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Yang K, Fei C, Gao X. Mechanism exploration of SanShi ShengXin Ointment in the treatment of pressure ulcers based on network pharmacology and molecular docking. Medicine (Baltimore) 2024; 103:e37390. [PMID: 38428859 PMCID: PMC10906572 DOI: 10.1097/md.0000000000037390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To explore the active ingredients, prospective targets, and action mechanisms of SanShi ShengXin Ointment in the treatment of pressure ulcers (PU) based on the network pharmacology technique and molecular docking technology. METHODS The active ingredients and action targets of Sanshishengxin Ointment were searched through the Traditional Chinese Medicine Systematic Pharmacology Database and Analysis Platform. The PU-related targets were retrieved from the GeneCards and DisGeNET databases. The intersection target genes of disease and drugs were obtained. The "disease-drug-active ingredient-target" was constructed using Cytoscape software. The intersection target genes were imported into the String database to construct a protein-protein interaction network for gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses. The Auto Dock software was used for relevant molecular docking. RESULTS A total of 78 active ingredients of SanShi ShengXin Ointment were obtained, corresponding to 539 target genes. There were 5896 PU-related target genes, and 373 intersection target genes of disease and drugs were obtained, such as STAT3, TP53, JUN, MAPK3, CTNNB1, involving PI3K-Akt, TNF, MAPK, and other related signaling pathways. CONCLUSION Based on network pharmacology and molecular docking analyses, this study demonstrates that SanShi ShengXin Ointment can treat PU through multicomponent, multitarget, and multipathway. .
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Affiliation(s)
- Kai Yang
- Postgraduate of First Clinical Medical College, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Chenchen Fei
- Postgraduate of First Clinical Medical College, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Xiang Gao
- Chief Physician of Surgical Department, The Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
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Aningalan AM, Walker SI, Gannon BR. A Peer-to-Peer Approach to Increasing Staff Competency and Engagement in Wound and Ostomy Care: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2024; 51:132-137. [PMID: 38527323 DOI: 10.1097/won.0000000000001061] [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: 03/27/2024]
Abstract
PURPOSE The purpose of this quality improvement (QI) project was to provide an innovative, participatory approach to the education of staff nurses and nursing support personnel to improve skills and competencies in wound and ostomy care while enhancing staff engagement and empowerment. PARTICIPANTS AND SETTING Project planning occurred between January and October 2020 and implementation began in November 2020. The project was implemented in 1 intensive care unit and 6 adult medical-surgical units of a 288-bed community hospital in the northeastern United States (Bronxville, New York). Participants included RNs and nursing support staff working in intensive care and medical-surgical units. A postimplementation survey was conducted in May 2021. APPROACH The Plan-Do-Study-Act (PDSA) model was used as a framework for this QI intervention. A peer-to-peer approach to staff education addressing different learning styles was used to improve knowledge and competencies of staff nurses pertaining to wound and ostomy care. OUTCOMES There were 72 participants; 68% (n = 49) exhibited knowledge retention 5 months after initial participation; 85% (n = 61) reported a high level of engagement; and 97.5% (n = 70) reported a high level of satisfaction 5 months after project implementation. IMPLICATIONS FOR PRACTICE An emerging need exists for educational innovation regarding wound and ostomy care to improve quality of care, nursing care outcomes, and staff engagement. Through a peer-to-peer approach to wound and ostomy care education, enhanced clinical knowledge and competencies can result in improved patient safety and increase care outcomes.
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Affiliation(s)
- Alexis M Aningalan
- Alexis M. Aningalan, DNP, RN, CWON, CPHQ, New York-Presbyterian Westchester, Bronxville, NY
- Stephanie I. Walker, BSN, RN, CWON, WCC, New York-Presbyterian Westchester, Bronxville, NY
- Brittany (Ray) Gannon, PhD, MSN, AGPCNP-BC, New York-Presbyterian-Institute of Nursing Excellence and Innovation
| | - Stephanie I Walker
- Alexis M. Aningalan, DNP, RN, CWON, CPHQ, New York-Presbyterian Westchester, Bronxville, NY
- Stephanie I. Walker, BSN, RN, CWON, WCC, New York-Presbyterian Westchester, Bronxville, NY
- Brittany (Ray) Gannon, PhD, MSN, AGPCNP-BC, New York-Presbyterian-Institute of Nursing Excellence and Innovation
| | - Brittany Ray Gannon
- Alexis M. Aningalan, DNP, RN, CWON, CPHQ, New York-Presbyterian Westchester, Bronxville, NY
- Stephanie I. Walker, BSN, RN, CWON, WCC, New York-Presbyterian Westchester, Bronxville, NY
- Brittany (Ray) Gannon, PhD, MSN, AGPCNP-BC, New York-Presbyterian-Institute of Nursing Excellence and Innovation
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ALFadhalah T, Lari M, Al Salem G, Ali S, Al Kharji H, Elamir H. Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study. BMC Health Serv Res 2024; 24:173. [PMID: 38326902 PMCID: PMC10851550 DOI: 10.1186/s12913-024-10615-x] [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: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Marjan Lari
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Shaimaa Ali
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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Stevens L, Liu J, Voigt N. Improving the Use of Subscale-Specific Interventions of the Braden Scale Among Nurses. J Contin Educ Nurs 2024; 55:42-48. [PMID: 37921477 DOI: 10.3928/00220124-20231030-04] [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: 11/04/2023]
Abstract
BACKGROUND Pressure injuries (PIs) are costly to hospitals and have a negative impact on patient outcomes. Despite the use of validated tools that describe PI risk, such as the Braden Scale, the incidence of PIs remains high. Studies have shown that Braden Scale subscale scores should be considered when planning care; however, there is a discrepancy between understanding the importance of subscale-specific interventions and implementation. The goal of this study was to test the ability of an educational intervention tailored to specific interventions based on the subscales of the Braden Scale to improve knowledge among nurses. METHOD This study was a prospective, quasi-experimental, single-group design where nurses (n = 35) from a neurosurgery stepdown unit in a large teaching hospital completed a preintervention survey (T1), attended an educational presentation, and then completed an immediate postintervention survey (T2) and a 2-month postintervention survey (T3). RESULTS Data analysis compared presurvey scores with postsurvey scores. Nursing comprehension improved from the preintervention survey (T1, M = 5.57) to the postintervention surveys (T2, M = 6.34; T3, M = 6.42) (p = .031). CONCLUSION Nurses showed increased comprehension after the educational intervention from T1 to T3. [J Contin Educ Nurs. 2024;55(1):42-48.].
