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Wong A, Lai P, Chong HH, Lien CTC, Graves N. The Clinical and Cost-Effectiveness of an Individualized Nutritional CAre (INCA) Bundle versus Standard Care for Adults with Pressure Injuries Receiving Home Nursing Services: A Protocol for a Cluster Randomized and Pragmatic Clinical Trial with an Economic Evaluation. Nutrients 2024; 16:299. [PMID: 38257192 PMCID: PMC10819700 DOI: 10.3390/nu16020299] [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: 12/27/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pressure injuries (PIs) represent a significant healthcare challenge in Singapore among the aging population. These injuries contribute to increased morbidity, mortality, and healthcare expenditure. Existing research predominantly explores single-component interventions in hospital environments, often yielding limited success. The INCA Trial aims to address this research gap by conducting a comprehensive, cluster randomized controlled trial that integrates education, individualized nutritional support, and community nursing care. This study is designed to evaluate clinical and cost-effectiveness outcomes, focusing on PI wound area reduction and incremental costs associated with the intervention. METHODS The INCA Trial employs a two-group, non-blinded, cluster randomized, and pragmatic clinical trial design, recruiting 380 adult individuals (age ≥ 21 years) living in the community with stage II, III, IV, and unstageable PI(s) who are receiving home nursing service in Singapore. Cluster randomization is stratified by postal codes to minimize treatment contamination. The intervention arm will receive an individualized nutrition and nursing care bundle (dietary education with nutritional supplementation), while the control arm will receive standard care. The 90-day intervention will be followed by outcome assessments extending over one year. Primary outcomes include changes in PI wound area and the proportion of participants achieving a ≥40% area reduction. Secondary outcomes include health-related quality of life (HRQOL), nutritional status, and hospitalization rates. Data analysis will be conducted on an intention-to-treat (ITT) basis, supplemented by interim analyses for efficacy and futility and pre-specified sensitivity and subgroup analyses. The primary outcome for the cost-effectiveness analysis will be based on the change to total costs compared to the change to health benefits, as measured by quality-adjusted life years (QALYs). DISCUSSION The INCA Trial serves as a pioneering effort in its approach to PI management in community settings. This study uniquely emphasizes both clinical and economic outcomes and melds education, intensive dietetic support, and community nursing care for a holistic approach to enhancing PI management.
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Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Precilla Lai
- Department of Nursing, Home Nursing Foundation, 490 Lorong 6 Toa Payoh, #05-10, Singapore 310490, Singapore;
| | - Hui Hsien Chong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | | | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School Singapore, 8 College Road, Singapore 169857, Singapore
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Aloweni FBAB, Lim SH, Agus NLB, Ang SY, Goh MM, Yong P, Fook-Chong S, Tucker-Kellogg L, Soh CR. Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients. AORN J 2023; 118:306-320. [PMID: 37882600 DOI: 10.1002/aorn.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 10/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.
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Yilmazer T, Tuzer H. The effect of a pressure ulcer prevention care bundle on nursing workload costs. J Tissue Viability 2022; 31:459-464. [PMID: 35595597 DOI: 10.1016/j.jtv.2022.05.004] [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: 12/14/2021] [Revised: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Abstract
AIM This study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. DESIGN, SETTING, AND PARTICIPANTS This prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. METHODS The study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018-30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018-15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. RESULTS The pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). CONCLUSION The pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.
