1
|
Zeng M, Li Y, Hu J, Peng M, Hu Y, Zhou C. Effect of various repositioning regimens on pressure wound ulcer occurrence in at-risk adult persons without existing pressure wound ulcers: A meta-analysis. Int Wound J 2023; 20:3776-3785. [PMID: 37381159 PMCID: PMC10588354 DOI: 10.1111/iwj.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
Meta-analysis research was implemented to appraise the effect of various repositioning regimens (RRs) on pressure wound ulcer (PWU) occurrence in at-risk adult persons without existing PWUs. Inclusive literature research till April 2023 was done and 1197 interconnected researches were revised. The 15 picked researches, enclosed 8510 at-risk adult persons without existing PWUs persons were in the utilised researchers' starting point, 1002 of them were utilising repositioning, 1069 were control, 3443 were utilising 2-<4 h repositioning and 2994 were utilising 4-6 h repositioning. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of various RRs on PWU occurrence in at-risk adult persons without existing PWUs by the dichotomous approach and a fixed or random model. Repositioning had significantly lower PWU (OR, 0.49; 95% CI, 0.32-0.73, p < 0.001) compared to control in at-risk adult persons without existing PWUs persons. 2-<4 h repositioning had significantly lower PWU (OR, 0.62; 95% CI, 0.42-0.90, p = 0.01) compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. Repositioning had significantly lower PWU compared to control in at-risk adult persons without existing PWU persons. 2-<4 h repositioning had significantly lower PWU compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of some of the chosen research found for the comparisons in the meta-analysis.
Collapse
Affiliation(s)
- Mei Zeng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yuan Li
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Juan Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Miao Peng
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yingchun Hu
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Chengli Zhou
- Department of Emergency MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| |
Collapse
|
2
|
Ciríaco GV, Menezes-Júnior LAAD, Oliveira WWD, Talvani A, Turbino Ribeiro SML. Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors. Clin Nutr ESPEN 2023; 55:285-291. [PMID: 37202058 DOI: 10.1016/j.clnesp.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). METHODS This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. RESULTS A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p < 0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1 kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). CONCLUSION Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.
Collapse
Affiliation(s)
| | - Luiz Antônio Alves de Menezes-Júnior
- Pós-doctorate Researcher in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto. Ouro Preto, Minas Gerais, Brazil.
| | - Wandeir Wagner de Oliveira
- Department of Family Medicine, Mental Health and Public Health, School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - André Talvani
- Associate Professor in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | | |
Collapse
|
3
|
de Souza GKC, Kaiser DE, Morais PP, Boniatti MM. Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients. Aust Crit Care 2023; 36:195-200. [PMID: 35232616 DOI: 10.1016/j.aucc.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Pressure injury is damage to the skin and underlying soft tissue that occurs in response to intense and/or prolonged skin pressure. The Braden scale is the most used in health services to assess pressure injury. However, this scale was not specifically developed for critically ill patients. The Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) scale was developed for patients in intensive care units. OBJECTIVE The objective of this study was to compare the accuracy of the CALCULATE scale with that of Braden in predicting the risk of pressure injury in critically ill patients. METHODS This was a prospective cohort study, involving patients who did not have pressure injury on admission to the intensive care unit of a tertiary hospital in the city of Porto Alegre, Brazil. Data collection took place between January and July 2020 using the Braden and CALCULATE scales, in addition to clinical and sociodemographic variables. Patients were followed up until discharge from the intensive care unit or death. RESULTS Fifty-one patients were included in the study. Of these, 29 (56.9%) developed pressure injury. To predict pressure injury onset, the areas under the receiver operator characteristic curve of the Braden scale on the first day and the lowest score during the first 3 days were 0.71 (0.56-0.86) and 0.70 (0.53-0.87), respectively. The areas under the receiver operator characteristic curve of the CALCULATE scale on the first day and the highest score during the first 3 days were 0.91 (0.82-0.99) and 0.92 (0.85-1.00), respectively. In the logistic regression analysis, the CALCULATE scale on the first day remained an independent predictor of pressure injury onset after controlling for age and length of stay in the intensive care unit. CONCLUSION We found that the CALCULATE scale may be more accurate than the Braden scale as a tool to assess the risk of developing pressure injury in critically ill patients.
