Use of Electronic Health Records to Identify Factors Related to Skin Changes in Terminal Patients

OBJECTIVE

To investigate the incidence of skin changes at life's end (SCALE) among hospice patients and identify associated factors.

METHODS

The authors conducted a retrospective chart review of demographic data, medical history, Braden Scale assessment scores, Charlson Comorbidity Index, symptom records, and medical treatments of patients admitted to a local teaching hospital's hospice unit between May 2019 and April 2021.

RESULTS

Most (79%) of the 300 hospice patients included in the study had cancer. Of the 181 patients who died, 49 (60.3%) had SCALE. Logistic regression analysis revealed that greater variations in Braden Scale scores from admission to predeath (odds ratio, 1.188; 95% CI, 1.014-1.392; P = .033), higher Eastern Cooperative Oncology Group grades (odds ratio, 1.965; 95% CI, 1.241-3.109; P = .004), and elevated Charlson Comorbidity Index scores (odds ratio, 1.514; 95% CI, 1.237-1.854; P < .001) significantly increased the likelihood of developing SCALE.

CONCLUSIONS

The findings suggest that the occurrence of SCALE may serve as a valuable clinical indicator for healthcare professionals to recognize that a patient is approaching the end of life. Consequently, the care approach should prioritize pain relief and promote comfort rather than wound healing in this patient population. These results provide evidence to support the integration of SCALE-related training programs for hospice care, which can increase healthcare professionals' awareness and understanding of SCALE. Ultimately, the implementation of such training programs may lead to more appropriate care for hospice patients with SCALE, enhancing their quality of life at the end of life.

Factors Associated With the Management of Pressure Injuries at the End of Life: A Scoping Review

Pressure injuries are a major problem in all health care settings. The incidence of pressure injuries at the end of life is as high as 58% in some facilities, and there is little consensus on how pressure injuries are managed at the end of life. A scoping review was conducted, to investigate what is known of the factors associated with the management of pressure injuries at the end of life. Literature was sourced from several databases. A total of 1760 potential sources were identified; after applying the Population Concept Context inclusion and exclusion criteria, 16 empirical research articles were sourced: 10 were quantitative, 5 were qualitative, and 1 was mixed methods. Studies were published between 2003 and 2021 and originated from Italy, the United States, Australia, Sweden, Brazil, Taiwan, Turkey, and Canada. Key interventions included regular second hourly turning, wound debridement, wound assessment, and application of various wound coverings. The most widely discussed management strategy, regular second hourly turning, proved controversial and inconsistent in practice. There were also inconsistencies with wound assessment, with practice not always following best evidence-based assessment guidelines. Research findings also highlighted issues with prognostication and identification of the end-of-life phase with no consistent tool applied to assist end-of-life pressure injury management decision-making.

Statistical and cross-sectional analysis of factors effecting the prevalence of pressure ulcer in hospital admitted stroke patients

Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.

Is it time to re-evaluate the inevitability of ulcers at the end of life?

BACKGROUND

The prevention of pressure injuries/ulcers (PI/PUs) in patients at the end of life is achievable, albeit challenging. Objective diagnostic tools, such as sub-epidermal moisture (SEM) scanning, support healthcare practitioners' clinical judgment in preventing PI/PUs.

AIM

A pragmatic study was conducted to assess the feasibility of preventing PI/PUs using SEM technology as an adjunct to routine care in a 22-bed inpatient hospice.

METHODS

Daily SEM scanning was introduced to support the device-trained practitioners' clinical judgment in detecting developing, non-visible PI/PUs. Preventive interventions were initiated by clinical judgment informed by Waterlow scores, visible, tactile skin and tissue assessments and scanner readings.

RESULTS

Prior to the study, the incidence of PI/PUs was 9%. The 6 month study period reported a 4.8% PI/PU incidence, 7/146 consenting patients developed a PI/PU, resulting in a 47% reduction in incidence rates.

CONCLUSION

Preventing the development of PI/PUs is possible with clinical judgment aided by SEM data.

Pressure Injury Prevention and Wound Management for the Patient Who Is Actively Dying: Evidence-Based Recommendations to Guide Care

Preventing pressure injuries and wound deterioration can be challenging for the patient at the end of life. Pressure injuries are often deemed unavoidable when a patient is actively dying; however, the time frame for this process is variable. As the skin fails in an actively dying patient, interventions should align with the patient and family's goals. This integrative literature review defines essential concepts to pressure injury and wound management during this final stage of life including (1) actively dying, (2) end of life, (3) palliative care, and (4) comfort measures. We also provide clinically relevant, evidence-based recommendations for pressure injury prevention and wound management of the patient who is actively dying.

Prevalence, incidence and associated factors of pressure injuries in hospices: A multicentre prospective longitudinal study

BACKGROUND

Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and incidence of pressure injuries in hospices are lacking.

AIM

To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time.

DESIGN

Multicentre prospective longitudinal observational study.

SETTING/PARTICIPANTS

Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands).

METHODS

Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients' death/discharge.

RESULTS

The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65-3.47), age >80 (OR = 2.01, 95%CI = 1.49-2.71), Braden score 'at risk' (OR = 1.92, 95%CI = 1.17-3.14), urinary catheter (OR = 1.96, 95%CI = 1.40-2.75), drowsiness (OR = 1.41, 95%CI = 1.02-1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01-2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01-2.79) and Braden score 'at risk' (OR = 4.45, 95%CI = 1.74-11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11-2.91), worsening pain (OR = 1.65, 95%CI = 1.10-2.49), drowsiness (OR = 1.79, 95%CI = 1.25-2.57) and dyspnea (OR = 1.48, 95%CI = 1.01-2.18).

CONCLUSIONS

The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors. Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's' life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies ('wound management' vs. 'wound palliation'), and resource utilization.

Effect of health literacy of caregivers on survival rates of patients under palliative care

AIM

In this study, we aimed to investigate the effect of health literacy of the patient caregiver on the care results of palliative care patients.

METHODS

Two hundred and forty-two patients who were hospitalised in palliative care units of seven hospitals in the city in January 2018 were involved in the study. Mortality of the patients was checked 3 months later. A survey interrogating the sociodemographic characteristics of the patients and Turkish translation of Health Literacy Survey - European Union to measure the health literacy level of the caregivers were used.

RESULTS

About 19.50% of the patient caregivers are in adequate (sufficient/perfect) HL group in term of general HL. Caregivers had difficulty to access information/knowledge of what to do in case of emergency. Prevalence of bedsore occurrence in patients whose caregiver has 'inadequate' HL is higher than patients whose caregiver has 'adequate' HL. Rate of 'inadequate HL' of the caregiver is higher in dead group. As the length of hospitalisation variable value increases 1 unit, risk of mortality decreases 2%.

CONCLUSIONS

Health literacy levels of the individuals dealing with the care of palliative unit patients hospitalised in our region are low. Amelioration of health literacy of the caregivers will have a direct effect on patient health and prevention of complications. Improving health literacy must be a priority target for a more quality patient care and less complication. The issues that caregivers felt themselves insufficient should be addressed and necessary actions should be taken in the identified issues.