O0440 Oct.5: 4:16pm - Reduction in Hospital Associated Pressure Injuries for Pediatric Extracorporeal Membrane Oxygenation Patients with Provider Education

Introduction: Pediatric patients are immobilized for certain procedures such as extracorporeal membrane oxygenation (ECMO). These procedures place the patient at high risk for developing hospital acquired pressure injuries (HAPI). The purpose of this quality improvement initiative was to implement HAPI prevention interventions and provider education and to evaluate the rate of HAPI occurrence in ECMO patients before and after implementation. We hypothesized that the number of ECMO patients who developed a HAPI would decrease.

Methods: All patients < 18 years old who were placed on ECMO at a university-based children’s hospital from 1/2012-3/2020 were identified. In 8/2018, the quality improvement initiative with implementation of HAPI education began which included: targeted HAPI prevention and ECMO provider education, Z-flow pillow provider education, and the addition of 2 wound care interventions for ECMO patients. This education was continued from 8/2018 until 12/2018 to reach all pediatric and neonatal intensive care unit (ICU) providers. Patients were categorized by year of ECMO cannulation and presence or absence of HAPI. The primary outcome was the development of a HAPI. Data were analyzed with chi-squared test.

Results: There were 116 ECMO patients identified and 5 (4.3%) developed a HAPI. All HAPI ECMO patients were cannulated in their right neck, with 60% (n=3) of them on veno-arterial (VA) ECMO with the other 40% (n=2) initiated on veno-venous (VV) and converted to veno-arterial (VA) EMCO. The median age for patients who developed HAPI was 31 days [IQR 8.5-211 days]. The median duration from the time of ECMO cannulation to HAPI development was 14 days [IQR 7-22 days]. The median total run time was 205 hours [IQR 150.5-744.5 hours]. All patients developed HAPI in their occipital region and one had an additional HAPI on their back. The HAPI rate was as follows by year: 7.7% in 2012, 0% in 2013, 0% in 2014, 0% in 2015, 4.6% in 2016, 0% in 2017, 20% in 2018, 0% in 2019, 0% so far in 2020. The overall HAPI rate dropped from 4.8% of ECMO patients prior to implementation of provider education to 0% of ECMO patients after completion of all interventions (p>0.99).

Conclusions: Overall, the development of HAPI in pediatric patients on ECMO was low (4.3%). Implementation of ICU provider education was successful at reducing the rate of HAPI development in pediatric ECMO patients.