Collapse
|
4
|
Levido A, Fulbrook P, Barakat-Johnson M, Campbell J, Delaney L, Latimer S, Walker RM, Wynne R, Doubrovsky A, Coyer F. Pressure injury prevention practice in Australian intensive care units: A national cross-sectional survey. Aust Crit Care 2023; 36:186-194. [PMID: 34955332 DOI: 10.1016/j.aucc.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs. MATERIALS AND METHODS An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location. RESULTS Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026). DISCUSSION AND CONCLUSION This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.
Collapse
Affiliation(s)
- Annabel Levido
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Australia; Research & Practice Development Unit, The Prince Charles Hospital, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Michelle Barakat-Johnson
- Hospital-Acquired Complication Operational Coordinator for Pressure Injury, Sydney Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Australia.
| | - Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Lori Delaney
- School of Nursing, Queensland University of Technology, Australia.
| | - Sharon Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Gold Coast Hospital and Health Service, Australia.
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Menzies Health Institute QLD, and the Division of Surgery, Princess Alexandra Hospital, Australia.
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Marcel Crescent Blacktown, NSW, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Fiona Coyer
- Joint Appointment School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK.
| |
Collapse
|
5
|
Asiri S. Turning and Repositioning Frequency to Prevent Hospital-Acquired Pressure Injuries Among Adult Patients: Systematic Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231215209. [PMID: 38050921 DOI: 10.1177/00469580231215209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Turning and repositioning is considered one of the strategies to reduce the incidence of pressure injuries (PIs) among hospitalized patients, as it helps to redistribute and minimize direct pressure on the targeted skin and enhance blood perfusion in the affected areas. The frequency of turning and repositioning is generally uniform across clinical settings, with most clinical guidelines recommending a substantial change in a patient's position according to their health status. Notably, the optimal time interval between the position changes has not yet been established. Therefore, this study aimed to review the current literature in relation to the frequency of turning and repositioning adult patients to prevent PIs. The author used a systematic review following Whittemore and Knafl's review strategy. The author used the following databases: CINAHL, Scopus, PubMed, ProQuest, Ovid, MedLine, Web of Science, and Google Scholar. During the search, Boolean logic operators, MeSH terms, and keywords were utilized. The researcher followed the Johns Hopkins Nursing Evidence-based Practice Grading Scale to evaluate the quality of selected studies. The search yielded 723 articles, of which 10 were included in this review. These 10 articles revealed several frequency intervals for comparison purposes: 2-hourly, 3-hourly, 4-hourly, and 6-hourly depending on the healthcare setting, with a combination of supine, 30° tilt, or 90° tilt. This review shows that the optimal frequency of turning and repositioning to prevent PIs remains unclear and further investigation is necessary. Considering the varying nature of clinical settings, there is a lack of clarity regarding a golden standard for the same. Therefore, patients' health conditions should be considered when choosing the proper frequency to prevent PIs.
Collapse
|
6
|
Mazzetti G, Sciolino L, Guglielmi D, Mongardi M, Nielsen K, Dawson J. Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation. J Nurs Manag 2022; 30:4294-4303. [PMID: 36190738 PMCID: PMC10092892 DOI: 10.1111/jonm.13827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIMS This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes. BACKGROUND Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources. METHODS Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models. RESULTS A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level. CONCLUSIONS Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices). IMPLICATIONS FOR NURSING MANAGEMENT In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.