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Affiliation(s)
- Tuba Yilmazer
- Department of Nursing, Ankara Yildirim Beyazit University Faculty of Health Sciences, Ankara, Turkey.
| | - Hilal Tuzer
- Department of Nursing, Ankara Yildirim Beyazit University Faculty of Health Sciences, Ankara, Turkey
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Yilmazer T, Tuzer H. Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units. J Wound Ostomy Continence Nurs 2022; 49:226-232. [PMID: 35523237 DOI: 10.1097/won.0000000000000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of a pressure injury prevention care bundle. DESIGN Prospective interventional study. SUBJECTS AND SETTING Participants were 13 nurses and 104 patients cared for in the intensive care unit for at least 24 hours in a university hospital in Ankara, Turkey. METHODS The study was conducted in 2 stages: the pre-care and post-care bundle stages. In the pre-care bundle stage, the pressure injury incidence of the patients was followed by the nurses. At the end of the third month, the researcher held a 1-day training program for the nurses about the care bundle use to promote correct implementation. In the post-care bundle stage, the nurses provided care according to the bundle. Compliance with the care bundle was assessed. Pressure injury incidence rates in the pre- and post-care bundle stages were compared. RESULTS The incidence of stage 1 pressure injury was 15.11 (1000 patient-days) in the pre-care bundle stage and 6.79 (1000 patient-days) in the post-care bundle stage; this reduction was not statistically significant. CONCLUSIONS A pressure injury prevention bundle was implemented in an intensive care unit, resulting in a decline in stage 1 pressure injuries.
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Affiliation(s)
- Tuba Yilmazer
- Tuba Yilmazer, PhD, RN , Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
- Hilal Tuzer, PhD, RN, Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hilal Tuzer
- Tuba Yilmazer, PhD, RN , Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
- Hilal Tuzer, PhD, RN, Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Constructing Inpatient Pressure Injury Prediction Models Using Machine Learning Techniques. Comput Inform Nurs 2020; 38:415-423. [PMID: 32205474 DOI: 10.1097/cin.0000000000000604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.
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Serraes B, Hecke AV, Van Tiggelen H, Anrys C, Verhaeghe S, Beeckman D. An exploration of nursing home residents' experiences of a non-powered static air mattress overlay to prevent pressure ulcers. Int Wound J 2020; 17:1166-1182. [PMID: 32603026 PMCID: PMC7949426 DOI: 10.1111/iwj.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/26/2022] Open
Abstract
Pressure ulcers are injuries to the skin and underlying tissue and are associated with a negative impact on well-being and health-related quality of life. This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents' perspectives and critical success factors when implementing a new non-powered static air mattress overlay to prevent pressure ulcers. Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair-bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non-powered static air mattress overlay. Interviews were conducted in the participants' personal rooms between June 2017 and March 2018. Interviews included broad, open-ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14-day observation period between day 3 and day 14. All interviews were audio-recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay. Implementation of a non-powered static air mattress overlay to prevent pressure ulcers has a far-reaching impact on nursing home residents' experiences. This study provides insight into the true meaning of patients' perspectives by focusing on learning from the patients' experiences that provide valuable information for healthcare professionals and other stakeholders.
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Affiliation(s)
- Brecht Serraes
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Nursing and Paramedical Department (General Hospital) AZ NikolaasSint‐NiklaasBelgium
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Staff member Nursing DepartmentGhent University HospitalGhentBelgium
| | - Hanne Van Tiggelen
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Charlotte Anrys
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of NursingVIVES University CollegeRoeselareBelgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- School of Nursing and MidwiferyRoyal College of Surgeons in IrelandDublinIreland
- School of Health SciencesÖrebro UniversityÖrebroSweden
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Southern DenmarkOdenseDenmark
- School of Nursing and MidwiferyMonash UniversityMelbourneAustralia