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Sharp A, Matthews G, Papageorgiou N, Till R, Raine D, Williams I, Grahame-Clarke C, Nair S, Abdul-Samad O, Vassiliou V, Garg P, Lim WY. Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy. Pacing Clin Electrophysiol 2023; 46:1465-1471. [PMID: 37910470 DOI: 10.1111/pace.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation is a well-established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns. METHODS Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant. RESULTS Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97-5.86, p < 0.001) on multivariable analysis. CONCLUSIONS SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.
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Affiliation(s)
- Alexander Sharp
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Richard Till
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Daniel Raine
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Ian Williams
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | | | - Santosh Nair
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Omar Abdul-Samad
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Vassilios Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Wei Yao Lim
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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Liu H, Zhang Y, Jiang H, Yao Q, Ren X, Xie C. Outcomes of hospital-acquired pressure injuries and present-on-admission pressure injuries: A propensity score matching analysis. J Tissue Viability 2023; 32:590-595. [PMID: 37563057 DOI: 10.1016/j.jtv.2023.08.001] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Pressure injuries (PIs) continue to present significant challenges. In recent years, the number of patients with present-on-admission pressure injury (POA-PI) has increased, but researchers have devoted little attention to it, and little is known about its clinical outcome. AIMS To compare the clinical outcomes of POA-PI and hospital-acquired pressure injury (HAPI) patients. METHODS In this study, hospitalized patients with pressure injuries were divided into two groups based on whether they acquired the injury in the hospital or already present at the time of their admission. The disease prognosis, duration of stay, and healthcare costs of patients with HAPI and POA-PI were evaluated using propensity score matching analysis (PSM), t-tests, and Mann-Whitney U tests. RESULTS The information on 1871 patients was retrieved from the electronic case system retroactively. A total of 305 pairs of patients were effectively matched between the two groups using propensity score matching (HAPI group = 305, POA-PI group = 305). There was no statistically significant difference at characteristics between the two groups (P > 0.05). The percentage of POA-PI group patients who were discharged from the hospital was greater than that of the HAPI group (P < 0.05). Conversely, the percentage of POA-PI group patients who died, ceased receiving treatment, or transferred to the hospital was lower than that of the HAPI group. Patients in the POA-PI group had shorter hospital stays than those in the HAPI group (P < 0.05). Patients in the POA-PI group had lower healthcare costs than those in the HAPI group (P < 0.05). CONCLUSIONS Patients with POA-PI have superior clinical outcomes than patients with HAPI, but make up the overwhelming majority of hospitalized patients. It is imperative that future research focuses on the reduction of POA-PI and HAPI incidence and the identification of therapies that will enhance patient prevention for these conditions.
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Affiliation(s)
- Hanmei Liu
- Affiliated Hospital of Zunyi Medical University, Zunyi, China; Philippine Women's University, Manila, Philippines
| | - Yongmei Zhang
- Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hu Jiang
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China.
| | | | - Xu Ren
- Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chaoqun Xie
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
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Tehrany PM, Zabihi MR, Ghorbani Vajargah P, Tamimi P, Ghaderi A, Norouzkhani N, Zaboli Mahdiabadi M, Karkhah S, Akhoondian M, Farzan R. Risk predictions of hospital-acquired pressure injury in the intensive care unit based on a machine learning algorithm. Int Wound J 2023; 20:3768-3775. [PMID: 37312659 PMCID: PMC10588304 DOI: 10.1111/iwj.14275] [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: 04/29/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Pressure injury (PI), or local damage to soft tissues and skin caused by prolonged pressure, remains controversial in the medical world. Patients in intensive care units (ICUs) were frequently reported to suffer PIs, with a heavy burden on their life and expenditures. Machine learning (ML) is a Section of artificial intelligence (AI) that has emerged in nursing practice and is increasingly used for diagnosis, complications, prognosis, and recurrence prediction. This study aims to investigate hospital-acquired PI (HAPI) risk predictions in ICU based on a ML algorithm by R programming language analysis. The former evidence was gathered through PRISMA guidelines. The logical analysis was applied via an R programming language. ML algorithms based on usage rate included logistic regression (LR), Random Forest (RF), Distributed tree (DT), Artificial neural networks (ANN), SVM (Support Vector Machine), Batch normalisation (BN), GB (Gradient Boosting), expectation-maximisation (EM), Adaptive Boosting (AdaBoost), and Extreme Gradient Boosting (XGBoost). Six cases were related to risk predictions of HAPI in the ICU based on an ML algorithm from seven obtained studies, and one study was associated with the Detection of PI risk. Also, the most estimated risksSerum Albumin, Lack of Activity, mechanical ventilation (MV), partial pressure of oxygen (PaO2), Surgery, Cardiovascular adequacy, ICU stay, Vasopressor, Consciousness, Skin integrity, Recovery Unit, insulin and oral antidiabetic (INS&OAD), Complete blood count (CBC), acute physiology and chronic health evaluation (APACHE) II score, Spontaneous bacterial peritonitis (SBP), Steroid, Demineralized Bone Matrix (DBM), Braden score, Faecal incontinence, Serum Creatinine (SCr) and age. In sum, HAPI prediction and PI risk detection are two significant areas for using ML in PI analysis. Also, the current data showed that the ML algorithm, including LR and RF, could be regarded as the practical platform for developing AI tools for diagnosing, prognosis, and treating PI in hospital units, especially ICU.