Collapse
Affiliation(s)
- Greta Mazzetti
- Department of Education StudiesUniversity of BolognaBolognaItaly
| | - Lorenzo Sciolino
- Hospital Care Service, General Direction for People Care, Health and WelfareEmilia‐Romagna RegionBolognaItaly
| | - Dina Guglielmi
- Department of Education StudiesUniversity of BolognaBolognaItaly
| | - Maria Mongardi
- Infectious Diseases Division, Diagnostics and Public Health DepartmentUniversity of VeronaVeronaItaly
| | - Karina Nielsen
- Sheffield University Management SchoolThe University of SheffieldSheffieldUK
| | - Jeremy Dawson
- Sheffield University Management SchoolThe University of SheffieldSheffieldUK
- School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUK
| |
Collapse
|
7
|
Everett Day S, Koirala B, McIltrot K. Repositioning Strategies to Prevent Pressure Injuries in the ICU: Integrative Review on Implementation Factors. Adv Skin Wound Care 2022; 35:344-351. [PMID: 35426838 DOI: 10.1097/01.asw.0000821772.03685.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To survey the literature to gain insight into nursing facilitators of and barriers to implementation of positioning/turning strategies to prevent hospital-acquired pressure injuries (PIs) in adult critical care patients. DATA SOURCES This integrative review surveyed literature across databases including PubMed, CINAHL, Embase, and Cochrane Library, and through hand searching. STUDY SELECTION Key terms included "pressure ulcer" OR "pressure sore*" OR "pressure injur*" AND "patient positioning" OR "turn" OR "turning" OR "patient repositioning" AND "critical care" OR "intensive care unit*" OR "inpatient*" AND "prevent*." Peer reviewed, English language articles published within the past 10 years were included. Inclusion and exclusion criteria narrowed the database yield to 432 articles. After title/abstract and full text review, 11 articles were included. DATA EXTRACTION Articles were appraised using the PRISMA flow diagram and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool. Data was extracted and major themes were identified. DATA SYNTHESIS The identified themes were synthesized into factors that facilitated or impeded the nursing implementation of turning/repositioning strategies to prevent hospital-acquired PIs. Facilitators were the use of verbal cues and alerts to improve compliance and nursing education on PI prevention. Barriers to successful implementation were increased nursing workload or burden, lack of staff, and perceived hemodynamic instability in ICU patients. CONCLUSIONS Future interventions can be tailored to mitigate barriers and reinforce facilitators to improve nursing compliance with repositioning/turning strategies. Increased compliance with these measures could aid in PI prevention in adult ICU patients.
Collapse
Affiliation(s)
- Symone Everett Day
- Symone Everett Day, BSN, RN, is Registered Nurse, Suburban Hospital, Bethesda, Maryland, United States. At Johns Hopkins School of Nursing, Baltimore, Maryland, Binu Koirala, PhD, MGS, RN, is Assistant Professor; and Kimberly McIltrot, DNP, CRNP, CWOCN, CNE, FAANP, FAAN, is Assistant Professor and DNP Program Director. The authors have disclosed no financial relationships related to this article. Submitted March 2, 2021; accepted in revised form May 11, 2021
| | | | | |
Collapse
|
8
|
Langemo D, Anderson J, Hanson D, Thompson P, Johnson E. The Conundrum of Turning/Repositioning Frequency, Sleep Surface Selection, and Sleep Disruption in Preventing Pressure Injury in Healthcare Settings. Adv Skin Wound Care 2022; 35:252-259. [PMID: 35442917 DOI: 10.1097/01.asw.0000824780.10098.d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing and Professional Development, University of North Dakota, Grand Forks, United States. Julie Anderson, PhD, RN, is Dean, Winona State University, Minnesota. Also at the University of North Dakota, Darlene Hanson, PhD, RN, is Clinical Professor, College of Nursing and Professional Development; Patricia Thompson, MS, RN, is Clinical Assistant Professor, College of Nursing and Professional Development; and Erika Johnson, MLIS, is Clinical Campus Librarian, School of Medicine and Health Sciences. Submitted June 8, 2021; accepted in revised form October 20, 2021
| | | | | | | | | |
Collapse
|
9
|
