Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study

Prevalence of pressure ulcers and associated factors among adult patients admitted at Comprehensive Specialized Hospital, Northwest Ethiopia, 2023

Pressure ulcers are a serious concern in patients with prolonged bedtime and present with common complications following surgery. It is one of the key performance indicators of the quality of nursing care provided to patients. Several studies have reported the prevalence of pressure ulcers in Ethiopia, but the current study area has not yet been fully addressed. Hence, the study aims to assess pressure ulcers and their associated factors among adult patients admitted to the surgical ward. An institution-based, cross-sectional study was conducted from April 15 to May 15, 2023. A systematic random sampling technique was used to select 480 patients. A standardized, pre-tested, and structured questionnaire was used. The results were presented descriptively using tables and figures. A binary logistic regression was used to assess associated factors. From a total of 480, all patients have participated with a 100% response rate. The prevalence rate of pressure ulcers was 10.2%. Being smoker [95% CI AOR 7.46 (2.64, 21.06)], bedridden [95% CI AOR 3.92 (1.28, 11.66)], having a length of hospital stay of greater than 20 days [95% CI AOR 3.01 (1.13, 8.02)], experiencing pain [95% CI AOR 3.20 (1.06, 7.51)], or having friction and shear [95% CI AOR 5.71 (1.91, 17.08)], were significantly associated with pressure ulcers. This study showed that a considerable proportion of patients had pressure ulcers. Smoking, having pain, being bedridden, being exposed to friction and shear problems, and length of hospital stay were significantly associated with pressure ulcers. Healthcare providers should educate patients about smoking risks, pain management, mattress installation, and linen care.

Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study

AIM

To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk-stratified intervention bundle.

DESIGN

Single-centre, cross-sectional, observational, prospective.

METHODS

The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation.

RESULTS

Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient-/carer-focused interventions was particularly poor, with evidence indicating they had been implemented for 3%-10% of patients. Also, nutritional screening-related interventions were implemented poorly. Clinically indicated implementation of heel-elevation devices and bariatric equipment was low for at-risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such.

CONCLUSION

While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them.

IMPLICATIONS FOR PATIENT CARE

Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation.

IMPACT

The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals.

REPORTING METHOD

The study adheres to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

None.

Pressure injury risk factors in adult orthopaedic surgical patients: a cross-sectional study and random forest

OBJECTIVE

To identify the most important risk factors for predicting pressure injury (PI) occurrence in adult orthopaedic surgical patients based on investigation data, thereby identifying at-risk patients and facilitating formulation of an effective patient care strategy.

METHOD

Patients were assessed with an instrument designed by the authors specifically for this study in a cross-sectional investigation following the STROBE checklist. The random forest method was adopted to select the most important risk factors and predict occurrence of PIs.

RESULTS

A dataset of 27 risk factors from 1701 patients was obtained. A subset of the 15 most important risk factors was identified. The random forest method had a high prediction accuracy of 0.9733 compared with 0.9281 calculated with a logistic model.

CONCLUSION

Results indicated that the selected 15 risk factors, such as activity ability, friction/shear force, skin type and anaesthesia score, performed very well in predicting the occurrence of PIs in adult orthopaedic surgical patients.

Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review

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.

Factors Associated with Intensive Care Units' Nurses Frequency of Performing Pressure Injury Prevention: A Cross-sectional Study

AIM

To explore factors associated with frequency of performing pressure injury prevention measures among a sample of intensive care units' nurses.

BACKGROUND

Pressure injuries may be unavoidable in specific circumstances; however, most pressure injuries may be considered preventable. Nursing actions at the point of care play a significant role in shaping pressure injury prevention.

METHODS

A cross-sectional, descriptive correlational design was used. Using convenience sampling method, 162 intensive care units' nurses were recruited from three hospitals in Riyadh, Saudi Arabia. The participants completed a survey that included Nurses' Practice of Pressure Ulcer Prevention Questionnaire, Pressure Ulcer Knowledge Assessment Tool, Attitude toward Pressure Ulcer Prevention, Pressure Ulcer Prevention Barriers instrument, and Intention to Use Pressure Injury Preventive Measures instrument. Data were analyzed using descriptive and inferential statistics.

RESULTS

Nurses lack of knowledge about pressure injury preventions. However, they possessed positive attitudes toward pressure injury preventions. Nurses faced some barriers to prevent pressure injuries. Most nurses agreed that there was social pressure to prevent pressure injury. They had an intention to use preventive measures to prevent pressure injury. Nurses performed pressure injury prevention frequently. The bivariate and multivariate analyses showed only barriers to prevent pressure injury were negatively associated with frequency of performing pressure injury prevention.