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Affiliation(s)
- Pooya M. Tehrany
- Department of Orthopaedic Surgery, Faculty of MedicineNational University of MalaysiaBaniMalaysia
| | - Mohammad Reza Zabihi
- Department of Immunology, School of MedicineTehran University of Medical SciencesTehranIran
| | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Student Research Committee, Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Pegah Tamimi
- Center for Research and Training in Skin Diseases and LeprosyTehran University of Medical SciencesTehranIran
| | - Aliasghar Ghaderi
- Center for Research and Training in Skin Diseases and LeprosyTehran University of Medical SciencesTehranIran
| | - Narges Norouzkhani
- Department of Medical Informatics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Student Research Committee, Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Mohammad Akhoondian
- Department of Physiology, School of Medicine, Cellular and the Molecular Research CenterGuilan University of Medical ScienceRashtIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
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Aningalan AM, Gannon BR. Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project. Adv Skin Wound Care 2023; 36:1-6. [PMID: 37861671 DOI: 10.1097/asw.0000000000000056] [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: 10/21/2023]
Abstract
OBJECTIVE To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement. METHODS This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates. RESULTS The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020. CONCLUSIONS Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.
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Affiliation(s)
- Alexis M Aningalan
- At NewYork-Presbyterian Westchester, Bronxville, New York, USA, Alexis M. Aningalan, DNP, RN, CWON, WCC, is Manager of Wound and Ostomy Care; and Brittany (Ray) Gannon, PhD, MSN, AGPCNP-BC, is Nurse Scientist. Acknowledgments : The authors thank Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN; Laurie A. Walsh, DNP, RN; Peggy Quinn, MPH, BSN, RN, CPHQ, NEA-BC; Catherine Lombardi, MSN RN-C, NE-BC, NHDP-BC; and Danielle LeStrange, MSN, MBA, RN, ACNS-BC, NEA-BC, FACHE, for providing leadership support and oversight; and Stephanie Walker, BSN, RN, CWON, WCC; and Hazel Holder, DNP, RN, ACCNS-AG, CCRN, for sharing their time and expertise during the conduct of the project. The authors have disclosed no financial relationships related to this article. Submitted August 15, 2022; accepted in revised form December 1, 2022
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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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Obaid LM, Ali I, Al Baker A, Al Shiekh Abdallah WO, Plando RL, Khawaldeh ME, Panaligan RKJ. Sustaining a culture of safety and optimising patient outcomes while implementing zero harm programme: a 2-year project of the nursing services - SBAHC. BMJ Open Qual 2023; 12:e002063. [PMID: 37821109 DOI: 10.1136/bmjoq-2022-002063] [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: 07/24/2022] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
This quality improvement report details how Sultan Bin Abdulaziz Humanitarian City (The City), the largest rehabilitation facility within Middle East with a capacity of 511 beds and more than 20 nursing in-patient units improved the quality and patient safety culture in nursing services after successfully adopting and implementing the zero harm programme.In healthcare settings, the idea of zero harm including zero incidents, zero injuries and injury-free are commonly used to highlight the importance of patient safety. Patient injuries and deaths resulting from hospital-acquired illnesses such as medication administration errors, falls, central line-associated bloodstream infections, hospital-acquired pressure injuries and catheter-associated urinary tract infection are largely preventable and grossly unacceptable occurrences. Achieving zero incidents of such critical measures can significantly impact treatment plan and enhance patient experience.The projects' purpose was to build a new culture of safety by implementing innovative strategy designed to protect patients from preventable harm while maintaining an extraordinary high standard of quality patient care. Additionally, the programme was established with the aim of instilling a sense of commitment to every nurse working in this organisation to anticipate potential harms and to be vigilant to prevent it before it reaches the patient.This document also describes a set of initiatives aimed at mitigating preventable incidents and ultimately achieving zero harm on our organisation. The result showed a significant increase by 95% between the percentage of nursing units that had 365 days of zero harm in 2020 and 2021. This improvement indicates that the concept of zero harm had been successfully inculcated among nursing units and had motivated nursing staff to uphold a higher culture of patient safety. Furthermore, by incorporating the Just Culture model into the electronic reporting system, the reporting rate of occurrences in the zero-harm programme was supported and sustained.
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Affiliation(s)
- Lina Mohammed Obaid
- Nursing Department, Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia
| | - Ibrahim Ali
- Quality Management Departement, Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia
| | - Ahmad Al Baker
- Nursing Department, Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia
| | | | - Rhez Legaspi Plando
- Nursing Department, Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia
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Şimşek E, Demir AS, Semerci R, Karadağ A. The incidence and prevalence of medical device-related pressure injuries in pediatric patients: Systematic review and meta-analysis. J Pediatr Nurs 2023; 72:e130-e138. [PMID: 37344345 DOI: 10.1016/j.pedn.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
PROBLEM To determine the pooled incidence and prevalence rate of medical device-related pressure injuries(MDRPIs) using the Braden QD scale, medical devices that frequently cause MDRPIs, and anatomical locations that are vulnerable to them. ELIGIBILITY CRITERIA Using the Braden QD scale, being published in English between 01/01/2018-and 01/03/2023. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations and registered in the International Prospective Register of Systematic Reviews database (No: CRD42021276501). SAMPLE A total of 7 studies with 25,742 pediatric patients were included. RESULTS The pooled prevalence and cumulative incidence of hospital-acquired pressure injuries(HAPIs) were 7.8% (95% CI: 5.2-11.4%) and 3.9% (95% CI: 0.5-24.6%) respectively, and the incidence rate was 8.2/1000 person-days (95% CI: 2.4-14.2/1000 person-days). The pooled prevalence and cumulative incidence of MDRPIs were 7% (95% CI: 5.5-8.8%) and 5% (95% CI: 3.2-7.8%) respectively, and the incidence rate was 6.7/1000 person-days (95% CI, 0.11-13.4/1000 person-days). The most affected anatomical locations were the face (29.1%), ankle/foot (20.1%), and head (15.7%). Medical devices that frequently caused MDRPIs were external monitoring devices (24.5%), respiratory devices (22.8%), and supportive/securing devices (14.9%). CONCLUSIONS According to the current systematic review and meta-analyses, the incidence and prevalence of HAPIs and MDRPIs are moderate to high. IMPLICATIONS The findings suggested that healthcare providers should pay more attention to reducing HAPIs and MDRPIs and future studies should be conducted to understand their characteristics and risk factors.