Coyer F, Cook JL, Doubrovsky A, Campbell J, Vann A, McNamara G, Edward KL, Hartel G, Fulbrook P. Implementation and evaluation of multilayered pressure injury prevention strategies in an Australian intensive care unit setting. Aust Crit Care 2021; 35:143-152. [PMID: 33992515 DOI: 10.1016/j.aucc.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pressure injuries are a ubiquitous, yet largely preventable, hospital acquired complication commonly seen in critically ill patients in the intensive care unit. OBJECTIVES The objectives of this study were to implement targeted evidence-based pressure injury prevention strategies and evaluate their effect through measurement of patient pressure injury observations. METHODS A prospective multiphased design was used in the intensive care unit of an Australian tertiary referral hospital using three study periods (period 1, weeks 1-18; period 2, weeks 19-28; and period 3, weeks 29-52). The interventions included staff-focused interventions and patient-focused interventions, with the latter defined in a work unit guideline. Weekly visual observations of critically ill patients' skin integrity were conducted by trained research nurses over 52 weeks from November 2015 to November 2016. The primary outcome measure was a pressure injury of any stage, identified at the weekly observation, and the effect of the intervention was evaluated through logistic regression. Reporting rigour has been demonstrated using the Standards for Quality Improvement Reporting Excellence checklist. RESULTS Over the whole study, 15.4% (95% confidence interval [CI] = 12.6, 18.2%, 97/631) of patients developed a pressure injury, with the majority of these injuries (73.2%, 95% CI = 64.4%, 82.0%, 71/97) caused by medical devices. After adjustment for covariates known to influence hospital-acquired pressure injury development, pressure injury rates for period 3 compared with period 1 were reduced (odds ratio = 0.41, 95% CI = 0.20-0.97, p = 0.0126). CONCLUSIONS We found the use of defined pressure injury prevention strategies targeted at both staff and patients reduced pressure injury prevalence.
Collapse
Affiliation(s)
- Fiona Coyer
- Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK; Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4029, Australia.
| | - Jane-Louise Cook
- School of Nursing, Queensland University of Technology, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Jill Campbell
- School of Nursing, Queensland University of Technology, Australia; Skin Integrity Services, Royal Brisbane and Women's Hospital, Australia.
| | - Amanda Vann
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Greg McNamara
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Karen-Leigh Edward
- Department of Health Professions, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Australia; Human and Health Sciences, University of Huddersfield, UK.
| | - Gunter Hartel
- School of Nursing, Queensland University of Technology, Australia; QIMR Berghofer Medical Research Institute, Australia.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research & Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
10
|
Factors affecting repositioning policy compliance: an integrative review. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective
To explore the factors affecting nurses’ compliance with repositioning policy.
Methods
An integrative review was conducted following the Whittemore and Knafl methodology to identify the problem related to repositioning policy compliance. We searched the following databases: Coherence Wounds Group Specialized Register (Jan 1997 to Jun 2019), Ovid MEDLINE (Jan 1997 to Jun 2019), EBSCO CINAHL (Jan 1997 to Jun 2019), and Clinical Key database (Jan 2014 to Oct 2018).
Results
The review revealed three factors that influence repositioning compliance: nurse-related factors, patient-related factors, and Environment-related factors.
Conclusions
These factors directly impact one another and, in turn, influence the compliance of nurses to the repositioning policy. However, there is no evidence currently available that explains the collective impact of these factors and how they interact to affect repositioning policy compliance. Nevertheless, all these factors are important and should be considered to enhance and further improve the quality of nursing care and adherence to the repositioning policy.
