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Chang W. Influence of severity of illnesses on risk of death in intensive care unit patients with severity of pressure injuries as mediating variable. Int Wound J 2024; 21:e14623. [PMID: 38149748 PMCID: PMC10961870 DOI: 10.1111/iwj.14623] [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: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow-up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death.
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Affiliation(s)
- Wen‐Pei Chang
- Department of NursingShuang Ho Hospital, Taipei Medical UniversityNew Taipei CityTaiwan
- School of NursingCollege of Nursing, Taipei Medical UniversityTaipeiTaiwan
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [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: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Wu Z, Song B, Liu Y, Zhai Y, Chen S, Lin F. Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review. J Tissue Viability 2023:S0965-206X(23)00055-4. [PMID: 37150650 DOI: 10.1016/j.jtv.2023.04.009] [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: 02/10/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings. METHODS A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention. RESULTS A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences". CONCLUSION The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.
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Affiliation(s)
- Zijing Wu
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Bing Song
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Yu Liu
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Yongzhen Zhai
- Department of Infectious Disease, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, Liaoning Province, China.
| | - Si Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, No.4 Chongshan East Road, Huanggu District, Shenyang, Liaoning Province, China.
| | - Frances Lin
- School of Health, University of the Sunshine Coast, Queensland, Australia.
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Weller CD, Turnour L, Connelly E, Banaszak-Holl J, Team V. Clinical Coders' Perspectives on Pressure Injury Coding in Acute Care Services in Victoria, Australia. Front Public Health 2022; 10:893482. [PMID: 35719639 PMCID: PMC9198603 DOI: 10.3389/fpubh.2022.893482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.
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Affiliation(s)
- Carolina Dragica Weller
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,*Correspondence: Carolina Dragica Weller
| | - Louise Turnour
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | | | - Jane Banaszak-Holl
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
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Adibelli S, Korkmaz F. Pressure injury prevention practices of intensive care unit nurses in Turkey: A descriptive multiple-methods qualitative study. J Tissue Viability 2022; 31:319-325. [PMID: 35144881 DOI: 10.1016/j.jtv.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the thoughts, deliberations and actual practices of intensive care unit (ICU) nurses regarding pressure injury (PI) prevention. DESIGN and Methods: This descriptive multi-method qualitative study was conducted using maximum variation sampling. Data were collected through semi-structured non-participating observations and semi-structured face-to-face interviews. The combination of observational and interview data was analysed together with the descriptive content analysis. FINDINGS Nine nurses were recruited. The main emerged themes were 'heuristic PI risk assessment', 'PI preventive practices' and 'factors affecting preventive practices.' The nurses performed risk assessment based on patients' activity-mobility level, pressure sources, body mass index, skin condition, nutritional issues, comorbidities, admission diagnosis and age. The PI preventive practices for reducing and relieving mechanical load were repositioning, mobilisation, supporting the body parts, measures for medical devices and applying massage. The practices for improving tissue tolerance were skin cleansing and moisturising, preventing excessive moisture and ensuring food intake. However, these measures did not entirely conform to evidence-based recommendations in actual practice. The nurses attributed the divergences to factors affecting their practice. In this respect, the factors affecting preventive practices were the availability of support materials and skincare products, patient/nurse ratios, the clinical condition of the patient, individual skin characteristics and interdependent nurse roles. CONCLUSION ICU nurse practices in PI prevention lack systematic approaches and evidence-based recommendations. These disadvantages emerge as inter- and intra-individual variances in implementing preventive practices in actual practice. Considering these divergences is crucial for the effective management of PI risk.
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Affiliation(s)
- Seyma Adibelli
- Hacettepe University Faculty of Nursing, 06100, Ankara, Turkey.
| | - Fatos Korkmaz
- Hacettepe University Faculty of Nursing, 06100, Ankara, Turkey.
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Lustig A, Gefen A. The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests. Int Wound J 2022; 19 Suppl 1:3-21. [PMID: 35142062 PMCID: PMC9478960 DOI: 10.1111/iwj.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.