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Affiliation(s)
- Enes Şimşek
- Koç University, School of Nursing, Department of Child Health and Disease Nursing, Istanbul, Turkey.
| | - Ayşe Sılanur Demir
- Koç University, School of Nursing, Department of Fundamentals of Nursing, Istanbul, Turkey
| | - Remziye Semerci
- Koç University, School of Nursing, Department of Child Health and Disease Nursing, Istanbul, Turkey
| | - Ayişe Karadağ
- Koç University, School of Nursing, Department of Fundamentals of Nursing, Istanbul, Turkey
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Barghouthi ED, Owda AY, Asia M, Owda M. Systematic Review for Risks of Pressure Injury and Prediction Models Using Machine Learning Algorithms. Diagnostics (Basel) 2023; 13:2739. [PMID: 37685277 PMCID: PMC10486671 DOI: 10.3390/diagnostics13172739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Pressure injuries are increasing worldwide, and there has been no significant improvement in preventing them. This study is aimed at reviewing and evaluating the studies related to the prediction model to identify the risks of pressure injuries in adult hospitalized patients using machine learning algorithms. In addition, it provides evidence that the prediction models identified the risks of pressure injuries earlier. The systematic review has been utilized to review the articles that discussed constructing a prediction model of pressure injuries using machine learning in hospitalized adult patients. The search was conducted in the databases Cumulative Index to Nursing and Allied Health Literature (CINAHIL), PubMed, Science Direct, the Institute of Electrical and Electronics Engineers (IEEE), Cochrane, and Google Scholar. The inclusion criteria included studies constructing a prediction model for adult hospitalized patients. Twenty-seven articles were included in the study. The defects in the current method of identifying risks of pressure injury led health scientists and nursing leaders to look for a new methodology that helps identify all risk factors and predict pressure injury earlier, before the skin changes or harms the patients. The paper critically analyzes the current prediction models and guides future directions and motivations.
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Affiliation(s)
- Eba’a Dasan Barghouthi
- Health Sciences Department, Arab American University, Ramallah P600, Palestine; (E.D.B.); (M.A.)
| | - Amani Yousef Owda
- Department of Natural Engineering and Technology Sciences, Arab American University, Ramallah P600, Palestine
| | - Mohammad Asia
- Health Sciences Department, Arab American University, Ramallah P600, Palestine; (E.D.B.); (M.A.)
| | - Majdi Owda
- Faculty of Data Science, Arab American University, Ramallah P600, Palestine;
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Hamidi L. Decreasing Pressure Injuries on an Adult Inpatient Unit through Implementation of a Nutrition Assessment and Management Process. Adv Skin Wound Care 2023; 36:1-5. [PMID: 37471453 DOI: 10.1097/asw.0000000000000004] [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: 07/22/2023]
Abstract
OBJECTIVE To lower the rate of hospital-acquired pressure injuries (HAPIs) by identifying at-risk patients based on the Braden Scale score, evaluating nutrition using a Mini Nutrition Assessment (MNA) tool, and implementing nutrition improvement measures. METHODS There were three steps in this intervention. First, patients with a Braden Scale score of 18 or lower were identified as being at risk for HAPI. Next, the MNA screening tool was implemented to identify nutrition deficiencies. The MNA screening tool can predict malnutrition, HAPI development, and/or additional complications. It is validated, cost-effective, and easy to administer to patients who are hospitalized with HAPI complications. In the final step, the author implemented a multicomponent nutrition intervention to improve the nutrition status of patients at risk for developing HAPI. RESULTS Included patients (N = 205) were hospitalized in the intermediate ICU, had a Braden Scale score of 18 or lower, and had poor nutrition status. There was a 74% decrease in HAPI rate following the MNA nutrition screening and management, with HAPI incidence decreasing from 1.9% preintervention to 0.5% postintervention. CONCLUSIONS Categorizing patients who are at risk for developing HAPI, assessing for nutrition deficiency, and then implementing a multicomponent nutrition intervention considerably reduced the rate of HAPIs per number of patients admitted to the unit.
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Affiliation(s)
- Lida Hamidi
- Lida Hamidi, DNP, BSN, RN, PCCN, is Doctor of Nursing Practitioner, College of Nursing, Medical University of South Carolina, Charleston, USA. Acknowledgment : This manuscript was completed as a requirement for the Doctorate of Nursing Practice degree from the College of Nursing, Medical University of South Carolina. The project described and the article was completed with the assistance of Drs Martha Sylvia, Michelle Mollica, and Emily Johnson at the Medical University of South Carolina, and Drs Marsha Lee and John Knauff at Lexington Medical Center. The author has disclosed no financial relationships related to this article. Submitted July 29, 2022; accepted in revised form November 18, 2022
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; 36:421-434. [PMID: 37471447 DOI: 10.1097/asw.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization." STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Özdemir ED, Uslu Y, Karabacak U, Eren D, Isabetli S. Pressure injuries in the operating room: who are at risk? J Wound Care 2023; 32:cxxviii-cxxxvi. [PMID: 37405971 DOI: 10.12968/jowc.2023.32.sup7a.cxxviii] [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: 07/07/2023]
Abstract
OBJECTIVE Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs. METHOD This study used a cohort design. The data were collected at Acıbadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data. RESULTS Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001). CONCLUSION Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.