Collapse
|
11
|
Avsar P, Moore Z, Patton D, O'Connor T, Budri AMV, Nugent L. Repositioning for preventing pressure ulcers: a systematic review and meta-analysis. J Wound Care 2020; 29:496-508. [DOI: 10.12968/jowc.2020.29.9.496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective:The aim of this systematic review was to assess the effects of different repositioning regimens on pressure ulcer (PU) incidence in at-risk adult individuals without existing PUs.Method:Using systematic review methodology, randomised controlled trials (RCTs), including cluster-RCTs, prospective non-RCTs, pre–post-studies and interrupted-time-series studies were considered. Specifically explored was the impact of the frequency of repositioning, use of repositioning systems and use of turning teams. The search was conducted in January 2019, using PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan.Results:A total of 530 records were returned, of which 16 met the inclusion criteria. Half of studies were conducted in intensive care units (50%). The mean sample size was 629±604 participants. Frequency of repositioning was explored in nine studies. PU incidence was 8% (n=221/2834) for repositioning every 2–3 hours, versus 13% (n=398/3050) for repositioning every 4–6 hours. The odds ratio (OR) was 0.75 (95% confidence interval (CI): 0.61–0.90, p=0.03), suggesting that there is a 25% reduction in the odds of PU development in favour of more frequent repositioning. Use of a repositioning system was explored in three studies. PU incidence was 2% (17/865) for the repositioning system, versus 5.5% (51/926) for care without using the repositioning system. The OR was 0.26 (95% CI: 0.05–1.29, p=0.10); this finding was not statistically significant. Use of a turning team was explored in two studies. PU incidence was 11% (n=22/200) with use of a turning team versus 20% (n=40/200) for usual care. The OR was 0.49 (95% CI: 0.27–0.86, p=0.01) suggesting that there is a 51% reduction in the odds of PU development in favour of use of a turning team. Using GRADE appraisal, the certainty of the evidence was assessed as low.Conclusion:The results of this systematic review indicate that more frequent repositioning and use of a turning team reduce PU incidence. However, given the low certainty of evidence, results should be interpreted with caution.
Collapse
Affiliation(s)
- Pinar Avsar
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
| | - Zena Moore
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Lida Institute, Shanghai
- Monash University, Melbourne, Australia
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Declan Patton
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Lida Institute, Shanghai
- Monash University, Melbourne, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Tom O'Connor
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Monash University, Melbourne, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Aglecia MV Budri
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Science, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
12
|
Comparing a patient positioning system to an overhead LIFT with pillows for impact on turning effectiveness. Intensive Crit Care Nurs 2020; 59:102847. [DOI: 10.1016/j.iccn.2020.102847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/08/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
|
13
|
Renganathan BS, Nagaiyan S, Preejith SP, Gopal S, Mitra S, Sivaprakasam M. Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. J Intensive Care Soc 2019; 20:309-315. [PMID: 31695735 PMCID: PMC6820230 DOI: 10.1177/1751143718804682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance. METHODS We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)). RESULTS We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001. CONCLUSION Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.
Collapse
Affiliation(s)
- BS Renganathan
- Department of Electrical Engineering,
Indian Institute of Technology Madras, Chennai, India
| | | | - SP Preejith
- Healthcare Technology Innovation Centre,
Chennai, India
| | - Shameer Gopal
- The Heart and Lung Centre, The Royal
Wolverhampton NHS Trust, UK
| | - Susovan Mitra
- Intensive Care Unit, Kauvery Hospital,
Chennai, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering,
Indian Institute of Technology Madras, Chennai, India
- Healthcare Technology Innovation Centre,
Chennai, India
| |
Collapse
|
14
|
Feng H, Wu Y, Su C, Li G, Xu C, Ju C. Skin injury prevalence and incidence in China: a multicentre investigation. J Wound Care 2019; 27:S4-S9. [PMID: 30307811 DOI: 10.12968/jowc.2018.27.sup10.s4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: To quantify the prevalence and incidence of different skin injuries, pressure ulcers (PU), skin tears (ST) and incontinence-associated dermatitis (IAD) in China, and to identify their causes to aid prevention and control. METHOD: A cross-sectional observational study was conducted across nine tertiary hospitals. Registered nurses were trained on a standard approach to injury assessment and examination. The study was carried out at the same time on the same day across the participating centres. Participating patients were examined for PU, ST or IAD. RESULTS: A total of 13,176 inpatients were assessed and 233 PU were identified, of which 126 occurred in hospitals, 99 cases at home and eight cases within community hospitals. In addition, there were 141 skin tears and 97 IADs. CONCLUSION: This study involved the largest number of hospitals, to date (in China). Therefore, the prevalence and rate of incidence of skin injury obtained in this study may represent a regional baseline in China.
