1
|
Williams AT, Bates-Jensen BM, Hodge F, Lee E, Levy-Storms L. Pressure injury pain over time among nursing home residents . Geriatr Nurs 2024; 59:362-371. [PMID: 39127012 DOI: 10.1016/j.gerinurse.2024.07.010] [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: 10/08/2023] [Revised: 06/25/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Examine pressure injury (PrI) pain severity, stability, and current treatment of PrI pain among nursing home (NH) residents using two assessment tools and a descriptive cohort study design. BACKGROUND PrI pain affects quality of life of NH residents yet, best assessment methods, stability of PrI pain, and how to take care of the pain are not well known. METHODS Data collected from 33 residents with PrI (stages 1-4) from 4 NHs. All PrI were staged and assessed using the Bates-Jensen Wound Assessment Tool (BWAT) to determine severity. Verbal Response Scale (VRS) and Pain Assessment in Advanced Dementia (PAINAD) were used to assess general and PrI pain 3 times a day for two days within one week. Data classified as: no, mild, moderate, or severe pain. Proportions of participants with different levels of PrI pain were calculated. T tests were conducted to examine differences across time; VRS and PAINAD were examined for agreement. RESULTS Participants were 74 % female, 49 % white, 58 % cognitively intact, 58 % functionally dependent, and had mean age of 82 years old. The majority (52 %; n = 17) were full thickness PrI, stage 3 (n = 5), stage 4 (n = 7), unstageable (n = 5). The majority of participants (82 %; n = 27) reported PrI pain on at least one of six assessments over the two days; with 57 % mild, 26 % moderate and 16 % severe pain. More severe pain occurred in afternoon. No differences existed across days. Although there was a positive relationship between VRS and PAINAD in pain assessments (r = 0.38, P<.05), the agreement between the two scales, as indicated by Cohen's kappa (K = 0.19, p=.28), was found to be poor. Of those with PrI pain, 22 % had pain documented in the Minimum Data Set (MDS). Only 42 % of participants who reported PrI pain received pain medication within 12 h of initial pain assessment. Out of 28 participants who received routine pain medication for general pain, 18 of them reported experiencing no pain. CONCLUSION While VRS and PAINAD scores exhibited a relationship, their agreement was limited. Documentation of PrI pain on the Minimum Data Set (MDS) was found to be inadequate. Notably, 40 % of participants reported higher levels of PrI pain in the afternoon, suggesting this time may be opportune for PrI pain assessment and management. Interestingly, participants who received medication for general pain did not report PrI pain, suggesting that treatment of general pain may effectively alleviate PrI pain symptoms.
Collapse
Affiliation(s)
| | - Barbara M Bates-Jensen
- School of Nursing, UCLA, Los Angeles, CA, USA; Division of Geriatrics, David Geffen School of Medicine, UCLA Los Angeles, CA, USA
| | - Felicia Hodge
- School of Nursing, UCLA, Los Angeles, CA, USA; School of Public Health, UCLA, Los Angeles, CA, USA
| | - Eunice Lee
- School of Nursing, UCLA, Los Angeles, CA, USA
| | - Lené Levy-Storms
- School of Nursing, UCLA, Los Angeles, CA, USA; School of Public Health, UCLA, Los Angeles, CA, USA; Luskin School of Public Affairs, Department of Social Welfare, UCLA, Los Angeles, CA, USA
| |
Collapse
|
2
|
Tao H, Zhang H, Ma Y, Lv L, Pei J, Jiao Y, Han L. Comparison of the predictive validity of the Braden and Waterlow scales in intensive care unit patients: A multicentre study. J Clin Nurs 2024; 33:1809-1819. [PMID: 38031387 DOI: 10.1111/jocn.16946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The first step in preventing pressure injuries (PIs), which represent a significant burden on intensive care unit (ICU) patients and the health care system, is to assess the risk for developing PIs. A valid risk assessment scale is essential to evaluate the risk and avoid PIs. OBJECTIVES To compare the predictive validity of the Braden scale and Waterlow scale in ICUs. DESIGN A multicentre, prospective and cross-sectional study. METHODS We