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Affiliation(s)
- Ezgi Dilan Özdemir
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Yasemin Uslu
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Ukke Karabacak
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Dilek Eren
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Serpil Isabetli
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
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Canfor J, Michailidis L, Williams C. Incidence and Characteristics of Suspected Deep Tissue Pressure Injuries on the Foot and Ankle: A Retrospective Study. J Wound Ostomy Continence Nurs 2023; 50:162-166. [PMID: 36867040 DOI: 10.1097/won.0000000000000956] [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: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to measure the incidence of suspected deep tissue pressure injuries (DTPIs) in patients admitted to the hospital, describe their location, identify the related hospital length of stay, and explore any associations between intrinsic or extrinsic factors relevant to DTPI development. DESIGN Retrospective review/audit of clinical data. SUBJECTS AND SETTING We reviewed pertinent medical data from patients reported as developing a suspected deep tissue injury during hospital admission from January 2018 to March 2020. The study setting was a large tertiary public health service in Victoria, Australia. METHODS Patients who developed a suspected deep tissue injury during hospital admission between January 2018 and March 2020 were identified through the hospital online risk recording system. Data were extracted from the relevant health records, including demographics, admission data, and pressure injury data. The incidence rate was expressed per 1000 patient admissions. Multiple regression analyses were used to determine associations between the time (days) to develop a suspected deep tissue injury and intrinsic (patient level) or extrinsic (hospital level) factors. RESULTS Six hundred fifty-one pressure injuries were recorded during the audit period. A minority (9.5%; n = 62) of patients developed a suspected deep tissue injury; all were located on the foot and ankle. The incidence of suspected deep tissue injuries was 0.18 per 1000 patient admissions. The mean length of stay among patients who developed a DTPI was 59.0 (SD = 51.9) days as compared to a mean of 4.2 (SD = 11.8) days for all patients admitted to the hospital during this period. Multivariate regression analysis determined that the longer time (in days) to develop a pressure injury was associated with having a higher body weight (Coef = 0.02; 95% CI = 0.00 to 0.04; P = .043), not having off-loading (Coef =-3.63; 95% CI =-6.99 to -0.27; P = .034), and an increasing number of ward transfers (Coef = 0.46; 95% CI = 0.20 to 0.72; P = .001). CONCLUSIONS Findings identified factors that may play a role in the development of suspected deep tissue injuries. A review of risk stratification in health services may be beneficial, with consideration to adjustments of procedural assessments of patients at risk.
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Affiliation(s)
- James Canfor
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
| | - Lucia Michailidis
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
| | - Cylie Williams
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
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Olson LM, Zonsius MC, Rodriguez-Morales G, Emery-Tiburcio EE. Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability. Home Healthc Now 2023; 41:105-111. [PMID: 36867484 DOI: 10.1097/nhh.0000000000001149] [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: 03/04/2023]
Abstract
This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.
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Affiliation(s)
- Linda M Olson
- Linda M. Olson is a chairperson and program director in the Department of Occupational Therapy in the College of Health Sciences at Rush University Medical Center in Chicago, where Mary C. Zonsius is an associate professor in the College of Nursing, Grisel Rodriguez-Morales is a manager and assistant professor in the Department of Social Work and Community Health, and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences. Contact author: Linda M. Olson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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18
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; Publish Ahead of Print:00129334-990000000-00021. [PMID: 36705972 DOI: 10.1097/01.asw.0000919408.20614.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization. STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022
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Prevention and management of hospital-acquired pressure injury among patients with lung disease in a hospital: a best practice implementation project. JBI Evid Implement 2022; 20:301-312. [PMID: 36378109 DOI: 10.1097/xeb.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. INTRODUCTION Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. METHODS Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. RESULTS Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. CONCLUSION The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.
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Jiao Y, Yuan C, Wu T, Zhang H, Wei Y, Ma Y, Zhang X, Han L. Incidence of pressure injuries in fracture patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:726-734. [PMID: 36109261 DOI: 10.1016/j.jtv.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I2 statistic and random-effects model were used to determine the heterogeneity. RESULTS A total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%). CONCLUSION The overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.
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Affiliation(s)
- Yanxia Jiao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Chenlu Yuan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Tong Wu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
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Krishnan S, Hong I, Couture G, Tzen YT, Reistetter T. Pressure Injury on Poststroke Admission Assessment to Skilled Nursing Facilities: Risk Factors, Management, and Impact on Rehabilitation. J Am Med Dir Assoc 2022; 23:1718.e13-1718.e20. [PMID: 35922014 DOI: 10.1016/j.jamda.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA, USA.
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Grace Couture
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare, Atlanta, GA, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Reistetter
- Department of Occupational Therapy, UT Health San Antonio, School of Health Professions, San Antonio, TX, USA
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22
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Promoting Safe Mobility. Am J Nurs 2022; 122:46-52. [DOI: 10.1097/01.naj.0000842256.48499.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weller CD, Turnour L, Connelly E, Banaszak-Holl J, Team V. Clinical Coders' Perspectives on Pressure Injury Coding in Acute Care Services in Victoria, Australia. Front Public Health 2022; 10:893482. [PMID: 35719639 PMCID: PMC9198603 DOI: 10.3389/fpubh.2022.893482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.