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Affiliation(s)
- Adi Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Cox J, Edsberg LE, Koloms K, VanGilder CA. Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:21-28. [PMID: 35040812 PMCID: PMC9200225 DOI: 10.1097/won.0000000000000834] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.
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Affiliation(s)
- Jill Cox
- Correspondence: Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, 180 University Ave. Newark, NJ 07102 ()
| | - Laura E. Edsberg
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Kimberly Koloms
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Catherine A. VanGilder
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
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Alshahrani B, Sim J, Middleton R. Nursing interventions for pressure injury prevention among critically ill patients: A systematic review. J Clin Nurs 2021; 30:2151-2168. [PMID: 33590917 DOI: 10.1111/jocn.15709] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
AIM To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. BACKGROUND Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings. DESIGN A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. METHODS Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis. RESULTS The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low. CONCLUSIONS Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries. RELEVANCE TO CLINICAL PRACTICE Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.
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Affiliation(s)
- Bassam Alshahrani
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Taibah University, Medina, Saudi Arabia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
| | - Rebekkah Middleton
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW, Australia
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Dave MS, Mobarak S, Spiers HVM, Tarazi M, Jamdar S. Improving knowledge and confidence in foundation doctors during specialty changeover. Int J Qual Health Care 2021; 32:490-494. [PMID: 32671391 DOI: 10.1093/intqhc/mzaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/07/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
QUALITY PROBLEM Foundation year junior doctors rotate every 4 months into different specialties. They are often expected to manage patients with complex underlying conditions despite inadequate clinical induction. INITIAL ASSESSMENT No structured induction was offered to junior doctors rotating to hepato-pancreatico-biliary surgery, a complex and highly specialized discipline within general surgery. We hypothesized that junior doctors will be lacking in both knowledge and confidence when managing these patients. CHOICE OF SOLUTION Create a structured induction programme and evaluate its effectiveness in improving knowledge and confidence amongst doctors. IMPLEMENTATION Plan Do Study Act methodology was used along with driver diagrams to map change. A learning resource was developed in the form of a booklet, which included relevant clinical information, processes for escalation and referral as well as guidance for managing acutely unwell patients. A structured 1-hour teaching programme was delivered to junior doctors alongside this. Pre- and post-session questionnaires and statistical analysis were used to determine effect. EVALUATION Marked improvements in both knowledge and confidence were seen. The intervention showed a statistically significant improvement. LESSONS LEARNED Clinical induction resources can improve junior doctors' knowledge and confidence in managing their patients. Such induction is both valuable and necessary. Similar interventions can be used with allied health professionals and can involve the use of technology and virtual learning.
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Affiliation(s)
- Madhav Sanatkumar Dave
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Shahd Mobarak
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Harry V M Spiers
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Munir Tarazi
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
| | - Saurabh Jamdar
- Department of Hepatobiliary and General Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford M13 9WL, UK
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Abstract
GENERAL PURPOSE To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and the mitigating measures that influence pressure injury (PI) development in the critical care population. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Choose a static intrinsic factor that increases the risk for the development of PI. 2. List several dynamic intrinsic risk factors for developing a PI. 3. Identify dynamic extrinsic risk factors that may predispose a patient to developing a PI. 4. Explain the pathophysiology of PI development.
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McNett M, O'Mathúna D, Tucker S, Roberts H, Mion LC, Balas MC. A Scoping Review of Implementation Science in Adult Critical Care Settings. Crit Care Explor 2020; 2:e0301. [PMID: 33354675 PMCID: PMC7746210 DOI: 10.1097/cce.0000000000000301] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The purpose of this scoping review is to provide a synthesis of the available literature on implementation science in critical care settings. Specifically, we aimed to identify the evidence-based practices selected for implementation, the frequency and type of implementation strategies used to foster change, and the process and clinical outcomes associated with implementation. DATA SOURCES A librarian-assisted search was performed using three electronic databases. STUDY SELECTION Articles that reported outcomes aimed at disseminating, implementing, or sustaining an evidence-based intervention or practice, used established implementation strategies, and were conducted in a critical care unit were included. DATA EXTRACTION Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. DATA SYNTHESIS Of 1,707 citations, 82 met eligibility criteria. Studies included prospective research investigations, quality improvement projects, and implementation science trials. The most common practices investigated were use of a ventilator-associated pneumonia bundle, nutritional support protocols, and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility bundle. A variety of implementation strategies were used to facilitate evidence adoption, most commonly educational meetings, auditing and feedback, developing tools, and use of local opinion leaders. The majority of studies (76/82, 93%) reported using more than one implementation strategy. Few studies specifically used implementation science designs and frameworks to systematically evaluate both implementation and clinical outcomes. CONCLUSIONS The field of critical care has experienced slow but steady gains in the number of investigations specifically guided by implementation science. However, given the exponential growth of evidence-based practices and guidelines in this same period, much work remains to critically evaluate the most effective mechanisms to integrate and sustain these practices across diverse critical care settings and teams.
