Evaluating the Effects of a Pressure Injury Prevention Algorithm

Early Identification, Intervention, and Prevention of Hospital-Acquired Pressure Injuries Using a Nurse-Driven Pressure Injury Prevention Program

PURPOSE/OBJECTIVES

The purpose of this quality improvement project was to reduce the hospital-acquired pressure injury (HAPI) rate to less than 1.177 per 1000 patient-days, increase staff competency and care in pressure injury prevention best practices through implementation of a nurse-driven pressure injury prevention program, to engage patients in pressure injury prevention through implementation of skin rounds, and improve staff adherence to documentation requirements for pressure injury interventions on an amputee/stroke unit.

DESCRIPTION OF THE PROJECT/PROGRAM

HAPIs can lead to negative patient outcomes including pain, infection, extended hospitalization, and morbidity. Using an evidence-based education strategy, the Agency for Healthcare Research and Quality pressure ulcer prevention clinical pathway and skin rounds were implemented. Focused education for nursing, staff competency, daily audits, HAPI rates, and documentation compliance were evaluated pre and post intervention.

OUTCOMES

The HAPI rate reduced from 1.177 to 0.272 per 1000 patient-days. After completion, the unit maintained zero pressure injuries, daily patient care for pressure injuries improved, documentation compliance increased, and staffs' knowledge and skill set in early identification, intervention, and prevention of pressure injuries heightened.

CONCLUSION

A nurse-driven pressure injury prevention program was successful in the reduction of the HAPI rate.

Pressure Injury on Poststroke Admission Assessment to Skilled Nursing Facilities: Risk Factors, Management, and Impact on Rehabilitation

OBJECTIVE

To describe pressure injury (PrI) prevalence, comorbidities, and rehabilitation utilization among older adults with stroke at skilled nursing facilities' (SNFs') admission assessment.

DESIGN

Retrospective cohort.

SETTING AND PARTICIPANTS

Older Medicare beneficiaries (>65 years old) with stroke admitted to SNFs.

METHODS

We extracted data between 2013 and 2014 using the Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. PI data were assessed during admission assessment.

RESULTS

Of the 65,330 older adults poststroke admitted to SNFs, 11% had at least 1 PrI present on admission assessment. Individuals who were non-Hispanic Black, with a longer hospital stay, from lower socioeconomic status, with higher proportions of comorbidities (eg, underweight, urinary and bowel incontinence, diabetes, congestive heart failure, arrhythmias, and infections), and higher functional impairments were likely to present with a PrI at SNF admission assessment. Compared with individuals with superficial PrI, individuals with deep PrI were more likely to be young-old (<75 years), non-Hispanic Black, from lower socioeconomic status, present with a shorter hospital stay, an intensive care unit stay, with higher functional impairments, skin integrity issues, system failure, and infections. Compared to those without PrI or superficial PrI, individuals with any-stage PrI or deep PrI were more likely to be cotreated by physical and occupational therapist and less likely to receive individual therapy. Those with PrI poststroke had low documented turning and repositioning rates than those without PrI.

CONCLUSIONS AND IMPLICATIONS

Identifying modifiable risk factors to prevent PrIs poststroke in SNFs will facilitate targeted preventative interventions and improve wound care efficacy and rehabilitation utilization for optimized patient outcomes. Identifying residents with a higher risk of PrI during acute care discharge and providing early preventive care during post-acute care would possibly decrease costs and improve outcome quality.

Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units

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.

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

AIM

To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients.

BACKGROUND

Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings.

DESIGN

A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.

METHODS

Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis.

RESULTS

The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low.

CONCLUSIONS

Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries.

RELEVANCE TO CLINICAL PRACTICE

Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

Care under the guidance of pressure injury prevention protocol: a nursing home sample

Pressure injury is a healthcare problem frequently encountered in nursing homes. This study evaluated the effects of the care delivered under the guidance of a protocol for pressure injury prevention at a nursing home. It was implemented in four phases. In the pre-protocol period, the pressure injury incidence and nurses' care practices were evaluated. In the second phase, nurses were trained to use the protocol. In the third phase, the nurses provided care under the guidance of the protocol (post-protocol period). In the fourth phase, the incidence of pressure injury and nurses' care practices were compared between the pre- and post-protocol periods. The average age of the older residents was 78.40±7.12 years, and all were at high or very high risk of pressure injury according to the Braden scale scores. Some 30% were bed bound; 90% had faecal and urinary incontinence; and 70% had malnutrition. The results showed that the pressure injury incidence reduced from 17.39% in the pre-protocol period to 10.87% in the post-protocol period, while the nurses' care practices improved in the post-protocol period. Thus, use of pressure injury-prevention protocols can reduce the incidence of these injuries in vulnerable care home residents.