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Moda Vitoriano Budri A, Moore Z, Patton D, O’Connor T, Nugent L, Mc Cann A, Avsar P. Impaired mobility and pressure ulcer development in older adults: Excess movement and too little movement—Two sides of the one coin? J Clin Nurs 2020; 29:2927-2944. [DOI: 10.1111/jocn.15316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Aglecia Moda Vitoriano Budri
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Zena Moore
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Cardiff University Cardiff UK
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Monash University Melbourne Vic. Australia
- UGent Ghent University Ghent Belgium
| | - Declan Patton
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- University of Wollongong Wollongong NSW Australia
| | - Tom O’Connor
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Lida Institute Shanghai China
| | - Linda Nugent
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Aisling Mc Cann
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Pinar Avsar
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
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Latimer S, Chaboyer W, Thalib L, McInnes E, Bucknall T, Gillespie BM. Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. J Clin Nurs 2019; 28:4119-4127. [DOI: 10.1111/jocn.14967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/03/2019] [Accepted: 05/29/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Sharon Latimer
- Menzies Health Institute Queensland, The School of Nursing and Midwifery Griffith University Southport Queensland Australia
- Gold Coast Hospital and Health Service Southport Queensland Australia
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, The School of Nursing and Midwifery Griffith University Southport Queensland Australia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences Qatar University Doha Qatar
| | - Elizabeth McInnes
- Nursing Research Institute St Vincent’s Health Australia Sydney, St. Vincent’s Hospital Melbourne & Australian Catholic University North Sydney New South Wales Australia
- School of Nursing, Midwifery and Paramedicine Australian Catholic University North Sydney New South Wales Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery Deakin University Geelong Victoria Australia
- Alfred Health Melbourne Victoria Australia
| | - Brigid M. Gillespie
- Menzies Health Institute Queensland, The School of Nursing and Midwifery Griffith University Southport Queensland Australia
- Gold Coast Hospital and Health Service Southport Queensland Australia
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Redley B, Baker T. Have you SCAND MMe Please? A framework to prevent harm during acute hospitalisation of older persons: A retrospective audit. J Clin Nurs 2018; 28:560-574. [PMID: 30129081 DOI: 10.1111/jocn.14650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients. BACKGROUND It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients. DESIGN Retrospective audit of medical records. METHODS A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation. RESULTS Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation. CONCLUSIONS The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation. RELEVANCE TO CLINICAL PRACTICE The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery, Nursing Research Centre, Monash Health-Deakin Partnership, Deakin University, Burwood, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
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August DL, New K, Ray RA, Kandasamy Y. Frequency, location and risk factors of neonatal skin injuries from mechanical forces of pressure, friction, shear and stripping: A systematic literature review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2017.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Whitty JA, McInnes E, Bucknall T, Webster J, Gillespie BM, Banks M, Thalib L, Wallis M, Cumsille J, Roberts S, Chaboyer W. The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial. Int J Nurs Stud 2017; 75:35-42. [DOI: 10.1016/j.ijnurstu.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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Martin D, Albensi L, Van Haute S, Froese M, Montgomery M, Lam M, Gierys K, Lajeunesse R, Guse L, Basova N. Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:473-483. [PMID: 28755424 DOI: 10.1111/wvn.12242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. AIMS To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. METHODS This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. RESULTS A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p < .001). The online tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. CONCLUSIONS Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. LINKING EVIDENCE TO ACTION Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare aides, patients and families.