Collapse
Affiliation(s)
- Haixia Feng
- Director Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Yanping Wu
- Head Nurse; Geriatric Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Chang Su
- Professor; Statistical Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Guohong Li
- Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Cuirong Xu
- Deputy Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Changping Ju
- Chief Nurse; Lishui Country People's Hospital, The Group Hospital, Zhongda Hospital, School of Medicine, Southeast University, China
| |
Collapse
|
15
|
Lam C, Elkbuli A, Benson B, Young E, Morejon O, Boneva D, Hai S, McKenney M. Implementing a Novel Guideline to Prevent Hospital-Acquired Pressure Ulcers in a Trauma Population: A Patient-Safety Approach. J Am Coll Surg 2018; 226:1122-1127. [DOI: 10.1016/j.jamcollsurg.2018.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
|
16
|
Ceylan B, Yapucu Gunes U, Uyar M. Examination of sacral tissue oxygen saturation among immobile patients. J Clin Nurs 2018; 27:3641-3651. [DOI: 10.1111/jocn.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Burcu Ceylan
- Department of Fundamentals of Nursing; Faculty of Health Sciences; Izmir Katip Celebi University; Cigli Izmir Turkey
| | - Ulku Yapucu Gunes
- Fundamentals of Nursing Department; Faculty of Nursing; Ege University; Bornova Izmir Turkey
| | - Mehmet Uyar
- Anesthesia and Reanimation Department; Medical Faculty; Ege University; Bornova Izmir Turkey
| |
Collapse
|
17
|
de Almeida Medeiros AB, da Conceição Dias Fernandes MI, de Sá Tinôco JD, Cossi MS, de Oliveira Lopes MV, de Carvalho Lira ALB. Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study. Intensive Crit Care Nurs 2018; 45:6-10. [DOI: 10.1016/j.iccn.2017.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 12/13/2022]
|
18
|
Pickham D, Berte N, Pihulic M, Valdez A, Mayer B, Desai M. Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). Int J Nurs Stud 2018; 80:12-19. [DOI: 10.1016/j.ijnurstu.2017.12.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 11/27/2022]
|
19
|
Loudet CI, Marchena MC, Maradeo MR, Fernández SL, Romero MV, Valenzuela GE, Herrera IE, Ramírez MT, Palomino SR, Teberobsky MV, Tumino LI, González AL, Reina R, Estenssoro E. Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study. Rev Bras Ter Intensiva 2018; 29:39-46. [PMID: 28444071 PMCID: PMC5385984 DOI: 10.5935/0103-507x.20170007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/17/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle". Results: Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor. Conclusion: A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.
Collapse
Affiliation(s)
- Cecilia Inés Loudet
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina.,Disciplina de Farmacologia Aplicada, Seção de Terapia Intensiva, Facultad de Ciencias Médicas, Universidad Nacional de La Plata - La Plata, Buenos Aires, Argentina
| | - María Cecilia Marchena
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Roxana Maradeo
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Laura Fernández
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Victoria Romero
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Graciela Esther Valenzuela
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Isabel Eustaquia Herrera
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Martha Teresa Ramírez
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Rojas Palomino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Mariana Virginia Teberobsky
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Leandro Ismael Tumino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Ana Laura González
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Rosa Reina
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Elisa Estenssoro
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| |
Collapse
|
20
|
Reducing Pressure Injury Incidence Using a Turn Team Assignment: Analysis of a Quality Improvement Project. J Wound Ostomy Continence Nurs 2017; 43:477-82. [PMID: 27607743 DOI: 10.1097/won.0000000000000258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to analyze outcomes of a quality improvement project that evaluated a turning intervention for prevention of facility-acquired pressure injuries. DESIGN A descriptive correlational study design examined the effectiveness of using a "turn team assignment" on pressure injury incidence and staff perceptions. SUBJECTS AND SETTING The study sample comprised RNs and patient care associates assigned to provide care for patients admitted on the first or any subsequent day of hospitalization to a surgical intensive care unit at a Midwest inner-city teaching hospital. METHODS Direct observation by expert clinicians occurred in 2-hour increments over a 14-day period using an 11-item, unit-designed process improvement tool. We collected information regarding cueing, concurrent turning, independent turning in lieu of the cue, staff support, and possible barriers to turning and repositioning. Staff perceptions were collected using an online tool via survey. The survey utilized a 14-item questionnaire, and a 5-point Likert Scale to identify staff perceptions and beliefs about the turn team intervention. Pressure injury occurrences were measured using data from our monthly prevalence study. RESULTS Pressure injury occurrences declined from 24.9% to 16.8% over the data collection period. There was a strong positive correlation between verbal cueing and turning (r = 0.815; P < .05). Staff perceptions supported preintervention education (64.3%) and cueing (93%; 78%) as effective interventions in completing patient turning. CONCLUSIONS Findings suggest that turn team assignments using verbal cueing are an effective intervention that decreases pressure injury occurrence. This intervention required no increase in staffing personnel, making this type of intervention reasonable and effective in improving frequency of repositioning and decreasing pressure injury prevalence rates.