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Affiliation(s)
- Molly McNett
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH
- College of Nursing, The Ohio State University, Columbus, OH
| | - Dónal O'Mathúna
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH
- College of Nursing, The Ohio State University, Columbus, OH
| | - Sharon Tucker
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH
- College of Nursing, The Ohio State University, Columbus, OH
| | - Haley Roberts
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH
| | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, OH
- Center for Healthy Aging, Self Management, and Complex Care, The Ohio State University, Columbus, OH
| | - Michele C Balas
- College of Nursing, The Ohio State University, Columbus, OH
- Center for Healthy Aging, Self Management, and Complex Care, The Ohio State University, Columbus, OH
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Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, Apóstolo J, Kirkpatrick P, Loveday H. Barriers and enablers to implementation of pressure injury prevention in hospitalized adults: a mixed methods systematic review protocol. JBI Evid Synth 2020; 18:2134-2139. [PMID: 32813459 DOI: 10.11124/jbisrir-d-19-00265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the proposed systematic review is to determine the barriers and enablers (or facilitators) to the implementation of pressure injury prevention among adults receiving care in the hospital setting. INTRODUCTION Hospital-acquired pressure injuries are preventable; however, they remain an ongoing safety and quality health care concern in many countries. There are various evidence-based preventative interventions for pressure injuries, but their implementation in clinical practice is limited. An understanding of the different factors that support (enablers or facilitators) and inhibit (barriers) the implementation of these interventions from different perspectives is important, so that targeted strategies can be incorporated into implementation plans. INCLUSION CRITERIA This review will include quantitative, qualitative, and mixed methods studies that investigate barriers and/or enablers in relation to hospital-acquired pressure injury prevention in hospitalized adults. Only English publications will be considered, with no publication date restrictions. METHODS The systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic review. Published studies will be searched in PubMed, CINAHL, Embase, PsycINFO and Scopus. Gray literature will also be considered. Critical appraisal and data extraction will be performed using standardized tools, followed by data transformation. Data synthesis will follow the convergent integrated approach.
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Affiliation(s)
- Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Judith Carrier
- The Wales Centre For Evidence Based Care: A JBI Centre of Excellence, Cardiff, Wales
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Kendra Rieger
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Salmond
- The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Newark, NJ, USA
| | - João Apóstolo
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Pamela Kirkpatrick
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, Scotland
| | - Heather Loveday
- The University of West London Centre for Evidence-Based Healthcare: A JBI Affiliated Group, London, UK
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Lin F, Wu Z, Song B, Coyer F, Chaboyer W. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. Int J Nurs Stud 2020; 102:103483. [DOI: 10.1016/j.ijnurstu.2019.103483] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 02/06/2023]
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Álvarez-Maldonado P, Reding-Bernal A, Hernández-Solís A, Cicero-Sabido R. Impact of strategic planning, organizational culture imprint and care bundles to reduce adverse events in the ICU. Int J Qual Health Care 2019; 31:480-484. [PMID: 30256944 DOI: 10.1093/intqhc/mzy198] [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: 03/19/2018] [Revised: 06/26/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of adverse events during a multifaceted program implementation. DESIGN Cross-sectional secondary analysis. SETTING The respiratory-ICU of a large tertiary care center. PARTICIPANTS Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used. INTERVENTIONS The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented. MAIN OUTCOME MEASURES Rates of adverse events (episodes per 1000 patient/days). RESULTS Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97). CONCLUSIONS A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Arturo Reding-Bernal
- Research Division, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Alejandro Hernández-Solís
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Raúl Cicero-Sabido
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico.,Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Copilco, Cd. Universitaria, CP 04510 Coyoacán, Mexico City, Mexico
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15
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De Meyer D, Van Hecke A, Verhaeghe S, Beeckman D. PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance. J Adv Nurs 2019; 75:1085-1098. [PMID: 30549321 DOI: 10.1111/jan.13932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