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Affiliation(s)
- Carolina Dragica Weller
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,*Correspondence: Carolina Dragica Weller
| | - Louise Turnour
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | | | - Jane Banaszak-Holl
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
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Nghiem S, Campbell J, Walker RM, Byrnes J, Chaboyer W. Pressure injuries in Australian public hospitals: A cost of illness study. Int J Nurs Stud 2022; 130:104191. [PMID: 35436596 DOI: 10.1016/j.ijnurstu.2022.104191] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are a leading hospital adverse event, yet they are mostly preventable. Understanding their financial costs will help to appreciate the burden they place on the health system and assist in better planning and management of health expenditures to prevent pressure injuries. OBJECTIVE To estimate the cost of pressure injuries in Australian public hospitals in 2020 demonstrating its economic burden in a well-resourced health system. METHODS A cost of illness study with a 12-month time horizon was conducted. Resource use for the treatment of pressure injuries and productivity loss due to pressure injuries were derived using a bottom-up approach. Parameters of the cost estimates were obtained from secondary sources and literature syntheses. A simulation with 10,000 draws was used to generate statistical properties of the cost estimates. RESULTS Based on a prevalence of 12.9%, the total cost of pressure injuries in Australian public hospitals was $9.11 billion [95% confidence intervals: 9.02, 9.21]. The two largest shares of costs were accounted for by the opportunity cost of excess length of stay of $3.60 billion [3.52, 3.68] and treatment costs of $3.59 billion [3.57, 3.60]. Productivity loss associated with pressure injuries amounts to $493 million [482, 504]. Hospital-acquired pressure injuries account for a total of $5.50 billion [5.44, 5.56], whereas pressure injuries present on admissions costed $3.71 billion [3.70, 3.72]. In terms of severity, Stage 2 pressure injuries contributed the most to total treatment costs, total excessive length of stay, and total loss of healthy life years. Australian society is willing to pay $1.43 billion [1.40, 1.45] to save 6,701 [6,595; 6,807] healthy life years lost by pressure injury. CONCLUSIONS Reducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia and will likely have similar benefits for other countries with comparable profiles. TWEETABLE ABSTRACT Australian public hospital study provides comprehensive analysis of the cost of pressure injury, including estimates of direct and indirect medical costs, and indirect non-medical costs - such as productivity and quality of life.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia.
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care; Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Josh Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anesi GL, Liu VX, Chowdhury M, Small DS, Wang W, Delgado MK, Bayes B, Dress E, Escobar GJ, Halpern SD. Association of ICU Admission and Outcomes in Sepsis and Acute Respiratory Failure. Am J Respir Crit Care Med 2022; 205:520-528. [PMID: 34818130 PMCID: PMC8906481 DOI: 10.1164/rccm.202106-1350oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Many decisions to admit patients to the ICU are not grounded in evidence regarding who benefits from such triage, straining ICU capacity and limiting its cost-effectiveness. Objectives: To measure the benefits of ICU admission for patients with sepsis or acute respiratory failure. Methods: At 27 United States hospitals across two health systems from 2013 to 2018, we performed a retrospective cohort study using two-stage instrumental variable quantile regression with a strong instrument (hospital capacity strain) governing ICU versus ward admission among high-acuity patients (i.e., laboratory-based acute physiology score v2 ⩾ 100) with sepsis and/or acute respiratory failure who did not require mechanical ventilation or vasopressors in the emergency department. Measurements and Main Results: Among patients with sepsis (n = 90,150), admission to the ICU was associated with a 1.32-day longer hospital length of stay (95% confidence interval [CI], 1.01-1.63; P < 0.001) (when treating deaths as equivalent to long lengths of stay) and higher in-hospital mortality (odds ratio, 1.48; 95% CI, 1.13-1.88; P = 0.004). Among patients with respiratory failure (n = 45,339), admission to the ICU was associated with a 0.82-day shorter hospital length of stay (95% CI, -1.17 to -0.46; P < 0.001) and reduced in-hospital mortality (odds ratio, 0.75; 95% CI, 0.57-0.96; P = 0.04). In sensitivity analyses of length of stay, excluding, ignoring, or censoring death, results were similar in sepsis but not in respiratory failure. In subgroup analyses, harms of ICU admission for patients with sepsis were concentrated among older patients and those with fewer comorbidities, and the benefits of ICU admission for patients with respiratory failure were concentrated among older patients, highest-acuity patients, and those with more comorbidities. Conclusions: Among high-acuity patients with sepsis who did not require life support in the emergency department, initial admission to the ward, compared with the ICU, was associated with shorter length of stay and improved survival, whereas among patients with acute respiratory failure, triage to the ICU compared with the ward was associated with improved survival.
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Affiliation(s)
- George L. Anesi
- Division of Pulmonary, Allergy, and Critical Care,,Palliative and Advanced Illness Research (PAIR) Center, and,Leonard Davis Institute of Health Economics
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente, Oakland, California
| | | | - Dylan S. Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Wei Wang
- Palliative and Advanced Illness Research (PAIR) Center, and
| | - M. Kit Delgado
- Palliative and Advanced Illness Research (PAIR) Center, and,Center for Emergency Care Policy and Research, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;,Leonard Davis Institute of Health Economics
| | - Brian Bayes
- Palliative and Advanced Illness Research (PAIR) Center, and
| | - Erich Dress
- Palliative and Advanced Illness Research (PAIR) Center, and
| | | | - Scott D. Halpern
- Division of Pulmonary, Allergy, and Critical Care,,Palliative and Advanced Illness Research (PAIR) Center, and,Leonard Davis Institute of Health Economics
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Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale. J Clin Nurs 2022; 32:1979-1992. [PMID: 35191111 DOI: 10.1111/jocn.16260] [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: 08/27/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES Providing the first meta-analysis of risk factors for pressure ulcer development in adult patients. BACKGROUND Pressure ulcers remain a serious health complication for patients and nursing staff. However, there is a lack of statistical evidence for risk factors as previous research did not include any quantitative synthesis. DESIGN Meta-analysis, using PRISMA guidelines. METHODS Studies from PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews and sources were screened and checked against the inclusion criteria. The risk of bias was evaluated using a slightly modified QUIPS tool. Data regarding population, design, statistical analysis and risk factors were extracted. Meta-analysis with comparable studies was conducted for age, sex, and Braden scale. The sub-group analysis was used to account for heterogeneity. RESULTS 28 studies with 570,162 patients were entered in meta-analysis. Older age and a low total Braden scale score increased the risk for pressure ulcers. All subscales excluding 'moisture' reached significance in meta-analysis based only on few studies, however, limiting overall evidence. Male sex achieved mixed results, too. CONCLUSION The first meta-analytic analysis shows evidence for age and Braden scale as risk factors for pressure ulcer development. Limitations regarding study quality and heterogeneity must be considered, highlighting the need for unifying certain conditions in risk factor research. RELEVANCE TO CLINICAL PRACTICE Patients at risk for new pressure ulcers can be identified by their total Braden score and age, whereas the latter is also connected to deeper pressure ulcers. Nurses and health personnel should pay great attention to patients in older age and undergo specific training to utilise and evaluate the Braden scale effectively, if necessary.
