The effectiveness of pressure ulcer prevention programme: A comparative study

Impact of family visit restrictions due to COVID-19 policy on patient outcomes: A cohort study

Aim

To investigate the impact of family visit restrictions during the COVID‐19 pandemic on deliriums, falls, pneumonia, pressure ulcers and readmissions among surgical inpatients with gastrointestinal (oncologic) diseases.

Design

Cohort study.

Methods

This study was conducted among adult inpatients undergoing gastrointestinal surgery in two academic hospitals. During the COVID‐19 outbreak in 2020, over a 10‐week period, one cohort was subjected to family visit restrictions. Per patient, one person per day was allowed to visit for a maximum of 30 min. This cohort was compared with another cohort in which patients were not subjected to such restrictions during a 10‐week period in 2019. Logistic regression analyses were used to investigate the impact of the restrictions on deliriums, falls, pneumonia, pressure ulcers and readmissions.

Results

In total, 287 patients were included in the 2020 cohort and 243 in the 2019 cohort. No differences were observed in the cohorts with respect to baseline characteristics. Logistic regression analyses showed no significant differences in deliriums, falls, pneumonia, pressure ulcers and readmissions between the cohorts.

Conclusion

We cautiously conclude that the family visit restrictions during the COVID‐19 pandemic did not contribute to deliriums, falls, pneumonia, pressure ulcers or readmissions in surgical patients with gastrointestinal (oncologic) diseases.

Impact

COVID‐19 influenced family‐centred care due to family visit restrictions. Nurses need to continue monitoring outcomes known to be sensitive to family‐centred care to gain insight into the effects of visit restrictions and share the results in order to include nurses' perspectives in COVID‐19‐decision‐making. Re‐implementing of family visit restrictions should be carefully considered in policy‐making.

Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study

The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.

The retention effect of staff education programme: Sustaining a decrease in hospital-acquired pressure ulcers via culture of care integration

Hospital‐acquired pressure ulcers (HAPUs) negatively affect patients during hospitalisation, putting patients at risk for further complications. HAPUs are one of the hospital quality key performance indicators (KPIs) that necessitate quality initiatives and/or programmes to minimise its occurrence and consequences. When quality initiatives are put into place and proven effective, the next important focus is sustainability of the effects. The original Saudi Arabian study based on data collected from 50 441 patients, showed that implementation of the pressure ulcer prevention programme (PUPP) was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The aim of this follow‐up check of the original study was to assess if the PUPP's effectiveness success was retained. Also, to try and determine why the implemented quality improvement programme to prevent HAPUs was so successfully retained. Designed and conducted as a systemic review, it tracked the outcomes of pressure ulcer rates during and post PUPP implementation that mostly focused on evidence‐based staff education, concentrating on years 2016 to 2018. Statistically significant reductions were captured by data that have been presented through Pearson Chi squares. HAPU decline was notable between year 2017 and 2018. This was followed by a further reduction in year 2018. The results determine retention effect sustainability of the initial positive results achieved. By doing so, the study was further able to establish that the PUPP had been integrated into the hospital system's care culture as evidenced by the reduction of HAPUs despite a large inpatient growth. Consideration of what contributing factors led to this successful integration of new knowledge into the care culture are also examined. KPIs can be used as indicators to help reinforce staff education. Culture of care (support of values and interventions taught during the PUPP) offer hope that these may be duplicated in future improvement projects. The supportive nature of a given culture of care may in fact be just as important as the practical education provided to staff members.

Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India: A pragmatic randomized controlled trial

BACKGROUND

Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients.

METHODOLOGY

Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted.

RESULTS

The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001).

CONCLUSION

Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.

Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia

A tertiary public hospital in Saudi Arabia set out in 2015 to establish a team focused on reducing hospital-acquired pressure ulcers (HAPUs). The pressure ulcer prevention program (PUPP) had a multifaceted approach and data were collected for a period of 5 years. The results showed a definite reduction in the incidences of HAPUs. Many such programs show similar positive results and echo many of the same considerations of risk, prevention strategies, and the need for early intervention. However, none of the other studies either replicate the hospital's PUPP nor the extent of the positive and lasting effect of the program. Eager to determine the contributing factor(s) in order that the project success could be continued and possibly replicated in other quality improvement projects, it was decided that an examination and comparison of other similar programs and their results would be necessary in order to uncover the answer. It was determined that the in-person in-home discharge follow-up portion of the program most likely had the largest effect on the outcomes. Outcomes that were supported by the pre-work completed during the hospital portion of the PUPP towards reducing HAPUs and readmissions.

The effectiveness of pressure ulcer prevention programme: A comparative study

Hospital-acquired pressure ulcers (HAPUs) affect patients during hospitalisation, putting patients at risk for further complications. HAPU is one of the hospital quality indicators that require quality initiatives or programmes to minimise its occurrence and consequences. The aim of this study was to assess the effectiveness of a developed quality improvement programme in preventing HAPUs. This is a retrospective comparative study, which tracked the outcomes of pressure ulcer prevention programme (PUPP) for 5 years from 2014 to 2018. Data from 50 441 patients were collected from different units in a tertiary hospital in the eastern region of Saudi Arabia. The programme focused on building a wound care team; providing education to hospital staff, patients, and their families; and continuous data monitoring, in addition to follow-up visits after discharge. Implementation of the programme was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The PUPP was effective in reducing the percentage of pressure ulcer cases. The programme can be extended and implemented in other hospitals.