conducted this study among 6416 patients admitted to ICUs in Gansu province of China from April 2021 to October 2022. The incidence and characteristics of PIs were collected. The risk assessment of PIs was determined using the Braden and Waterlow scale. The sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve of the two scales were compared. RESULTS Out of 5903 patients, 72 (1.2%) developed PIs. The sensitivity, specificity, positive and negative predictive, and the area under the curve of the Braden scale were 77.8%, 50.9%, 0.014 and 0.996, and 0.689, respectively. These values for the Waterlow scale were 54.2%, 71.1%, 0.017, 0.994 and 0.651. CONCLUSIONS Both scales could be used for risk assessment of PIs in ICU patients. However, the accuracy of visual inspection for assessment of skin colour, nursing preventive measures for patients and scales inter-rater inconsistency may limited the predictive validity statistics. RELEVANCE TO CLINICAL PRACTICE Both scales could be used for PIs risk assessment. The low specificity of the Braden scale and low sensitivity of the Waterlow scale remind medical staff to use them in combination with clinical judgement and other objective indicators. PATIENT OR PUBLIC CONTRIBUTION This study was designed to enhance the management of PIs. Patients and the general public were not involved in the study design, analysis, and interpretation of the data or manuscript preparation.
Collapse
Affiliation(s)
- Hongxia Tao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Gansu Medical College, Pingliang, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Juhong Pei
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Yanxia Jiao
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| |
Collapse
|
3
|
Krishnan S, Hong I, Couture G, Tzen YT, Reistetter T. Pressure Injury on Poststroke Admission Assessment to Skilled Nursing Facilities: Risk Factors, Management, and Impact on Rehabilitation. J Am Med Dir Assoc 2022; 23:1718.e13-1718.e20. [PMID: 35922014 DOI: 10.1016/j.jamda.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe pressure injury (PrI) prevalence, comorbidities, and rehabilitation utilization among older adults with stroke at skilled nursing facilities' (SNFs') admission assessment. DESIGN Retrospective cohort. SETTING AND PARTICIPANTS Older Medicare beneficiaries (>65 years old) with stroke admitted to SNFs. METHODS We extracted data between 2013 and 2014 using the Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. PI data were assessed during admission assessment. RESULTS Of the 65,330 older adults poststroke admitted to SNFs, 11% had at least 1 PrI present on admission assessment. Individuals who were non-Hispanic Black, with a longer hospital stay, from lower socioeconomic status, with higher proportions of comorbidities (eg, underweight, urinary and bowel incontinence, diabetes, congestive heart failure, arrhythmias, and infections), and higher functional impairments were likely to present with a PrI at SNF admission assessment. Compared with individuals with superficial PrI, individuals with deep PrI were more likely to be young-old (<75 years), non-Hispanic Black, from lower socioeconomic status, present with a shorter hospital stay, an intensive care unit stay, with higher functional impairments, skin integrity issues, system failure, and infections. Compared to those without PrI or superficial PrI, individuals with any-stage PrI or deep PrI were more likely to be cotreated by physical and occupational therapist and less likely to receive individual therapy. Those with PrI poststroke had low documented turning and repositioning rates than those without PrI. CONCLUSIONS AND IMPLICATIONS Identifying modifiable risk factors to prevent PrIs poststroke in SNFs will facilitate targeted preventative interventions and improve wound care efficacy and rehabilitation utilization for optimized patient outcomes. Identifying residents with a higher risk of PrI during acute care discharge and providing early preventive care during post-acute care would possibly decrease costs and improve outcome quality.
Collapse
Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA, USA.