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Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Manuel Widdel
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Julian Kirchhoff
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohieddine Jelali
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, Aachen, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020761. [PMID: 35055583 PMCID: PMC8776011 DOI: 10.3390/ijerph19020761] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 01/27/2023]
Abstract
Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.
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Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
- Correspondence:
| | - Manuel Widdel
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julian Kirchhoff
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Mohieddine Jelali
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
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Porcel-Gálvez AM, Allande-Cussó R, Fernández-García E, Naharro-Álvarez A, Barrientos-Trigo S. Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings. J Tissue Viability 2022; 31:339-345. [PMID: 35000818 DOI: 10.1016/j.jtv.2022.01.001] [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: 11/04/2021] [Revised: 12/07/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive validity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these indicators reflecting the patient's condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. METHODS A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. RESULTS The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85-0.923). Within the 30-point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54-33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. CONCLUSIONS The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.
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Affiliation(s)
- Ana María Porcel-Gálvez
- Department of Nursing, University of Seville, Research Group PAIDI-CTS 1050, "Complex Care, Chronocity and Health Outcomes", 41009, Avenzoar st., Seville, Spain.
| | - Regina Allande-Cussó
- Department of Nursing, University of Seville, Research Group PAIDI-CTS 1050, "Complex Care, Chronocity and Health Outcomes", 41009, Avenzoar st., Seville, Spain.
| | - Elena Fernández-García
- Department of Nursing, University of Seville, Research Group PAIDI-CTS 1050, "Complex Care, Chronocity and Health Outcomes", 41009, Avenzoar st., Seville, Spain.
| | - Alonso Naharro-Álvarez
- Department of Nursing, University of Seville, Research Group PAIDI-CTS 1050, "Complex Care, Chronocity and Health Outcomes", 41009, Avenzoar st., Seville, Spain.
| | - Sergio Barrientos-Trigo
- Department of Nursing, University of Seville, Research Group PAIDI-CTS 1050, "Complex Care, Chronocity and Health Outcomes", 41009, Avenzoar st., Seville, Spain.
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Stoltenberg S, Kotila J, Heikkilä A, Kvist T, Junttila K. Incidence and risk factors for pressure injuries in adults in specialised medical care: a prospective observational study. J Wound Care 2021; 30:945-953. [PMID: 34747213 DOI: 10.12968/jowc.2021.30.11.945] [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: 11/11/2022]
Abstract
INTRODUCTION Hospital-acquired pressure injuries are one of the most important indicators of quality patient care. It is important to identify high-risk patients to guide the implementation of appropriate prevention strategies. This can be done by using an assessment tool that covers the main risk factors for pressure injuries. AIM The purpose of the study was to describe the incidence of pressure injuries and the associated risk factors among patients assessed with the Prevent Pressure Injury (PPI) risk assessment tool developed by the Helsinki University Hospital. METHOD The study was conducted by selecting six wards from medical, surgical and neurological units. The target group were the patients being treated in the study units who gave their informed consent. The research data were retrieved from electronic patient records. RESULTS From the target group, 332 patients were eligible to participate in the study. The pressure injury risk was found to increase with longer hospital stays and older age. Surgical patients had an increased risk of pressure injuries compared to other specialty fields. A primary diagnosis of musculoskeletal or connective tissue disease, and secondary diagnoses of hypertension and cerebral haemorrhage, were linked with an increased pressure injury risk. A total of nine pressure injuries occurred in nine patients, with an incidence of 2.5% (stages II-IV). CONCLUSION The observation and recording of pressure injuries in specialised medical care remain insufficient. Longer hospital stays, older age and surgery increase pressure injury risk. Also, patients' primary and secondary diagnoses may increase the pressure injury risk. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Jaana Kotila
- Helsinki University Hospital and University of Helsinki, Finland
| | - Anniina Heikkilä
- Helsinki University Hospital and University of Helsinki, Finland
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Munoz N, Posthauer ME. Nutrition strategies for pressure injury management: Implementing the 2019 International Clinical Practice Guideline. Nutr Clin Pract 2021; 37:567-582. [PMID: 34462964 DOI: 10.1002/ncp.10762] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Nutrition is an important component in the prevention and treatment of pressure injuries (PIs). The skin is the largest organ of the body, and macronutrients and micronutrients in specific amounts are required to maintain and repair body tissues. The European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel, and the Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: 2019 Clinical Practice Guideline includes nutrition recommendations for PI management. This manuscript identifies the key nutrients required for wound healing, reviews the evidence in the 2019 nutrition recommendations, and translates the recommendations provided into key points to be incorporated into policy and practice that impact patient outcomes.