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Affiliation(s)
- Donna Martin
- Xi Lambda, Associate Professor, University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, Winnipeg, Manitoba, Canada
| | - Lisa Albensi
- Xi Lambda, Director of Health Services, Southern Health Sante-Sud Regional Authority, Bethesda Regional Health Centre, Steinbach, Manitoba, Canada
| | - Stephanie Van Haute
- Program Development Officer, Manitoba HIV Program, Winnipeg Manitoba; Nursing Supervisor, St. Boniface Hospital, Winnipeg Manitoba; Facility Patient Care Manager, Seven Oaks General Hospital, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Maria Froese
- Physiotherapist, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Mary Montgomery
- Occupational Therapist, Seven Oaks Hospital, Occupational Therapy, Winnipeg, Manitoba, Canada
| | - Mavis Lam
- Registered Dietician, Seven Oaks Hospital, Clinical Nutrition, Winnipeg, Manitoba, Canada
| | - Kendra Gierys
- Continuing Education Instructor, Seven Oaks Hospital, Critical Care, Winnipeg, Manitoba, Canada
| | - Rob Lajeunesse
- Program Care Team Manager, Seven Oaks Hospital, Renal Health, Winnipeg, Manitoba, Canada
| | - Lorna Guse
- Associate Professor, University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, Winnipeg, Manitoba, Canada
| | - Nataliya Basova
- Xi Lambda, Registered Nurse, Health Sciences Centre, Central Support Services, Surgical Relief Team, Winnipeg, Manitoba, Canada
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Feng H, Li G, Xu C, Ju C, Suo P. A quality control circle process to improve implementation effect of prevention measures for high-risk patients. Int Wound J 2017; 14:1094-1099. [PMID: 28580759 DOI: 10.1111/iwj.12764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of the study was to analyse the influence of prevention measures on pressure injuries for high-risk patients and to establish the most appropriate methods of implementation. Nurses assessed patients using a checklist and factors influencing the prevention of a pressure injury determined by brain storming. A specific series of measures was drawn up and an estimate of risk of pressure injury determined using the Braden Scale, analysis of nursing documents, implementation of prevention measures for pressure sores and awareness of the system both before and after carrying out a quality control circle (QCC) process. The overall scores of implementation of prevention measures ranged from 74.86 ± 14.24 to 87.06 ± 17.04, a result that was statistically significant (P < 0.0025). The Braden Scale scores ranged from 8.53 ± 3.21 to 13.48 ± 3.57. The nursing document scores ranged from 7.67 ± 3.98 to 10.12 ± 1.63; prevention measure scores ranged from 11.48 ± 4.18 to 13.96 ± 3.92. Differences in all of the above results are statistically significant (P < 0.05). Implementation of a QCC can standardise and improve the prevention measures for patients who are vulnerable to pressure sores and is of practical importance to their prevention and control.
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Affiliation(s)
- Haixia Feng
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guohong Li
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Cuirong Xu
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Changping Ju
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Peiheng Suo
- Department of Nursing, School of Medicine, Southeast University, Nanjing, China
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Roberts S, Wallis M, McInnes E, Bucknall T, Banks M, Ball L, Chaboyer W. Patients' Perceptions of a Pressure Ulcer Prevention Care Bundle in Hospital: A Qualitative Descriptive Study to Guide Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:385-393. [PMID: 28395394 DOI: 10.1111/wvn.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients' perceptions of the intervention. AIMS To identify patients' perceptions and experiences of a PUPCB in hospital. METHODS This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. FINDINGS Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery; (b) understanding pressure ulcer prevention (PUP) enhances participation; and (c) individual factors impact patients' engagement in PUP. DISCUSSION The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients' existing knowledge and beliefs, and perceived advantage of the intervention; ability for human interaction; and patient-related facilitators and barriers to participating in PUP care. LINKING EVIDENCE TO ACTION This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients.