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Grace Couture
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare, Atlanta, GA, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Reistetter
- Department of Occupational Therapy, UT Health San Antonio, School of Health Professions, San Antonio, TX, USA
| |
Collapse
|
4
|
Osmancevic S, Bauer S. Pain and its associated factors in nursing home residents. Geriatr Nurs 2022; 47:13-17. [PMID: 35779377 DOI: 10.1016/j.gerinurse.2022.06.005] [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: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
This study examined the associated factors of pain in nursing home residents in Austria. A secondary data analysis was conducted with data collected in the 'Nursing Quality Measurement 2.0' study, which is conducted annually in Austrian healthcare institutions. Data from nursing homes from 2016 to 2019 were used. Of the 1,239 residents, 40.4% had experienced pain in the last 7 days and/or were experiencing pain at the time of the survey. The regression analysis showed that diseases of the musculoskeletal system, diseases of the skin and subcutaneous tissue, diseases of the circulatory system, pressure injuries, and a risk of malnutrition were statistically associated with pain (Χ2 (11) = 82,392, p < 0.000). Healthcare professionals working in nursing homes need to be aware of associated factors when treating pain in residents. This awareness is important because it enables professionals to identify high-risk groups and take appropriate steps.
Collapse
Affiliation(s)
- Selvedina Osmancevic
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria
| |
Collapse
|
5
|
Kim D, Park C, Briesacher BA. Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study. Prev Med Rep 2021; 21:101285. [PMID: 33489720 PMCID: PMC7804969 DOI: 10.1016/j.pmedr.2020.101285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022] Open
Abstract
The total number of Americans age 65 and older is expected to nearly double by 2060, and the number of Americans admitted to nursing homes is likewise anticipated to escalate. Studies have found living alone to be an important risk factor for mortality. Yet little is known about possible spillover health effects of living in a community where many elderly residents live alone. Even less is known about whether these risks persist after entering nursing homes. Our study population consisted of 874,162 US elderly adults newly admitted to nursing homes in 2011, as identified from the 3.0 Minimum Data Set. Data on these individuals were linked to Medicare claims and 2010 Census data. In this cohort study, we estimated multivariable-adjusted hazard ratios for the associations between the quartiles of county-level percentage of households with those age 65 or older living alone and the individual-level risks of all-cause mortality until December 31, 2013, controlling for county-, nursing home facility-, and individual-level factors. Older adults in counties belonging to the highest quartile of elderly single-occupancy households had a 8% higher risk of dying (HR = 1.08; 95% CI = 1.04-1.12, p < 0.001) after entering nursing homes compared to those in counties belonging to the lowest quartile. There was evidence of a linear trend (p for trend < 0.001). Should these findings be confirmed in future studies, it would suggest that living arrangements in elderly communities may have spillover health effects onto their residents. Programs and interventions that modify such living arrangements may yield more favorable health trajectories among older Americans, who are increasingly aging in place and at growing risk of entering nursing homes.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, United States
| | - Chanhyun Park
- Department of Pharmacy & Health Systems Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Becky A. Briesacher
- Department of Pharmacy & Health Systems Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| |
Collapse
|
6
|
Kwong EWY, Chen LY, Kwan RYC, Lee PH. The effectiveness of a pressure injury prevention program for nursing assistants in private for-profit nursing homes: A cluster randomized controlled trial. J Adv Nurs 2020; 76:1780-1793. [PMID: 32285486 DOI: 10.1111/jan.14391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 02/04/2023]
Abstract
AIM To examine the effectiveness of a pressure injury prevention program for private for-profit nursing homes. DESIGN This study was a two-arm cluster randomized controlled trial. Ten private for-profit nursing homes made up the clusters. METHODS The participants were nursing home residents who aged 60 or above regardless of whether or not having pre-existing pressure injuries and also three types of nursing home assistants who provided direct care to the residents from 10 private for-profit nursing homes. These 10 nursing homes were randomly assigned to either the experimental or the control group. There were 477 and 536 resident participants and 51 and 62 nursing assistant participants in the experimental and control groups, respectively. The residents were the study participants and the nursing assistant participants were the interveners. The experimental group had the pressure injury prevention program implemented while the control group received the usual care. The primary study outcome which was the pressure injury incidence was analysed by GEE. Significance was set at a p-value of ≤.05. The data were collected between September 2017-March 2018. RESULT There were significant interactive effects of time and group on the incidence of pressure injuries (p = .0015) and on the skill performance of the nursing assistant participants (p < .0001). CONCLUSIONS An evidence-based pressure injury prevention program reduced the development of the pressure injuries and improved the skill performance of the nursing assistant participants. It is highly recommended that private for-profit nursing homes with high proportion of non-professional nursing assistants and insufficient nurses adopt this program for improving the prevention care of pressure injuries. IMPACT This research has an impact on prevention care of pressure injury in private for-profit nursing homes with high proportion non-professional nursing assistants which have the similar characteristics as the nursing homes studied in various regions and countries. TRIAL REGISTRATION The Controlled Trial registration ID is NCT02270385.
