1
|
Chegini Z, Kolawole IO, Behforoz A. The effects of educational intervention on patient participation in pressure injury prevention: a pilot study. J Wound Care 2023; 32:S10-S17. [PMID: 37300865 DOI: 10.12968/jowc.2023.32.sup6.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patients' roles in reducing pressure injuries (PIs) are emphasised in clinical guidelines, although patients' preferences are undetermined. This study evaluated the effects of a pilot six-month educational intervention on patient participation in PI prevention. METHOD A convenience sampling method was used to select patients admitted to medical-surgical wards at one of the teaching hospitals in Tabriz, Iran. This is a one-group pre-test and post-test interventional study, conducted via quasi-experimental design. Using a pamphlet, patients received education in preventing PIs. Data collected before and after intervention through a questionnaire were analysed using descriptive and inferential statistics (McNemar and paired t-tests) in SPSS software (IBM Corp., US). RESULTS The study cohort consisted of 153 patients. Findings revealed that the knowledge of the patients about PIs, patients' ability to talk with the nurses, information received about PIs, and patients' ability to participate in decisions related to PI prevention had significantly increased following the intervention (p<0.001). CONCLUSION Educating patients can improve their knowledge to enable them to participate in PI prevention. The findings of this study suggests further research is necessary on factors influencing patients' participation in such self-care behaviours.
Collapse
Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ali Behforoz
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
2
|
Quantitative iTRAQ LC-MS/MS reveals muscular proteome profiles of deep pressure ulcers. Biosci Rep 2021; 40:225016. [PMID: 32458987 PMCID: PMC7295623 DOI: 10.1042/bsr20200563] [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: 03/17/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Pressure ulcers (PUs) are a common clinical issue lacking effective treatment and validated pharmacological therapy in hospital settings. Ischemia-reperfusion injury of deep tissue, especially muscle, plays a vital role in the formation and development of the overwhelming majority of PUs. However, muscular protein expression study in PUs has not been reported. Herein, we aimed to investigate the muscular proteins profiles in PUs and to explore the pathological mechanism of PUs. The iTRAQ LC-MS/MS was conducted to detect the protein profiles in clinical muscle samples of PUs. The GO and KEGG pathways analyses were performed for annotation of differentially expressed proteins. Protein-protein interaction (PPI) network was constructed by STRING online database, and hub proteins were validated by the immunoblotting. Based on proteomics results, we found a number of proteins that were differentially expressed in PU muscle samples compared with the normal and identified unique proteins expression patterns between these two groups, suggesting that they might involve in pathological process of the disease. Importantly, cathepsin B and D, as well as other autophagy-lysosome and apoptosis associated proteins were identified. Further experiments characterize the expression of these proteins and their regulation in the process of apoptosis and autophagy. These findings may provide novel insights into the mechanisms of lysosome-associated pathways involved in the initiation of PUs. This is the first study linking proteomics to PUs muscle tissues, which indicated cathepsin B and D might be key drug target for PUs.
Collapse
|
3
|
Wong AL, Walia GS, Bello R, Aquino CS, Sacks JM. Pressure ulcer prevalence and perceptions on prevention: a hospital-wide survey of health professionals. J Wound Care 2019; 27:S29-S35. [PMID: 29641343 DOI: 10.12968/jowc.2018.27.sup4.s29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hospital-acquired pressure ulcers (HAPUs) remain a problem despite numerous prevention initiatives. To understand why, it is necessary to know health professionals' perceptions regarding the importance of prevention, and the usability of current initiatives. We hypothesised that positive perceptions of existing initiatives would not be correlated with low HAPU prevalence, and that health professionals would perceive the initiatives to have a low usability. METHOD A two-part, online survey was developed and distributed electronically to nurses, in-training physicians and attending physicians, across all inpatient and perioperative departments of an academic hospital. Part one of the survey was the Agency for Healthcare Research and Quality (AHRQ) Staff Attitude Scale on beliefs regarding PU prevention; part two was additional questions on the usability of existing preventative initiatives. The results of the survey were compared with quarterly HAPU prevalence data by hospital unit. RESULTS In total, 839 health professionals completed the survey (579 nurses, 131 residents, 119 attending physicians). The mean score for the AHRQ survey was 42.5 (≥40 denoting positive perceptions). There was a moderate correlation between AHRQ scores and prevalence of HAPUs (r=-0.60, p=0.402). For usability, repositioning was felt to be the most effective intervention (mean: 4.54, standard deviation (SD): 0.64), while educational posters were felt to be the least effective (mean: 3.31, SD: 0.99). Respondents generally rated satisfaction much lower, with no single initiative significantly better than the others (range: 3.21-3.79). Perceived effectiveness and satisfaction were all positively correlated. CONCLUSION High HAPU prevalence, despite position perceptions, suggests that prevention methods are not as effective as thought, or they are not being used as widely as they should. Further research should take advantage of positive attitudes by prospectively investigating the usability of novel interventions.