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Affiliation(s)
- Shelley Roberts
- Research Fellow, Griffith University, NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Gold Coast Campus, QLD, Australia
| | - Marianne Wallis
- Professor of Nursing, University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, Maroochydore DC, QLD, Australia
| | - Elizabeth McInnes
- Deputy Director, Nursing Research Institute, St Vincent's Health Australia, Sydney, and Australian Catholic University, School of Nursing, Midwifery and Paramedicine, North Sydney, NSW, Australia
| | - Tracey Bucknall
- Professor and Associate Head of School (Research), Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, and Foundational Chair in Nursing, Alfred Health, Geelong, VIC, 3220, Australia
| | - Merrilyn Banks
- Director of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Department of Nutrition and Dietetics, Herston, QLD, Australia
| | - Lauren Ball
- Research Fellow, NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD, Australia
| | - Wendy Chaboyer
- Director of NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD, Australia
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Roberts S, McInnes E, Bucknall T, Wallis M, Banks M, Chaboyer W. Process evaluation of a cluster-randomised trial testing a pressure ulcer prevention care bundle: a mixed-methods study. Implement Sci 2017; 12:18. [PMID: 28193242 PMCID: PMC5307838 DOI: 10.1186/s13012-017-0547-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As pressure ulcers contribute to significant patient burden and increased health care costs, their prevention is a clinical priority. Our team developed and tested a complex intervention, a pressure ulcer prevention care bundle promoting patient participation in care, in a cluster-randomised trial. The UK Medical Research Council recommends process evaluation of complex interventions to provide insight into why they work or fail and how they might be improved. This study aimed to evaluate processes underpinning implementation of the intervention and explore end-users' perceptions of it, in order to give a deeper understanding of its effects. METHODS A pre-specified, mixed-methods process evaluation was conducted as an adjunct to the main trial, guided by a framework for process evaluation of cluster-randomised trials. Data was collected across eight Australian hospitals but mainly focused on the four intervention hospitals. Quantitative and qualitative data were collected across the evaluation domains: recruitment, reach, intervention delivery and response to intervention, at both cluster and individual patient level. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. RESULTS In the context of the main trial, which found a 42% reduction in risk of pressure ulcer with the intervention that was not significant after adjusting for clustering and covariates, this process evaluation provides important insights. Recruitment and reach among clusters and individuals was high, indicating that patients, nurses and hospitals are willing to engage with a pressure ulcer prevention care bundle. Of 799 intervention patients in the trial, 96.7% received the intervention, which took under 10 min to deliver. Patients and nurses accepted the care bundle, recognising benefits to it and describing how it enabled participation in pressure ulcer prevention (PUP) care. CONCLUSIONS This process evaluation found no major failures relating to implementation of the intervention. The care bundle was found to be easy to understand and deliver, and it reached a large proportion of the target population and was found to be acceptable to patients and nurses; therefore, it may be an effective way of engaging patients in their pressure ulcer prevention care and promoting evidence-based practise.
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Affiliation(s)
- Shelley Roberts
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, NSW, 2060, Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia.,Alfred Health, Melbourne, VIC, 3004, Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore, QLD, 4558, Australia
| | - Merrilyn Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, 4019, Australia
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
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Roberts S, McInnes E, Wallis M, Bucknall T, Banks M, Chaboyer W. Nurses' perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nurs 2016; 15:64. [PMID: 27895528 PMCID: PMC5117662 DOI: 10.1186/s12912-016-0188-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative pressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster randomised trial in eight Australian hospitals. Understanding nurses' perspectives of such an intervention is imperative when interpreting results and translating evidence into practice. As part of a process evaluation for the main trial, this study assessed nurses' perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice. METHODS This qualitative descriptive study involved semi-structured interviews with nursing staff at four Australian hospitals that were intervention sites for a cluster randomised trial testing a pressure ulcer prevention care bundle. Four to five participants were purposively sampled at each site. A trained interviewer used a semi-structured interview guide to question participants about their perceptions of the care bundle. Interviews were digitally recorded, transcribed and analysed using thematic analysis. RESULTS Eighteen nurses from four hospitals participated in the study. Nurses' perceptions of the intervention are described in five themes: 1) Awareness of the pressure ulcer prevention care bundle and its similarity to current practice; 2) Improving awareness, communication and participation with the pressure ulcer prevention care bundle; 3) Appreciating the positive aspects of patient participation in care; 4) Perceived barriers to engaging patients in the pressure ulcer prevention care bundle; and 5) Partnering with nursing staff to facilitate pressure ulcer prevention care bundle implementation. CONCLUSIONS Overall, nurses found the care bundle feasible and acceptable. They identified a number of benefits from the bundle, including improved communication, awareness and participation in pressure ulcer prevention care among patients and staff. However, nurses thought the care bundle was not appropriate or effective for all patients, such as those who were cognitively impaired. Perceived enablers to implementation of the bundle included facilitation through effective communication and dissemination of evidence about the care bundle; strong leadership and ability to influence staff behaviour; and simplicity of the care bundle.