Collapse
Affiliation(s)
- Enid W-Y Kwong
- School of Nursing, Putian University, Putian, Fujian Province, China.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Liang Y Chen
- School of Nursing, Putian University, Putian, Fujian Province, China
| | - Rick Y-C Kwan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
7
|
Bowers B. Improving practice and informing policy development: The impact of gerontological nursing research. Geriatr Nurs 2020; 41:32-37. [PMID: 32024595 DOI: 10.1016/j.gerinurse.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Nurses have always approached the clinical care challenges they encounter with a combination of critical observation and a profound concern for human suffering. Beginning in earnest in the early 1980s, nurse researchers have pursued the answers to questions about the wellbeing of older adults, particularly those suffering from serious, chronic conditions. This paper offers three exemplars of nursing research domains that illustrate the creativity and commitment of nurse researchers seeking to understand and improve pervasive clinical problems experienced by older adults and to demonstrate the profound influence these activities have had on the evolution of the science and the quality of care for older adults. The impact of this work is reflected in practice protocols, institutional policies, government oversight, and improved outcomes for patients.
Collapse
Affiliation(s)
- Barbara Bowers
- University of Wisconsin-Madison, School of Nursing, 5133 Signe Skott Cooper Hall, Madison, WI 53705, United States.
| |
Collapse
|
8
|
Abstract
BACKGROUND There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries. OBJECTIVES We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults. METHODS This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital's electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis. RESULTS The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress. DISCUSSION Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.
Collapse
|
9
|
Effect of an Educational and Organizational Intervention on Pain in Nursing Home Residents: A Nonrandomized Controlled Trial. J Am Med Dir Assoc 2019; 19:1118-1123.e2. [PMID: 30471802 DOI: 10.1016/j.jamda.2018.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management. DESIGN Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only. SETTING One hundred fifty-nine NHs located in France. PARTICIPANTS A subgroup of 3722 residents. MEASURES Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests. RESULTS A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls. CONCLUSION/IMPLICATIONS Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management.
Collapse
|
10
|
Kim J, Lyon D, Weaver MT, Keenan G, Chen X(J. The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults. J Adv Nurs 2019; 75:1219-1228. [PMID: 30456856 PMCID: PMC7227670 DOI: 10.1111/jan.13913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/02/2018] [Indexed: 12/01/2022]
Abstract
AIMS To examine the effect of psychological distress in mediating the relationship between the severity of pressure injury and pain intensity in hospitalized adults. BACKGROUND Despite the prevalence of pressure injury (previously known as pressure ulcers) in hospitalized adults, the current knowledge of pain associated with pressure injury is limited and findings are inconsistent. There is also a lack of understanding of the relationship between psychological distress and pain from pressure injury. DESIGN Retrospective cross-sectional secondary analysis of data from electronic health records. METHODS The data were retrieved from the third day of admission in the period between 2013 - 2016 through the Integrated Data Repository (IDR). Electronic health records were reviewed to collect data as needed. The mediation effect was tested by using path analysis implemented through Mplus. RESULTS Path analysis revealed that the severity of pressure injuries and psychological distress have significant direct effects on pain intensity in hospitalized adults. However, the relationship between the severity of pressure injury and pain intensity was not significantly mediated by psychological distress. CONCLUSION Hospitalized adults who have more severe pressure injury and more treatments for psychological distress experienced greater pain intensity. Healthcare providers must pay attention to treating psychological distress among hospitalized adults to manage pain. Further study is needed to validate these findings and it should incorporate more appropriate measures of psychological distress. The lack of standardized nursing documentation in electronic health records severely limits the usefulness of data from electronic health records for nursing research.
