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Fulbrook P, Lovegrove J, Ven S, Schnaak S, Nowicki T. Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study. J Adv Nurs 2024. [PMID: 38969344 DOI: 10.1111/jan.16309] [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: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
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.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Schnaak
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tracy Nowicki
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, Moore Z, Deakin J, Carlini J, Lovegrove J, Jahandideh S, Gillespie BM. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104768. [PMID: 38642429 DOI: 10.1016/j.ijnurstu.2024.104768] [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: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42023423058. TWEETABLE ABSTRACT Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/SharonLLatimer
| | - Udeshika Priyadarshani
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Emma Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jenny Sim
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney Australia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/jodie_deakin3
| | - Joan Carlini
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Health Consumer and Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Josephine Lovegrove
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Sepideh Jahandideh
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. https://twitter.com/bgillespie6
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3
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Kottner J, Coleman S, Balzer K. Pressure ulcer risk assessment: Where will the journey take us? Int J Nurs Stud 2024; 150:104646. [PMID: 38096628 DOI: 10.1016/j.ijnurstu.2023.104646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Jan Kottner
- Charité-Universitätsmedizin Berlin, Germany.
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Wan CS, Cheng H, Musgrave-Takeda M, Liu MG, Tobiano G, McMahon J, McInnes E. Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review. Int J Nurs Stud 2023; 145:104557. [PMID: 37453248 DOI: 10.1016/j.ijnurstu.2023.104557] [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: 02/28/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting. OBJECTIVES To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. DESIGN A convergent integrated mixed-methods systematic review was conducted using the JBI approach. DATA SOURCE English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. REVIEW METHODS Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques. RESULTS Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators. CONCLUSIONS These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings. PROSPERO REGISTRATION CRD42021250885.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Heilok Cheng
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mika Musgrave-Takeda
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mark Guosheng Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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5
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:499-507. [PMID: 36316177 DOI: 10.4037/ajcc2022659] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. OBJECTIVE To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria. RESULTS Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury. CONCLUSIONS Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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6
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Lovegrove J, Fulbrook P, Miles S, Steele M. Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2022; 35:186-203. [PMID: 34144865 DOI: 10.1016/j.aucc.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, noninvasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and noninvasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I2 = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I2 = 0%) and heel (risk ratio = 0.31, p = 0.02; I2 = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2000, South Africa.
| | - Sandra Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, 1100 Nudgee Road, Banyo, Queensland, Australia 4014.
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Gong X, Xu R. Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta-analysis. Int Wound J 2021; 19:1463-1470. [PMID: 34962078 PMCID: PMC9493227 DOI: 10.1111/iwj.13743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of prophylactic sacral protective dressings on preventing pressure injury. A systematic literature search up to July 2021 was performed, and 11 studies included 5150 community or hospital-based adult subjects requiring care at the start of the study; 2832 of them were using sacral protective dressings and 2318 were given standard care with no sacral protective dressings. They were reporting relationships between the effects of prophylactic sacral protective dressings on preventing pressure injury. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of prophylactic sacral protective dressings on preventing pressure injury using the dichotomous method with a random or fixed-effect model. Sacral protective dressings had a significantly lower incidence of pressure injuries (OR, 0.39; 95% CI, 0.28-0.53, P < .001) compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Sacral protective dressings had a significantly lower incidence of pressure injuries compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Further studies are needed to confirm these findings.