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Affiliation(s)
- Shelley Roberts
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, NSW 2060 Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558 Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220 Australia
| | - Merrilyn Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4019 Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
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Chaboyer W, Bucknall T, Webster J, McInnes E, Gillespie BM, Banks M, Whitty JA, Thalib L, Roberts S, Tallott M, Cullum N, Wallis M. The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. Int J Nurs Stud 2016; 64:63-71. [PMID: 27693836 DOI: 10.1016/j.ijnurstu.2016.09.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. OBJECTIVE To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. DESIGN Pragmatic cluster randomised trial. SETTING Eight tertiary referral hospitals with >200 beds each in three Australian states. PARTICIPANTS 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure ulcer because of limited mobility; expected to stay in hospital ≥48h and able to read English. METHODS Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients' participation in pressure ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. RESULTS Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure ulcers developed (pressure ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33; p=0.198). No adverse events or harms were reported. CONCLUSIONS Although the pressure ulcer prevention care bundle was associated with a large reduction in the hazard of ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure ulcer prevention care bundle was effective but the sample size too small to detect this.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
| | - Tracey Bucknall
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Alfred Health, Melbourne, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Joan Webster
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St. Vincent's Health Australia (Sydney), Darlinghurst, NSW 2010, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
| | - Brigid M Gillespie
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Merrilyn Banks
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - Jennifer A Whitty
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, Australia; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7JT, United Kingdom
| | - Lukman Thalib
- Public Health Program, Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Shelley Roberts
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Mandy Tallott
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Nicky Cullum
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Marianne Wallis
- Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing and Midwifery, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
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Balzer K, Kottner J. Evidence-based practices in pressure ulcer prevention: Lost in implementation? Int J Nurs Stud 2015; 52:1655-8. [DOI: 10.1016/j.ijnurstu.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 11/17/2022]
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Burton C, Rycroft-Malone J. An Untapped Resource: Patient and Public Involvement in Implementation Comment on "Knowledge Mobilization in Healthcare Organizations: A View From the Resource-Based View of the Firm". Int J Health Policy Manag 2015; 4:845-7. [PMID: 26673471 DOI: 10.15171/ijhpm.2015.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/06/2015] [Indexed: 11/09/2022] Open
Abstract
This commentary considers the potential role of patient and public involvement in implementation. Developing an analytical thread from the resource-based view of the Firm, we argue that this involvement may create unique resources that have the capacity to enhance the impact of implementation activity for healthcare organisations.
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Latimer S, Chaboyer W, Gillespie BM. The repositioning of hospitalized patients with reduced mobility: a prospective study. Nurs Open 2015; 2:85-93. [PMID: 27708804 PMCID: PMC5047314 DOI: 10.1002/nop2.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022] Open
Abstract
AIM To determine the frequency of patient repositioning across three consecutive nursing shifts (day, evening and night) and to identify predictors of repositioning frequency. BACKGROUND Patient repositioning is a frequently implemented pressure injury prevention strategy. Yet, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility. DESIGN An observational prospective study. METHODS Chart audits were used to gather clinical and demographic data. Semi-structured observations were conducted every 30 minutes for a continuous 24-hour period. Observational data included the patient's body position, the frequency of repositioning, assistance require to reposition and the use of support surfaces. RESULTS Patients were repositioned frequently during the day and evening and least at night time. Elevation of the head of the bed (1-45°) was the most frequently adopted position. The independent predictors of repositioning frequency were age and gender, with older patients and males repositioned less frequently.
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Affiliation(s)
- Sharon Latimer
- Griffith UniversitySchool of Nursing and MidwiferyMeadowbrookQueenslandAustralia
| | - Wendy Chaboyer
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
| | - Brigid M. Gillespie
- Griffith UniversityNHMRC Research Centre for Excellence in Nursing Interventions (NCREN)Gold CoastQueenslandAustralia
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