AIM To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. BACKGROUND Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. DESIGN Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. METHODS Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. RESULTS Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. CONCLUSION This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
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Affiliation(s)
- Dorien De Meyer
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
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Swan J. Use of dermal gel pads in preventing and managing pressure ulcers in ICU: an audit. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:S42-S47. [PMID: 30418864 DOI: 10.12968/bjon.2018.27.sup20.s42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most of the pressure ulcers (PUs) that developed in the intensive care unit (ICU) of an acute trust were medical-device related. While use of a dermal pad was recommended as part of its pressure ulcer prevention strategy, staff were concerned that it tended to tear or split while in use. An alternative gel pad (Dermisplus® Prevent, Frontier Medical), that was cost-effective and appeared to be more robust, was identified. A 4-week non-comparative audit involving 37 patients was therefore undertaken to investigate the effect of this alternative gel pad on PU incidence in the ICU. With the exception of the change in the gel pad used, there was no difference to the overall PU prevention strategy. No new PUs developed during the audit period with the new gel pad, although there was also no reduction in incidence compared with the previous 3 months. None of the four patients (11%) with blanching erythema developed category 1 PUs. There were also no reports of tearing or splitting with the new gel pad. The ICU staff commented that they found the new gel pad simpler to use, easier to clean and more robust than the previous product used. Following the audit, the ICU incorporated the new gel pad into its PU prevention strategy.
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Affiliation(s)
- Joanna Swan
- Lead Tissue Viability Nurse, University Hospitals Birmingham NHS Trust
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18
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Furnival J, Boaden R, Walshe K. Conceptualizing and assessing improvement capability: a review. Int J Qual Health Care 2018; 29:604-611. [PMID: 28992146 PMCID: PMC5890875 DOI: 10.1093/intqhc/mzx088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/05/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose The literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research. Data sources An iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English. Data extraction The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted. Results of data synthesis The instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely. Conclusion The assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare.
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Affiliation(s)
- Joy Furnival
- Improvement Directorate, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK
| | - Ruth Boaden
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Alliance Manchester Business School, Booth Street West, Manchester M15 6PB, UK
| | - Kieran Walshe
- Health Management Group, Alliance Manchester Business School, Booth Street West, Manchester M15 6PB, UK
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Stephens M, Bartley C, Betteridge R, Samuriwo R. Developing the tissue viability seating guidelines. J Tissue Viability 2017; 27:74-79. [PMID: 28919021 DOI: 10.1016/j.jtv.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on seating and preventing pressure ulcers. At the request of the UK Tissue Viability Society the aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. METHODS AND FINDINGS The evidence base informing the guidelines was obtained by applying a triangulation of methods: a literature review, listening event and stakeholder group consultation. The purpose was to engage users and carers, academics, clinicians, inspectorate and charities, with an interest in seating, positioning and pressure management to: gather views, feedback, stories, and evidence of the current practices in the field to create a greater awareness of the issue. CONCLUSION The new guidelines are inclusive of all people with short and long-term mobility issues to include all population groups. The document includes evidence on where pressure ulcers develop when seated, risk factors, best possible seated position and what seat adjustments are required, the ideal seating assessment, interventions, self-help suggestions and key seating outcomes. The updated TVS CPGs have been informed by the best available evidence, the insights and wisdom of experts, stakeholders and people who spend extended periods of time sitting.
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Affiliation(s)
| | - Carol Bartley
- School of Health Sciences, University of Salford, UK
| | | | - Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, UK; Wales Centre for Evidence Based Care, Cardiff University, UK; Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, UK
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