(1273) Reinforcing Pressure Ulcer Prevention Through Hospital-Wide In Situ Simulation-Based Nurse Education

Introduction: Pressure ulcers (PU), though relatively rare, can result in significant morbidity among hospitalized children. At Children's Hospital of Illinois, PU prevention efforts lacked standardization and efficient compliance monitoring, leading to a PU rate of 0.283/1000 patient days as of January 2023, compared to the national average of 0.127/1000 patient days. To address this issue, a QI project was initiated with the objectives: (a) implement standardized care for PU prevention using in-situ simulation exercises, (b) establish robust compliance monitoring.

Methods: The project commenced in January 2023 with the design and development of 3 PU manikins representing neonatal, infant, and child patients for point-of-care nursing education. 14 PU were accurately replicated on the manikins based on real patient events. Furthermore, an evidence-based PU prevention bundle comprising 18 questions across 5 elements was adapted from Solutions for Patient Safety guidelines. Nursing education included comprehensive training on risk scoring using the Braden QD Scale, wound assessment classification, and competency assessments. Compliance was assessed using a Redcap-based tool. Outcome was rate of stage 3/4 and unstageable PU/1000 patient days.

Results: Compliance assessment with the PU prevention bundle commenced in 04/2023, while in-situ nursing education began 06/2023. Over a two-month period, 73% (62/85) of ICU nurses, 70% (16/23) of oncology nurses, 88% (36/41) of general pediatric nurses, and 78% (107/138) of neonatal nurses were trained through situational simulations. A total of 46 compliance assessments were conducted, with 23 conducted before the education initiative (04-05/23) and 23 after (06-07/23). The number of audits fully compliant across all 5 elements increased from 56% (13/23) to 70% (16/23), showing a positive trend (p=0.07). The most notable improvement was observed in element 3 (patient positioning), where compliance increased from 65% to 83%. Hospital sustained 0 PU rate from 02-05/23, 0.355 in 06/23, no PUs were recorded in 07/23.

Conclusions: Innovative simulation-based training that mirrors real patient events, coupled with diligent compliance monitoring, can significantly enhance nursing skills and drive positive changes in practice, ultimately elevating patient safety levels.