CONCLUSIONS

Several factors that may influence ICU nurses' behavior to perform PIPs have been identified. The participants reflected positive attitude, positive social pressure, and intention to perform PIPs. Nevertheless, they need to improve their knowledge of PIPs and reduce the barriers prevented them from performing PIPs.

Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities

OBJECTIVE

To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland.

METHODS

A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument.

RESULTS

According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices.

CONCLUSIONS

Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.

Effectiveness of negative-pressure wound therapy compared to wet-dry dressing in pressure injuries

This study aims to compare the effects of Negative-Pressure Wound Therapy (NPWT) and wet-to-dry dressing on Stages 3 and 4 pressure injuries (PI), This study is a randomized controlled trial. A total of 30 patients with Stages 3 and 4 pressure injuries were included in the study. The patients were divided into two groups: NPWT group and the wet-to-dry dressing group. All patients received 3 rounds of treatment. Data were collected with a Patient Identification Form, Pressure Ulcer Scale for Healing (PUSH) Tool and the findings of the Three-Dimensional Wound Measurement (3DWM) device. We found that granulation tissue formation was more significant in the experimental group (p < .05), and that there was more significant wound shrinkage (p < .05) with a more significant decrease in the PUSH Tool scores (p < .05). The wounds were assessed with the tool and the 3DWM system. Device measurements were found to be correlated with PUSH Tool findings (p < .05). There was a significant correlation between device-measured granulation findings and PUSH Tool score results of the experimental group's third measurements (p < .05). We conclude that NPWT is an effective treatment method for pressure injuries, and 3DWM device is a useable wound assessment tool.

Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis

Introduction

Repositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes.

Objective

To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis.

Concept Description

Repositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences.

Discussion

Repositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications.

Conclusion

Repositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.

Knowledge and practices of operating room nurses in the prevention of pressure injuries

BACKGROUND

Operating room (OR) nurses play an important role in preventing the pressure injuries (PIs) that may develop during the perioperative process. This study was conducted to determine OR nurses' level of knowledge about PIs, and how they manage them.

METHODS

This is a cross-sectional, quantitative and descriptive study. The sample of the study consisted of 234 OR nurses working in eight different public hospitals in Ankara. The questionnaire applied in this study was prepared in accordance with the guidelines. This questionnaire consisted of three sections: demographic profiling, common preventive practices, and the knowledge of OR nurses about intraoperative PI prevention.

FINDINGS

66.7% of the participants had received education about PIs during their basic nursing training, and 41.5% had received education after graduation. 97.4% of OR nurses did not follow international guidelines about PIs. The mean total score of the OR nurses for the questions about PIs was 52.0 ± 13.7 out of a possible score of 100. The lowest mean score was obtained for the topic of 'staging pressure injuries', and the highest score was obtained from 'interventions to prevent pressure injuries'. In addition, 81.5% of the OR nurses stated that they were not given information about patients with a high PI risk by clinical nurses. 97.9% of the OR nurses did not use a scale to assess intraoperative PI risks. Fewer than half of the nurses said that they assessed the risk of PIs during surgery. 90.8% the nurses did not record risk assessment and interventions to prevent PIs.

CONCLUSION

There is a need to incorporate basic operating room PI (ORPI) training into both the basic nursing and in-service training to improve the knowledge of OR nurses about how to prevent and manage ORPIs. In addition, measures to assess PI risk and prevent ORPI should be included in institutional policies and procedures.

Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: a systematic review and meta-analysis

Background

Globally, PUs are recognized as one of the five most frequent causes of harm to clients. With millions affected globally, the national pooled prevalence of pressure ulcers in Ethiopia remains unknown. Hence, this review and meta-analysis aimed to determine the prevalence of pressure ulcers among hospitalized clients in Ethiopia.

Methods

Studies were retrieved through search engines in PubMed, Scopus, WHO Afro Library, Google Scholar, Africa Journals Online, and Web of Science. Heterogeneity between-studies were checked using the I² test. A funnel plot and Egger’s regression test was used to assess the presence of publication bias. The random-effect model was fitted to estimate summary effects and 95% confidence intervals (CIs) across studies. The analyses were performed using STATA™ Version 14 software.

Results

The pooled prevalence of pressure ulcer in Ethiopia was assessed using seven studies involving a total of 1881 participants. The pooled prevalence of pressure ulcers in Ethiopia was 11.7% (95% CI: 7.28, 16.13). The subgroup analysis showed that the estimated magnitude of pressure ulcers was 15.89% (95% CI: 13.32, 18.46); among studies, their sample size was greater than or equal to 250.