Collapse
Affiliation(s)
- Junglyun Kim
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Debra Lyon
- Department of Biobehavioral Nursing, College of Nursing, University of Florida, Gainesville, Florida
| | - Michael T. Weaver
- Department of Biobehavioral Nursing, College of Nursing, University of Florida, Gainesville, Florida
| | - Gail Keenan
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Xinguang (Jim) Chen
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
11
|
Anrys C, Van Tiggelen H, Verhaeghe S, Van Hecke A, Beeckman D. Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium. Int Wound J 2018; 16:325-333. [PMID: 30412652 DOI: 10.1111/iwj.13032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/31/2023] Open
Abstract
The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.
Collapse
Affiliation(s)
- Charlotte Anrys
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Hanne Van Tiggelen
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Ann Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| |
Collapse
|
12
|
|
13
|
La Frenais FL, Bedder R, Vickerstaff V, Stone P, Sampson EL. Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing. J Am Geriatr Soc 2018; 66:376-382. [PMID: 29274247 PMCID: PMC5838548 DOI: 10.1111/jgs.15238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. DESIGN Systematic review. SETTING We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). PARTICIPANTS LTC residents. MEASUREMENTS We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. RESULTS Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. CONCLUSION Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively.
Collapse
Affiliation(s)
- Francesca L. La Frenais
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Rachel Bedder
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Institute of Cognitive NeuroscienceUniversity College LondonLondonUnited Kingdom
| | - Victoria Vickerstaff
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Patrick Stone
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Elizabeth L. Sampson
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison TeamNorth Middlesex University HospitalLondonUnited Kingdom
| |
Collapse
|
14
|
Mearns ES, Liang M, Limone BL, Gilligan AM, Miller JD, Schaum KD, Waycaster CR. Economic analysis and budget impact of clostridial collagenase ointment compared with medicinal honey for treatment of pressure ulcers in the US. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:485-494. [PMID: 28860830 PMCID: PMC5566395 DOI: 10.2147/ceor.s133847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Pressure ulcer (PU) treatment poses significant clinical and economic challenges to health-care systems. The aim of this study was to assess the cost-effectiveness and budget impact of enzymatic debridement with clostridial collagenase ointment (CCO) compared with autolytic debridement with medicinal honey (MH) for PU treatment from a US payer/Medicare perspective in the hospital outpatient department setting. Methods A cost-effectiveness analysis using a Markov model was developed using a 1-week cycle length across a 1-year time horizon. The three health states were inflammation/senescence, granulation/proliferation (ie, patients achieving 100% granulation), and epithelialization. Data sources included the US Wound Registry, Medicare fee schedules, and other published clinical and cost studies about PU treatment. Results In the base case analysis over a 1-year time horizon, CCO was the economically dominant strategy (ie, simultaneously conferring greater benefit at less cost). Patients treated with CCO experienced 22.7 quality-adjusted life weeks (QALWs) at a cost of $6,161 over 1 year, whereas MH patients experienced 21.9 QALWs at a cost of $7,149. Patients treated with CCO achieved 11.5 granulation weeks and 6.0 epithelization weeks compared with 10.6 and 4.4 weeks for MH, respectively. The number of clinic visits was 40.1 for CCO vs 43.4 for MH, and the number of debridements was 12.3 for CCO compared with 17.6 for MH. Probabilistic sensitivity analyses determined CCO dominant in 72% of 10,000 iterations and cost-effective in 91%, assuming a benchmark willingness-to-pay threshold of $50,000/quality-adjusted life year ($962/QALW). The budget impact analysis showed that for every 1% of patients shifted from MH to CCO, a cost savings of $9,883 over 1 year for a cohort of 1,000 patients was observed by the payer. Conclusion The results of these economic analyses suggest that CCO is a cost-effective, economically dominant alternative to MH in the treatment of patients with PUs in the hospital outpatient department setting.