Collapse
Affiliation(s)
- Alison L Wong
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax Infirmary Site, Halifax, NS, Canada, Center for Bioengineering Innovation and Design, Johns Hopkins University, Baltimore, MD, US
| | - Gurjot S Walia
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ricardo Bello
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Carla S Aquino
- Nursing Clinical Quality and Magnet Program, Department of Nursing Administration. Johns Hopkins Hospital, Baltimore, MD, US
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
| |
Collapse
|
4
|
Kim GH, Lee JY, Kim J, Kim HJ, Park JU. Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050704. [PMID: 30818780 PMCID: PMC6427666 DOI: 10.3390/ijerph16050704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate the prevalence pattern of pressure injuries (PIs), or ‘sores’, in South Korea and investigate the factors affecting its development. We estimated the annual prevalence of PIs using the National Inpatient Sample (NIS) data extracted from the Health Insurance Review and Assessment Service (HIRA) database from 2009 to 2015. Multivariable logistic regression was performed to examine the association between hospitalization and socio-demographic characteristics, such as sex, age, type of health insurance, Charlson Comorbidity Index (CCI), and plegia comorbidity. We found that inpatients with PIs make up to 0.86% of the total population in South Korea in 2015, which had shown a steady increase from the previous years. And male, old age, low socioeconomic status (SES), and the patients’ severity such as high CCI and the plegia comorbidity were strongly associated with hospitalization due to PI. Based on our results, it would be anticipated that the medical cost for treatment and management of PIs will increase in the future, and it will be accelerated due to the rapidly aging society. In addition, patients in low SES and patients with severe comorbidities would be relatively more burdensome, threatening their household economy and further reducing the quality of life. Therefore, PIs should not be overlooked as the responsibility of just the nursing care professionals but should be recognized as one of the serious societal problems. The establishment of an intense medical care system is needed not only to reduce the prevalence of PIs but also to increase the awareness in people with PI patients.
Collapse
Affiliation(s)
- Gyeong Hoe Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul 03080, Korea.
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul 03080, Korea.
| | - Jayeun Kim
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea.
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin 31801, Korea.
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea.
| |
Collapse
|
5
|
Padula WV, Black JM. The Standardized Pressure Injury Prevention Protocol for improving nursing compliance with best practice guidelines. J Clin Nurs 2018; 28:367-371. [DOI: 10.1111/jocn.14691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- William V. Padula
- Department of Pharmaceutical and Health EconomicsLeonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern California Los Angeles California
- Department of Acute and Chronic CareJohns Hopkins School of Nursing Baltimore Maryland
| | - Joyce M. Black
- College of NursingUniversity of Nebraska Medical Center Omaha Nebraska
| |
Collapse
|
6
|
Kottner J, Hahnel E, Lichterfeld-Kottner A, Blume-Peytavi U, Büscher A. Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators. Int Wound J 2017; 15:218-224. [PMID: 29178544 DOI: 10.1111/iwj.12854] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term "quality indicator" regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence-based and internationally comparable indicators to help improve patient care and safety worldwide.
Collapse
Affiliation(s)
- Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Lichterfeld-Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Büscher
- German Network for Quality Development in Care (DNQP), University of Applied Sciences, Osnabrück, Germany
| |
Collapse
|
7
|
Padula WV. Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study. J Wound Ostomy Continence Nurs 2017; 44:413-419. [PMID: 28816929 PMCID: PMC5592987 DOI: 10.1097/won.0000000000000358] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. DESIGN Retrospective observational cohort. SAMPLE AND SETTING We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. METHODS We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. RESULTS Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). CONCLUSIONS Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.