Conclusion

The current review reported that the pooled prevalence of pressure ulcers in Ethiopia was relatively high. Hence, policymaker and healthcare providers should give attention to reduce the magnitude of pressure ulcers. Furthermore, further a meta-analysis study could be conducted to identify individual and health care service-related factors related to the occurrence of pressure ulcers.

Nursing care for older patients with pressure ulcers: A qualitative study

Aim

To explore the experience and perception of pressure ulcers in a group of nurses caring for older patients.

Design

A qualitative study based on interviews with (N = 6) nurses working with older patients.

Method

A qualitative approach was applied using thematic analysis influenced by Braun and Clarke.

Results

The findings comprised one main theme "Prevention of pressure ulcers is important" and four sub-themes "Nursing resources on the ward," "Basic nursing skills-lift the duvet," "Introduction of new nurses on the ward-bedside teaching" and "Missing articulation of pressure ulcers." Bedside teaching and experienced nurses may create a culture on the ward where basic nursing skills and observations are articulated.

Comparison of platelet-rich plasma gel in the care of the pressure ulcers with the dressing with serum physiology in terms of healing process and dressing costs

This research was carried out with the aim of comparing the effects of platelet-rich plasma (PRP) gel and gas dressing with serum physiologic applied to stage II pressure ulcer in coccyx of patients for 2 months on healing process and dressing costs. This prospective randomised controlled experimental study was conducted with 60 patients hospitalised in the palliative care unit after surgery. The experimental group (n = 30) was dressed with platelet-rich plasma gel. The control group (n = 30) was treated with serum physiologic dressing. At the end of the 20th observation of the patients in the experimental group, it was found that the mean scores of area, exudate, and tissue type in pressure sores decreased statistically (P < .001). In the control group, no significant difference was found between the mean PUSH score at the end of the 20th observation (P > .05). The study showed that PRP gel had a positive effect on healing of stage II pressure ulcers with platelet-rich plasma gel dressings. In addition, when evaluated in the long term, it was concluded that platelet-rich plasma gel is easily accessible and less costly than serum physiological dressing.

Risk for surgical positioning injuries: scale validation in a rehabilitation hospital

OBJECTIVE

to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital.

METHOD

analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics.

RESULTS

most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries.

CONCLUSION

the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.

Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study

OBJECTIVE

The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU).

METHODS

A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP).

RESULTS

The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU).

CONCLUSION

Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.

Prevalence of pressure injury among Chinese community-dwelling older people and its risk factors: A national survey based on Chinese Longitudinal Healthy Longevity Survey

AIM

To investigate the distribution of pressure injuries among older adults in China and to identify the associated risk factors.

DESIGN

Cross-sectional study.

METHODS

The identified subjects were collected from 2012 wave of a national Chinese Longitudinal Healthy Longevity Survey. Older people were defined as being 65 years of age or older. We used chi-square test and binary logistic regression to investigate the risk factors of pressure injury development.

RESULTS

A total of 55 older people were documented as suffering from pressure injuries among 6,961 older Chinese adults, with a prevalence of 0.8%. In the group of disability, the prevalence of pressure injuries from high to low was 3.6% in the highly limited group, 0.4% in the moderately limited group, and 0.3% in the not limited group. The prevalence of pressure injury among older people with stroke, cancer, and dementia were 2%, 4.2%, and 6.6%, respectively. According to the final binary logistic regression analysis, age, disability, incontinence, cancer, and dementia emerged as important risk factors for pressure injury development.

CONCLUSION

Pressure injury among Chinese community-dwelling aged people was shown to be associated with age, disability, incontinence, cancer, and dementia. As the development of pressure injury may distinctly increase the burden on individuals and healthcare systems, the social and related institutions should actively prevent and control the disease.

IMPACT

The results of this study will improve the identification of pressure injury among older Chinese people and contribute to the development of effective pressure injury risk management interventions.

