattaroli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Francesca Grussu
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Silvia Lico
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Patrizia Losani
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marjola Giergji
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simonetta Magli
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Faustino Marino
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Antonella Mongelli
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Martina Nazzarri
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mauro Pace
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Palmieri
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Ilaria Pannacci
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Franca Paparozzi
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Manuel Pomponi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Anna Portanova
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Preziosi
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Angela Ragni
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Massimiliano Raponi
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tommaso Renzetti
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mirialda Rizzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marco Roberti
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Eleonora Sasso
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Secci
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Daniele Selvaggio
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Serafini
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giorgio Spuntarelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Urbano Urbani
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Valentina Vanzi
- Division of General and Specialized Pediatrics, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Roshani Permatunga
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Santamaria
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
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Luo WJ, Zhou XZ, Lei JY, Xu Y, Huang RH. Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit. World J Clin Cases 2021; 9:10956-10968. [PMID: 35047606 PMCID: PMC8678852 DOI: 10.12998/wjcc.v9.i35.10956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children. However, the performances of those scales have not yet been compared in China.
AIM To compare the Waterlow, Braden Q, and Glamorgan scales, and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit (PICU).
METHODS Trained nurses used the Waterlow, Braden Q, and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital (China) within 24 h of admission from May 2017 to December 2020 in two stages. Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.
RESULTS The incidence of pressure ulcers was 3/28 (10.7%) in the PICU and 5/314 (1.6%) in the general pediatric ward. For children in the general ward, the Waterlow, Braden Q, and Glamorgan scales had comparable area under the operating characteristic curve (AUC) of 0.870, 0.924, and 0.923, respectively, and optimal cut-off values of 14, 14, and 29 points. For PICU, the Waterlow, Braden Q, and Glamorgan scales had slightly lower AUC of 0.833, 0.733, and 0.800, respectively, and optimal cut-off values of 13, 16, and 27 points. Braden Q demonstrated a satisfactory specificity, and during the second stage of the study for PICU patients, the AUC of the Braden Q scale was 0.810, with an optimal cut-off value of 18.35 points.
CONCLUSION The Waterlow, Braden Q, and Glamorgan scales have comparable performance, while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.
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Affiliation(s)
- Wen-Jun Luo
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Xue-Zhen Zhou
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Jia-Ying Lei
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Ying Xu
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Rui-Hua Huang
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
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