Collapse
Affiliation(s)
- William V. Padula
- William V. Padula, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
8
|
Gunningberg L, Bååth C, Sving E. Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study. J Nurs Manag 2017; 26:140-147. [DOI: 10.1111/jonm.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
| | - Carina Bååth
- Faculty of Health, Sciences and Technology; Department of Health Sciences; Karlstad University; County Council of Värmland; Värmland Sweden
| | - Eva Sving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Region Gävleborg; Gävle Sweden
| |
Collapse
|
9
|
Padula WV, Gibbons RD, Pronovost PJ, Hedeker D, Mishra MK, Makic MBF, Bridges JFP, Wald HL, Valuck RJ, Ginensky AJ, Ursitti A, Venable LR, Epstein Z, Meltzer DO. Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model. J Am Med Inform Assoc 2017; 24:e95-e102. [PMID: 27539199 PMCID: PMC7651933 DOI: 10.1093/jamia/ocw118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/25/2016] [Accepted: 07/09/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6%, are costly to treat, and result in Medicare reimbursement penalties. Medicare codes HAPUs according to Agency for Healthcare Research and Quality Patient-Safety Indicator 3 (PSI-03), but they are sometimes inappropriately coded. The objective is to use electronic health records to predict pressure ulcers and to identify coding issues leading to penalties. MATERIALS AND METHODS We evaluated all hospitalized patient electronic medical records at an academic medical center data repository between 2011 and 2014. These data contained patient encounter level demographic variables, diagnoses, prescription drugs, and provider orders. HAPUs were defined by PSI-03: stages III, IV, or unstageable pressure ulcers not present on admission as a secondary diagnosis, excluding cases of paralysis. Random forests reduced data dimensionality. Multilevel logistic regression of patient encounters evaluated associations between covariates and HAPU incidence. RESULTS The approach produced a sample population of 21 153 patients with 1549 PSI-03 cases. The greatest odds ratio (OR) of HAPU incidence was among patients diagnosed with spinal cord injury (ICD-9 907.2: OR = 14.3; P < .001), and 71% of spinal cord injuries were not properly coded for paralysis, leading to a PSI-03 flag. Other high ORs included bed confinement (ICD-9 V49.84: OR = 3.1, P < .001) and provider-ordered pre-albumin lab (OR = 2.5, P < .001). DISCUSSION This analysis identifies spinal cord injuries as high risk for HAPUs and as being often inappropriately coded without paralysis, leading to PSI-03 flags. The resulting statistical model can be tested to predict HAPUs during hospitalization. CONCLUSION Inappropriate coding of conditions leads to poor hospital performance measures and Medicare reimbursement penalties.
Collapse
Affiliation(s)
- William V Padula
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert D Gibbons
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Peter J Pronovost
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Critical Care and Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Manish K Mishra
- Department of Community & Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - John FP Bridges
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi L Wald
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Robert J Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | | | | | | | | | - David O Meltzer
- Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
10
|
Zubkoff L, Neily J, King BJ, Dellefield ME, Krein S, Young-Xu Y, Boar S, Mills PD. Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2016; 42:485-AP2. [DOI: 10.1016/s1553-7250(16)42091-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
11
|
|
12
|
Meddings J. Using administrative discharge diagnoses to track hospital-acquired pressure ulcer incidence--limitations, links, and leaps. Jt Comm J Qual Patient Saf 2015; 41:243-5. [PMID: 25990889 DOI: 10.1016/s1553-7250(15)41033-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School, Department of Internal Medicine, Division of General Medicine, Ann Arbor, USA
| |
Collapse
|
13
|
Padula WV, Makic MBF, Wald HL, Campbell JD, Nair KV, Mishra MK, Valuck RJ. Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008–2012: Tracking Changes Since the CMS Nonpayment Policy. Jt Comm J Qual Patient Saf 2015; 41:257-63. [DOI: 10.1016/s1553-7250(15)41035-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|