Collapse
Affiliation(s)
| | - Michael Liang
- Truven Health Analytics, an IBM Company, Cambridge, MA, USA
| | | | | | | | | | | |
Collapse
|
15
|
Jackson D, Durrant L, Bishop E, Walthall H, Betteridge R, Gardner S, Coulton W, Hutchinson M, Neville S, Davidson PM, Usher K. Pain associated with pressure injury: A qualitative study of community-based, home-dwelling individuals. J Adv Nurs 2017; 73:3061-3069. [DOI: 10.1111/jan.13370] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Debra Jackson
- Oxford Institute for Nursing; Midwifery & Allied Health Research (OxINMAHR). The Colonnade; Oxford Brookes University; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- Faculty of Health; University of Technology; Sydney Australia
| | - Lisa Durrant
- Oxford Institute for Nursing; Midwifery & Allied Health Research (OxINMAHR). The Colonnade; Oxford Brookes University; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | | | - Helen Walthall
- Oxford Institute for Nursing; Midwifery & Allied Health Research (OxINMAHR). The Colonnade; Oxford Brookes University; Oxford UK
| | - Ria Betteridge
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | | | - Wendy Coulton
- Oxford Institute for Nursing; Midwifery & Allied Health Research (OxINMAHR). The Colonnade; Oxford Brookes University; Oxford UK
| | - Marie Hutchinson
- School of Nursing; Southern Cross University; Lismore New South Wales Australia
| | - Stephen Neville
- School of Nursing; Auckland University of Technology; Auckland New Zealand
| | | | - Kim Usher
- Oxford Institute for Nursing; Midwifery & Allied Health Research (OxINMAHR). The Colonnade; Oxford Brookes University; Oxford UK
- School of Health; University of New Zealand; Australia
| |
Collapse
|
16
|
Effects of two different fabrics on skin barrier function under real pressure conditions. J Tissue Viability 2017; 26:150-155. [DOI: 10.1016/j.jtv.2016.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 12/21/2022]
|
17
|
La Frenais F, Stone P, Sampson EL. Analgesic prescribing in care home residents: how epidemiological studies may inform clinical practice. Pain Manag 2016; 6:561-568. [PMID: 27383004 DOI: 10.2217/pmt-2016-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Care home residents are often frail with multiple comorbidities and cognitive impairment, most commonly caused by dementia. This population is under-represented in clinical trials, leading to a lack of valid and reliable evidence to inform clinicians' prescribing practice. This paper summarizes how epidemiological research conducted in similar populations can inform pain management by describing pain prevalence, risk factors, typical features and functional consequences. This evidence can help overcome the numerous barriers to optimal pain management in care home residents.
Collapse
Affiliation(s)
- Francesca La Frenais
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield & Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
| |
Collapse
|
18
|
Kim J, Ahn H, Lyon DE, Stechmiller J. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients. Healthcare (Basel) 2016; 4:healthcare4010007. [PMID: 27417595 PMCID: PMC4934541 DOI: 10.3390/healthcare4010007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 12/10/2015] [Accepted: 12/28/2015] [Indexed: 01/15/2023] Open
Abstract
Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.
Collapse
Affiliation(s)
- Junglyun Kim
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Hyochol Ahn
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Debra E Lyon
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Joyce Stechmiller
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| |
Collapse
|