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Affiliation(s)
- Xinyan Gong
- Department of Cardiology, Yiwu Central Hospital, Yiwu, China
| | - Ruimin Xu
- Emergency Department, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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Lovegrove J, Ven S, Miles SJ, Fulbrook P. Comparison of pressure injury risk assessment outcomes using a structured assessment tool versus clinical judgement: A systematic review. J Clin Nurs 2021; 32:1674-1690. [PMID: 34854158 DOI: 10.1111/jocn.16154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whilst performing a pressure injury risk assessment is not in itself preventive, risk status identification is critical to inform the judicious implementation of prevention strategies. Risk assessment is mostly undertaken using a structured tool informed by clinical judgement, though there is a perception that use of clinical judgement alone may be sufficient. OBJECTIVES Within acute hospital settings, to identify differences in outcomes (risk status, preventive interventions) following nursing assessment of pressure injury risk when using a structured assessment tool compared to clinical judgement. DESIGN Systematic review. DATA SOURCES EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus, Web of Science, Ovid EMBASE. METHODS Primary research relevant to the objectives was eligible for inclusion. Databases were searched in February 2021 (limits: date 2010-2020, English language, adults). Two reviewers undertook the review process, with a third as arbitrator. Appraisal was undertaken using Joanna Briggs Institute critical appraisal tools. Included studies are synthesised narratively. Reporting is in accordance with the PRISMA Statement. RESULTS Five moderate to high-quality studies were included. Synthesis was limited by heterogeneity. Several risk assessment tools and methods of clinical judgement were used. Three studies reported pressure injury risk status using both assessment approaches, but in only one did nurses undertake both. Risk status, as identified by each method, varied and was sometimes contradictory. Three studies reported some elements of preventive intervention prescription and/or implementation following risk assessment, but comparison between approaches was limited. CONCLUSIONS Some research suggests that risk status varies across different methods of pressure injury risk assessment, but it is unclear what impact this has on preventive intervention use. Risk status was not well linked to preventive interventions. Research is warranted to examine the influence that each approach to risk assessment alone and combined has on identified risk and preventive intervention prescription and implementation. REGISTRATION A protocol was prospectively registered with PROSPERO (CRD42021224747).
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Affiliation(s)
- Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Saroeun Ven
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Sandra J Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Lee HJ, Han MY, Hwang JH, Park KJ, Shin KM, Kim ES, Lee HJ, Lim A, Han EJ, Park JY, Jang YS. Risk factors for heel pressure injury in cardiovascular intensive care unit patients. Int Wound J 2021; 19:1158-1164. [PMID: 34734481 PMCID: PMC9284623 DOI: 10.1111/iwj.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
This study analyzed the risk factors for heel pressure injury in cardiovascular intensive care unit patients with the aim of laying the groundwork for preventive nursing interventions. We conducted a retrospective case‐control study of 92 patients who were admitted to the cardiovascular surgical or medical intensive care unit of a university hospital in South Korea between January and December 2017. Of these patients, 31 and 61 were included to the heel pressure injury group and the non‐heel pressure injury group, respectively. Data on their demographic, disease‐related, and intensive care unit treatment characteristics, as well as the degree of pressure injury, were collected from the hospital's electronic medical records using a standardized form. Cardiac surgery (P < .001), operation time (P = .001), use of a mechanical ventilator (P < .001), use of vasoconstrictors (P < .001), use of sedative drugs (P < .001), and extracorporeal membrane oxygenation treatment (P < .001) were identified as significant risk factors for heel pressure injury. A total of 22 patients (71%) from the heel pressure injury group developed deep tissue injury, and 16 patients (51.6%) who received extracorporeal membrane oxygenation treatment developed heel pressure injury.
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Affiliation(s)
- Hyeon Jeong Lee
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Min Young Han
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Graduate School, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jung Hwa Hwang
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kang Ju Park
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyung Min Shin
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Sil Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyea Jung Lee
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Arum Lim
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea
| | - Eun Jin Han
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Ju Yeon Park
- Division of Nursing, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - Yeon Soo Jang
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea
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10
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Kottner J. Systematic reviews in pressure ulcer/injury research: A comment on Lovegrove et al. (2021). Int J Nurs Stud 2021; 122:104039. [PMID: 34325917 DOI: 10.1016/j.ijnurstu.2021.104039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jan Kottner
- Institute of Clinical Nursing Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
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