Collapse
|
21
|
Sutton LJ, Jarden RJ. Improving the quality of nurse-influenced patient care in the intensive care unit. Nurs Crit Care 2016; 22:339-347. [PMID: 27976489 DOI: 10.1111/nicc.12266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/10/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quality of care is a major focus in the intensive care unit (ICU). AIM To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU. DESIGN A framework for QI was developed and implemented as part of a practice change initiative. METHODS Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies. RESULTS Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily). CONCLUSIONS The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing. RELEVANCE TO CLINICAL PRACTICE The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued.
Collapse
Affiliation(s)
- Lynsey J Sutton
- Wellington Regional Hospital, Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Wellington, New Zealand.,Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, New Zealand
| | - Rebecca J Jarden
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| |
Collapse
|
22
|
Tayyib N, Coyer F. Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:432-444. [PMID: 27712030 DOI: 10.1111/wvn.12177] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention. AIMS The aim was to synthesize the best available evidence regarding the effectiveness of single strategies designed to reduce the incidence and prevalence of HAPUs development in ICUs. METHODS The search strategy was designed to retrieve studies published in English across CINAHL, Medline, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Mednar between 2000 and 2015. All adult ICU participants were aged 18 years or over. This review included randomized controlled trials, quasi-experimental and comparative studies. The studies that were selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical-appraisal instruments. RESULTS The review included 25 studies, and the meta-analysis revealed a statistically significant effect of a silicon foam dressing strategy in reducing HAPUs incidence (effect size = 4.62; 95% CI: 0.05-0.29; p < .00001, effect size = 4.50; 95% CI: 0.05-0.31; p = .00001, respectively) in critically ill patients. Evidence of the effectiveness of nutrition, skin-care regimen, positioning and repositioning schedule, support surfaces, and the role of education in prevention of HAPUs development in the ICU was limited, which precludes strong conclusions. LINKING EVIDENCE TO ACTION The review provides an evidence-based guide to future priorities for clinical practice. In particular, a silicone foam dressing has positive impact in reducing sacrum and heel HAPUs incidence in the ICU.
Collapse
Affiliation(s)
- Nahla Tayyib
- Doctoral Candidate, School of Nursing, Queensland University of Technology, Queensland, Australia.,Lecturer, School of Nursing, Umm Al-Qura University, Saudi Arabia
| | - Fiona Coyer
- Professor of Nursing, School of Nursing, Queensland University of Technology, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
23
|
Li D. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units. J Clin Nurs 2016; 25:2336-47. [PMID: 27302084 DOI: 10.1111/jocn.13363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. BACKGROUND Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. DESIGN A retrospective, comparative, descriptive, correlational study. METHOD A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. RESULT The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. CONCLUSION This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. RELEVANCE TO CLINICAL PRACTICE The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation.
