1
|
Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, Coleman K, Campbell J. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial. J Wound Care 2021. [PMID: 32931368 DOI: 10.12968/jowc.2020.29.sup9a.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. METHOD Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. RESULTS The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. CONCLUSION Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible.
Collapse
Affiliation(s)
- M D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - L J Ross
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Webster
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - A Mudge
- Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Herston, QLD
| | - M Stankiewicz
- Centre for Research & Education in Nursing, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Coleman
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Campbell
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| |
Collapse
|
2
|
Kozica-Olenski S, Treleaven E, Hewitt M, McRae P, Young A, Walsh Z, Mudge A. Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey. J Hum Nutr Diet 2021; 34:687-694. [PMID: 33491875 DOI: 10.1111/jhn.12854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. METHODS A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. RESULTS Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). CONCLUSIONS This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.
Collapse
Affiliation(s)
- S Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - E Treleaven
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - M Hewitt
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Mater Health, Brisbane, QLD, Australia
| | - P McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - A Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Z Walsh
- Nutrition and Dietetics, Brighton Health Campus, Brighton, QLD, Australia
| | - A Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| |
Collapse
|
3
|
Hunter SC, Kim B, Mudge A, Hall L, Young A, McRae P, Kitson AL. Experiences of using the i-PARIHS framework: a co-designed case study of four multi-site implementation projects. BMC Health Serv Res 2020; 20:573. [PMID: 32576197 PMCID: PMC7310499 DOI: 10.1186/s12913-020-05354-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Its underlying philosophy is that implementing research into healthcare practice is complex, unpredictable and non-linear which therefore requires a flexible and responsive approach to implementation. Facilitation is recognized as the central ingredient of this approach, and i-PARIHS now provides a Facilitation Guide with associated tools. This multiple case study of four implementation projects explored how the i-PARIHS framework has been practically operationalized by diverse implementation project teams. METHODS A co-design approach was used to elicit the experiences of four implementation project teams who used the i-PARIHS framework to guide their implementation approach. We conducted the established co-design steps of (i) setting up for success, (ii) gathering the experience, and (iii) understanding the experience. In particular we explored teams' approaches to setting up their projects; why and how they used the i-PARIHS framework and what they learnt from the experience. RESULTS We found both commonalities and differences in the use of i-PARIHS across the four implementation projects: (i) all the projects used the Facilitation Checklist that accompanies i-PARIHS as a starting point, (ii) the projects differed in how facilitation was carried out, (iii) existing tools were adapted for distinct phases: pre-implementation, during implementation, and post-implementation stages; and (iv) project-specific tools were often developed for monitoring implementation activities and fidelity. CONCLUSIONS We have provided a detailed overview of how current users of i-PARIHS are operationalising the framework, which existing tools they are using or adapting to use, and where they have needed to develop new tools to best utilise the framework. Importantly, this study highlights the value of existing tools from the published i-PARIHS Facilitation Guide and provides a starting point to further refine and add to these tools within a future Mobilising Implementation of i-PARIHS (or "Mi-PARIHS") suite of resources. Specifically, Mi-PARIHS might include more explicit guidance and/or tools for developing a structured implementation plan and monitoring fidelity to the implementation plan, including recording how strategies are tailored to an evolving context.
Collapse
Affiliation(s)
- S C Hunter
- College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia.
| | - B Kim
- Centre for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - A Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, QLD, Australia
| | - L Hall
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - A Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, QLD, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - P McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - A L Kitson
- College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
4
|
Byrnes A, Worrall J, Young A, Mudge A, Banks M, Bauer J. Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study. J Hum Nutr Diet 2018; 31:818-824. [DOI: 10.1111/jhn.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A. Byrnes
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Worrall
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| | - A. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove QLD Australia
| | - A. Mudge
- Internal Medicine and Aged Care; Royal Brisbane and Women's Hospital; Herston QLD Australia
- Institute for Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
- School of Medicine; The University of Queensland; St Lucia QLD Australia
| | - M. Banks
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Bauer
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| |
Collapse
|
5
|
Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, Coleman K, Campbell J. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial. J Wound Care 2017; 25:384-92. [PMID: 27410392 DOI: 10.12968/jowc.2016.25.7.384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. METHOD Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. RESULTS The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. CONCLUSION Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. DECLARATION OF INTEREST This research was supported by a grant from the Queensland Health, Health Practitioner Research Scheme. The authors have no conflicts of interest to declare.
Collapse
Affiliation(s)
- M D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - L J Ross
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Webster
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - A Mudge
- Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Herston, QLD
| | - M Stankiewicz
- Centre for Research & Education in Nursing, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD
| | - K Coleman
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| | - J Campbell
- Skin Integrity Services Royal Brisbane & Women's Hospital, Herston, QLD
| |
Collapse
|
6
|
Hwang R, Morris N, Mandrusiak A, Mudge A, Suna J, Adsett J, Russell T. Timed up and go test: A reliable test in patients with chronic heart failure? Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Mudge A. Multiple readmissions: Problem or opportunity? Rev Clin Esp 2015; 215:29-30. [DOI: 10.1016/j.rce.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
|
8
|
Hickey A, Suna J, Marquart L, Javorsky G, Munns A, Denaro C, Mudge A, Atherton J. Achieving medication titration for patients with heart failure in the real world. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Webster J, Coleman K, Mudge A, Marquart L, Gardner G, Stankiewicz M, Kirby J, Vellacott C, Horton-Breshears M, McClymont A. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial). BMJ Qual Saf 2011; 20:297-306. [DOI: 10.1136/bmjqs.2010.043109] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
|
11
|
Abstract
The development of geriatricshas greatly improved care for older people. Leon Flicker (doi: 10.1136/bmj.39538.481273.AD) believesspecialist care remains important for this vulnerable group,butC P Denaro and A Mudge argue that age divisions are no longer relevant
Collapse
Affiliation(s)
- C P Denaro
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia.
| | | |
Collapse
|
12
|
Mudge A, Laracy S, Richter K, Denaro C. Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care. Intern Med J 2006; 36:558-63. [PMID: 16911547 DOI: 10.1111/j.1445-5994.2006.01135.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health-care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients. AIM To enhance assessment, communication, care and discharge planning by restructuring consistent, patient-centred multidisciplinary teams in a general medicine service. METHODS Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral-based multidisciplinary models with existing staffing levels. RESULTS Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6-month readmissions. In-hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients' ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed-day savings. CONCLUSION This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.
Collapse
Affiliation(s)
- A Mudge
- Department of Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | | | | | | |
Collapse
|