The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross-sectional, exploratory descriptive study in China

The aim of this study was to assess the prevalence, incidence, and the associated factors of pressure injuries (PIs) among immobile hospitalised patients in China. Being immobile during hospitalisation put these patients at a higher risk of PIs. There is little literature about pressure injury (PI) prevalence or PI incidence in immobile hospitalised patients in hospitals in China. This was a multicentre, cross-sectional, exploratory descriptive study. A total of 23 985 immobile patients were recruited from 25 general hospitals in six provinces of China from November 1, 2015 to March 18, 2016. Information was collected on demographic characteristics, physical assessment information, and treatment and nursing care measures. The PI period prevalence was 3.38%, and the PI cumulative incidence was 1.23%. Most PIs (84.03%) were Stage 1 or Stage 2. A total of 48.22% of PIs occurred in the sacrum or heel region. In the multivariate analysis, the following factors were associated with higher PI prevalence: age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, the usage of fixation or restraint devices, and patient's discharge diagnosis (lower limb fracture, malnutrition, and spinal cord injury). PI prevalence for immobile hospitalised patients in the study was lower than those reported in literature. However, because of the large population in China, the number of patients who suffer with PIs can be very high. The relating factors of higher PI prevalence identified in this study were consistent with current literature. Patients with a higher number of these associated factors should be monitored more closely, and preventative measures should be taken to prevent PI occurrence in high-risk populations.

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study

AIMS AND OBJECTIVES

To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications.

BACKGROUND

Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking.

DESIGN

Cross-sectional study.

METHODS

A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models.

RESULTS

Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia.

CONCLUSION

Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Prescription of pressure injury preventative interventions following risk assessment: An exploratory, descriptive study

This exploratory, descriptive study aimed to identify and describe the pressure injury preventative interventions prescribed by nurses following the assessment of a patient's pressure injury risk and to compare the prescribed interventions relative to the assessed risk level. A total of 200 inpatients in a tertiary Australian hospital were included. Patients' charts were audited within 24 hours of admission. Data collected included patient characteristics, pressure injury risk assessment score and level, and preventative interventions prescribed. Most patients were assessed as not being at risk, with the largest group of at-risk patients assessed as being at high risk. Some not-at-risk patients were prescribed interventions intended for those at risk, while prescription rates of preventative interventions recommended for those at any level of risk were variable (6%-64%). Significant associations were found between assessed pressure injury risk and preventative intervention prescription. Preventative intervention prescription was inadequate, potentially exposing some patients to pressure injury. However, the association between intervention prescription and risk level suggests that nurses are prescribing interventions relative to risk. A more structured approach to intervention prescription according to risk level, such as a care bundle, may help to improve nurses' preventative intervention prescription and ensure that all at-risk patients receive appropriate preventative interventions.

Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings

The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e-learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital-acquired pressure injuries and the percentages of each stage of pressure of injury 1-4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure-relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice.

The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study

OBJECTIVE

To ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers.

BACKGROUND

Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals.

DESIGN

A cross-sectional study design was used.

METHODS

Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China. The investigators were divided into two groups. The investigators in group 1 examined the patients' skin. When a pressure ulcer was found, a pressure ulcer assessment form was completed. The investigators in group 2 provided guidance to the nurses, who assessed all patients and completed another questionnaire. A multivariate logistic regression analysis was used to analyse the relationship between the possible risk factors and pressure ulcer.

RESULTS

The overall prevalence rate of pressure ulcers in the 25 hospitals ranged from 0%-3.49%, with a mean of 1.26%. The most common stage of the pressure ulcers was stage II (41.4%); most common anatomical locations were sacrum (39.5%) and the feet (16.4%). Braden score (p < .001), expected length of stay (p < .001), incontinence (p < .001), care group (p = .011), hospital location (p < .001), type of hospitals (p = .004), ages of patients (p < .001) were associations of pressure ulcers from the multivariate logistic regression analysis.

CONCLUSIONS

The overall prevalence rate of pressure ulcers in Chinese hospitals was lower than that reported in previous investigations. Specific characteristics of pressure ulcer patients were as follows: low Braden score, longer expected length of stay, double incontinence, an ICU and a medical ward, hospital location in the Pearl River Delta, a university hospital and an older patient.

RELEVANCE TO CLINICAL PRACTICE

The survey could make managers know their prevalence level of pressure ulcers and provide priorities for clinical nurses.

Does participating in a clinical trial affect subsequent nursing management? Post-trial care for participants recruited to the INTACT pressure ulcer prevention trial: A follow-up study

BACKGROUND

Participation in a clinical trial is believed to benefit patients but little is known about the post-trial effects on routine hospital-based care.

OBJECTIVES

To describe (1) hospital-based, pressure ulcer care-processes after patients were discharged from a pressure ulcer prevention, cluster randomised controlled trial; and (2) to investigate if the trial intervention had any impact on subsequent hospital-based care.

METHODS

We conducted a retrospective analysis of 133 trial participants who developed a pressure ulcer during the clinical trial. We compared outcomes and care processes between participants who received the pressure ulcer prevention intervention and those in the usual care, control group. We also compared care processes according to the pressure ulcer stage.