Collapse
Affiliation(s)
- Dan Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
24
|
Jackson D, Hutchinson M, Barnason S, Li W, Mannix J, Neville S, Piper D, Power T, Smith GD, Usher K. Towards international consensus on patient harm: perspectives on pressure injury policy. J Nurs Manag 2016; 24:902-914. [DOI: 10.1111/jonm.12396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Debra Jackson
- Oxford Brookes University; Oxford UK
- Oxford University Hospital NHS Foundation Trust; Oxford UK
- University of New England; Lismore New South Wales Australia
| | | | - Susan Barnason
- University of Nebraska Medical Center; Lincoln Nebraska USA
| | - William Li
- The University of Hong Kong; Hong Kong China
| | - Judy Mannix
- Western Sydney University; Sydney New South Wales Australia
| | | | - Donella Piper
- University of New England; Lismore New South Wales Australia
| | - Tamara Power
- University of Technology Sydney; Sydney New South Wales Australia
| | | | - Kim Usher
- University of New England; Lismore New South Wales Australia
| |
Collapse
|
25
|
Kim SM, Ju RK, Lee JH, Jun YJ, Kim YJ. Unusual cause of a facial pressure ulcer: the helmet securing the Sengstaken-Blakemore tube. J Wound Care 2015; 24:S14-6. [PMID: 26075510 DOI: 10.12968/jowc.2015.24.sup6.s14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many medical devices, such as pulse oximetry, ventilation masks and other splints are put on critically ill patients. Although these devices are designed to deliver relatively low physical pressure to the skin of the patient, they can still cause pressure ulcers (PUs) in critically ill patients. There are reports of medical device-related PUs on the face. Here we describe forehead skin necrosis caused by the securing helmet for the Sengstaken-Blakemore tube. It is difficult to detect this kind of PU early, because most of the patients have decreased mental status or delirium due to varix bleeding. For this reason, medical staff should be aware of the risk of developing a PU by the device and take preventive measures accordingly.
Collapse
Affiliation(s)
- S M Kim
- The Catholic University of Korea, Bucheon St. Mary's Hospital
| | - R K Ju
- The Catholic University of Korea, Bucheon St. Mary's Hospital
| | - J H Lee
- The Catholic University of Korea, Bucheon St. Mary's Hospital
| | - Y J Jun
- The Catholic University of Korea, Bucheon St. Mary's Hospital
| | - Y J Kim
- The Catholic University of Korea, Bucheon St. Mary's Hospital
| |
Collapse
|
26
|
Makic MBF, Rauen C, Watson R, Poteet AW. Examining the evidence to guide practice: challenging practice habits. Crit Care Nurse 2015; 34:28-45; quiz 46. [PMID: 24692464 DOI: 10.4037/ccn2014262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Nurses are the largest segment of the nation's health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients' outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.
Collapse
|
27
|
|
28
|
|
29
|
Cobb J, Bélanger L, Park S, Shen T, Rivers C, Dvorak M, Street J, Noonan V. Evaluation of a pilot Pressure Ulcer Prevention Initiative (PUPI) for patients with traumatic spinal cord injury. J Wound Care 2014; 23:211-2, 214, 216-8 passim. [DOI: 10.12968/jowc.2014.23.5.211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J.E. Cobb
- Vancouver General Hospital, Vancouver, Canada
- Rick Hansen Institute, Vancouver, Canada
| | - L.M.A. Bélanger
- Vancouver General Hospital, Vancouver, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, Canada
- Rick Hansen Institute, Vancouver, Canada
| | - S.E. Park
- Rick Hansen Institute, Vancouver, Canada
| | - T. Shen
- Rick Hansen Institute, Vancouver, Canada
| | - C.S. Rivers
- Department of Orthopedics, University of British Columbia, Vancouver, Canada
- Rick Hansen Institute, Vancouver, Canada
| | - M.F. Dvorak
- Department of Orthopedics, University of British Columbia, Vancouver, Canada
| | - J.T. Street
- Department of Orthopedics, University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
30
|
|