162 - From Paper to Pocket: Digitally Implementing a Pressure Injury Care Bundle in the PICU

Publication Number: 3156.162

Axel Ivander, Johns Hopkins Children's Center, Baltimore, MD, United States; Sirisha Yalamanchi, Rutgers, Robert Wood Johnson Medical School, Lincroft, NJ, United States

Background: Pressure injuries (PI) cause significant morbidity and cost in critically ill children, with PICU prevalence ranging from 7–44%. Neonates and infants are especially vulnerable due to immature skin and device use. Our institution introduced a PI Care Bundle in 2019, but bedside accessibility remained limited. Mobile health platforms may improve bundle adherence, however, pediatric data is limited.

Objective: To implement a mobile web application integrating the institutional PI Care Bundle and evaluate its impact on nursing satisfaction and accessibility.

Design/Methods: A quality improvement study was conducted in a tertiary PICU. A web-based mobile application (“mAPP”) incorporating the PI Care Bundle was developed for real-time bedside use. Three 3-month Plan-Do-Study-Act (PDSA) cycles (March 2024–March 2025) guided iterative design improvements. Nursing feedback was collected through pre- and post-intervention surveys based on validated mHealth application quality criteria. Application usage analytics and bundle documentation data were also tracked.

Results: Before implementation, 33% of nurses knew how to access the PI bundle. Post-implementation, 100% reported awareness and accessibility, with satisfaction rising from 33% to 100%. Survey scores showed consistent improvements in design, organization, and usability across cycles. Application traffic demonstrated uptake, with 200 total visits and return rates increasing from 31% (cycle 1) to 74% (cycle 3). Nurses endorsed the mAPP as reducing workload and improving care quality.

Conclusion(s): A mobile web-based application increased accessibility and satisfaction with PI bundle use in the PICU. Further study will evaluate its effect on PI incidence.

App Utilization Metrics Across PDSA Cycles
IMG_0099.jpegTrends in app engagement from three sequential Plan-Do-Study-Act (PDSA) cycles demonstrate progressive adoption and sustained use of the mobile web-based Pressure Injury (PI) bundle application. Return rate and bounce rate improved across cycles, with users increasingly revisiting the app and spending time on key pages.

Nursing Survey Scores on App Quality and Usability
IMG_0100.jpegNursing survey results based on validated mHealth app quality assessment criteria showed consistent improvement across domains of design, information quality, and subjective usability through three PDSA cycles. Overall app rating increased from 4.78 to 4.89, reflecting enhanced satisfaction, intuitive design, and perceived impact on workflow and care quality.