Care Bundles Can Reduce Hospital-Acquired Pressure Injuries

Care Bundles Can Reduce Hospital-Acquired Pressure Injuries 150 150 Brianne Moore

Reliable implementation of care bundles reduces the number of serious hospital-acquired pressure injuries

Hospital-acquired pressure injuries (PI) are a significant cause of preventable harm that can increase hospitalization costs and length of stay. Up to 27 percent of pediatric intensive care unit (PICU) patients and up to 23 percent of neonatal intensive care unit (NICU) patients sustain PIs in the hospital, according to recent literature. Treatment of a single PI can cost $20,000 or more.

A recent study published in Pediatric Quality and Safety demonstrates the effectiveness of using care bundles to avoid hospital-acquired PIs in children. Care bundles are sets of evidence-based interventions that result in improved outcomes when reliably implemented.

“The study aimed to do two things: more accurately report the incidence of pressure injuries, and then reduce their incidence,” says Gary Frank, MD, MS, chief quality and patient safety officer at Children’s Healthcare of Atlanta and lead author of the study. “Before we can reduce a problem, we need to understand its actual size.”

The Children’s Hospitals Solutions for Patient Safety (SPS) Network is a network of over 100 pediatric institutions dedicated to eliminating hospital-acquired patient harm. Each of the original 33 SPS hospitals participated in the collaborative effort to reduce the incidence of serious PIs. The authors recognized that PIs tend to be underreported, so the initial focus was to increase reporting through the use of active surveillance, which involves a team of experts (e.g., wound-ostomy certified nurses, pressure injury prevention champions) assessing all patients on a given unit for pressure injuries on a routine basis, preferably weekly. This proved to be an effective strategy with the authors reporting a statistically significant increase in the number of early PIs (Stage 2). In addition, bundle implementation led to a statistically significant decrease in more serious pressure injuries (Stage 3 and 4).

The second phase of the study used funnel chart analysis to independently analyze the impact of each of the bundle elements in a larger cohort of 64 hospitals. The authors determined that the hospitals that adopted each bundle element, measured compliance and achieved 80 percent bundle compliance (reliability) had the lowest PI rates.

“Interestingly, we found that, in some cases, hospitals that implemented a bundle element but did not monitor how reliably it was administered had significantly higher PI rates – even more than hospitals that didn’t implement the bundle element at all,” adds Dr. Frank.

“It just goes to show that if an institution wants to make a change, it needs to be deliberate. Our data shows that pressure injuries are underreported – if an institution doesn’t think pressure injuries are a problem, our results show that that is almost never true. It’s not enough to just use the bundle, you need to monitor it and use it reliably in order for reduction to occur.”

The research team continues to focus on the importance of active surveillance and reliable bundle implementation. The team is also trying to understand best practices for reduction of specific device related PIs.



Frank G, Walsh KE, Wooton S, Bost J, Dong W, Keller L, Miller M, Zieker K, Brilli RJ. Impact of a pressure injury prevention bundle in the solutions for patient safety networkPediatric Quality and Safety. 2017 Mar/Apr;2(2)e013.

About the author

Brianne is interning as a science writer and editor for Clinical & Research Communications at Nationwide Children's Hospital. She contributes to a variety of publications, including Pediatrics Nationwide and PediatricsOnline.