RESULTS

A repositioning schedule was reported for 19 (14.3%) patients; 33 (24.8%) had a dressing applied to the pressure ulcer; 17 (12.8) patients were assessed by a wound care team; and 20 (15.0%) were seen by an occupational therapist. Patients in the trial's intervention group were more likely to have the presence of a pressure ulcer documented in their chart (odds ratio (OR) 8.18, 95% confidence intervals (CI) 3.64-18.36); to be referred to an occupational therapist OR 0.92 (95% CI 0.07; 0.54); to receive a pressure relieving device OR 0.31 (95% CI 0.14; 0.69); or a pressure relieving mattress OR 0.44 (95% CI 0.20; 0.96). Participants with Stage 2 or unstageable ulcers were more likely than others to have dressings applied to their wounds (p=<0.001) and to be referred to an occupational therapist for protective devices (p=0.022).

CONCLUSION

Participants in the intervention group of a clinical trial were more likely to receive additional post trial care and improved documentation compared with those in the control group but documentation of pressure ulcer status and care is poor.

Impact of teamwork on missed care in four Australian hospitals

AIMS AND OBJECTIVES

Investigate effects of teamwork on missed nursing care across a healthcare network in Australia.

BACKGROUND

Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events.

DESIGN

A descriptive exploratory study.

METHODS

Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care.

RESULTS

The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care.

CONCLUSION

Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed.

RELEVANCE TO CLINICAL PRACTICE

These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally.

Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study

Background

Oropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay.

Objective

The overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m², eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay.

Design

The study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period.

Results

Mean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018).

Conclusions

Essential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.

Prevención de lesiones de piel: educación en el equipo de salud y familiares de personas hospitalizadas

<p>Introducción. Las lesiones de piel como las úlceras por presión y dermatitis asociada a la incontinencia son un problema asociado a la edad, movilidad, humedad, alimentación, eliminación o estado mental y afectan negativamente la calidad de vida de las personas y su familia; su prevención mediante educación permite disminuir su aparición y contribuye a brindar un cuidado de calidad. Objetivo. Fortalecer los conocimientos en prevención de lesiones de piel del equipo de enfermería y cuidadores de personas hospitalizadas en el área de medicina interna y la unidad de cuidado intensivo de un hospital universitario de Bogotá, D.C. Materiales y métodos. Estudio de intervención prospectiva con prueba de entrada diagnóstica para identificar el conocimiento del equipo de enfermería. Se realizaron tres intervenciones educativas y, posteriormente, se aplicó una prueba que estableció los cambios logrados. Del mismo modo, se aplicó un cuestionario de intervención a tres cuidadores permanentes, identificando qué actividades preventivas conocían y cómo las realizaban; finalmente, se suministró un folleto de apoyo con tópicos generales de cuidado de la piel. Resultados. Participaron 21 personas, cuya caracterización identificó que el grado de conocimiento es superior a mayor edad y más tiempo de experiencia laboral. Se establecieron cambios positivos en los conocimientos del equipo de enfermería entre el porcentaje de la prueba de entrada diagnóstica (76.81%) y la prueba posterior a la intervención (84.41%). Conclusión. Es importante realizar intervenciones educativas permanentes a los implicados en el cuidado preventivo de lesiones de piel para generar trasformaciones positivas en el equipo de salud y los cuidadores.</p>

Pressure injury prevention strategies in acute medical inpatients: an observational study

BACKGROUND

Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients' pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning.

METHOD

An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The sample comprised adult medical inpatients with reduced mobility. A subsample of participants assessed at pressure injury risk on admission was drawn from this sample. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility.

RESULTS

There was suboptimal planning and implementation of pressure injury prevention strategies for the sample and subsample. There was a significant relationship between planned and implemented support surfaces at both hospitals; however, no relationship existed between the planned and implemented of regular repositioning at either site.

CONCLUSION

The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces; however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.

Patients' knowledge of and participation in preventing pressure ulcers- an intervention study

The aim of this study was to evaluate a patient information pamphlet on pressure ulcer (PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet 'How can you help to stop pressure ulcers?' developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.

Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care

The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study

BACKGROUND

Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals.

OBJECTIVE

To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level.

DESIGN

A cross-sectional study.

SETTING

Six of the 11 invited hospitals in South-Eastern Norway agreed to participate.

PARTICIPANTS

Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded.

METHODS

The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels.

RESULTS

The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level.

CONCLUSIONS

Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important.