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Affiliation(s)
- Nancy Munoz
- VA Southern Nevada Healthcare System, North Las Vegas, Nevada, USA
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Anderson C, Bekele Z, Qiu Y, Tschannen D, Dinov ID. Modeling and prediction of pressure injury in hospitalized patients using artificial intelligence. BMC Med Inform Decis Mak 2021; 21:253. [PMID: 34461876 PMCID: PMC8406893 DOI: 10.1186/s12911-021-01608-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/08/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries (PIs) induce significant patient suffering, inflate healthcare costs, and increase clinical co-morbidities. PIs are mostly due to bed-immobility, sensory impairment, bed positioning, and length of hospital stay. In this study, we use electronic health records and administrative data to examine the contributing factors to PI development using artificial intelligence (AI). METHODS We used advanced data science techniques to first preprocess the data and then train machine learning classifiers to predict the probability of developing PIs. The AI training was based on large, incongruent, incomplete, heterogeneous, and time-varying data of hospitalized patients. Both model-based statistical methods and model-free AI strategies were used to forecast PI outcomes and determine the salient features that are highly predictive of the outcomes. RESULTS Our findings reveal that PI prediction by model-free techniques outperform model-based forecasts. The performance of all AI methods is improved by rebalancing the training data and by including the Braden in the model learning phase. Compared to neural networks and linear modeling, with and without rebalancing or using Braden scores, Random forest consistently generated the optimal PI forecasts. CONCLUSIONS AI techniques show promise to automatically identify patients at risk for hospital acquired PIs in different surgical services. Our PI prediction model provide a first generation of AI guidance to prescreen patients at risk for developing PIs. CLINICAL IMPACT This study provides a foundation for designing, implementing, and assessing novel interventions addressing specific healthcare needs. Specifically, this approach allows examining the impact of various dynamic, personalized, and clinical-environment effects on PI prevention for hospital patients receiving care from various surgical services.
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Affiliation(s)
- Christine Anderson
- grid.214458.e0000000086837370School of Nursing, University of Michigan, Ann Arbor, MI 48109 USA
| | - Zerihun Bekele
- grid.214458.e0000000086837370Statistics Online Computational Resource (SOCR), University of Michigan, Ann Arbor, MI 48109 USA
| | - Yongkai Qiu
- grid.131063.60000 0001 2168 0066Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN 46556 USA
| | - Dana Tschannen
- grid.214458.e0000000086837370School of Nursing, University of Michigan, Ann Arbor, MI 48109 USA
| | - Ivo D. Dinov
- grid.214458.e0000000086837370School of Nursing, University of Michigan, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Statistics Online Computational Resource (SOCR), University of Michigan, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Department of Health Behavior and Biological Sciences (HBBS), School of Nursing, University of Michigan, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, MI 48109 USA
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Implementing Evidence-Based Pressure Injury Prevention Interventions: Veterans Health Administration Quality Improvement Collaborative. J Nurs Care Qual 2021; 36:249-256. [PMID: 32868734 DOI: 10.1097/ncq.0000000000000512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury prevention is a persistent concern in nursing. The Veterans Health Administration implemented a creative approach with successful outcomes across the United States. PROBLEM Pressure injury prevention is a measure of nursing quality of care and a high priority in the Veterans Health Administration. METHODS A 12-month Virtual Breakthrough Series Collaborative utilizing coaching and group calls was conducted to assist long-term and acute care teams with preventing pressure injuries. INTERVENTIONS Interventions from the Veterans Health Administration Skin Bundle were implemented, including pressure-relieving surfaces, novel turning techniques, specialized dressings, and emollients to prevent skin breakdown. RESULTS The aggregated pressure injury rate for all teams decreased from Prework to the Action phase from 1.0 to 0.8 per 1000 bed days of care (P = .01). The aggregated pressure injury rates for long-term care units decreased from Prework to Continuous Improvement from 0.8 to 0.4 per 1000 bed days of care (P = .021). CONCLUSION The Virtual Breakthrough Series helped reduce pressure injuries.
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Gallo AM, Doyle RAC, Beckman J, Lizarraga CG. Blending Evidence-Based Practice and Lean Six Sigma Methodology to Reduce Hospital-Acquired Pressure Injuries in a Progressive Care Unit. J Nurs Care Qual 2021; 35:295-300. [PMID: 31834201 DOI: 10.1097/ncq.0000000000000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) continue to challenge acute care facilities. Best practice to reduce HAPI includes assessment, documentation, positioning, and treatment. LOCAL PROBLEM In spite of using evidence-based practices, the hospital's gastrointestinal/genitourinary progressive care unit had more HAPIs each month than the other units in the hospital. METHODS A combination of Lean Six Sigma and evidence-based practice was used to decrease HAPIs. INTERVENTIONS The T program (turn, touch, and tidy) was developed to address the areas of concern identified in the root cause analysis. RESULTS HAPIs were reduced from 22 in the previous 2 quarters to zero for 3 consecutive quarters with a cost avoidance to $379 767. CONCLUSIONS The successful implementation of the T program was the result of blending Lean Six Sigma and evidence-based practice.
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Affiliation(s)
- Ana-Maria Gallo
- School of Nursing, Azusa Pacific University, San Diego Regional Campus, California (Dr Gallo); Sharp Healthcare, Grossmont Hospital, La Mesa, California (Mss Doyle and Beckman); and UC San Diego Health, California (Ms Lizarraga)
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Team V, Team L, Jones A, Teede H, Weller CD. Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome. Front Med (Lausanne) 2021; 7:558696. [PMID: 33553194 PMCID: PMC7862742 DOI: 10.3389/fmed.2020.558696] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.
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Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Lydia Team
- Monash Health, Clayton, VIC, Australia.,School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Young D, Kudchadkar SR, Friedman M, Lavezza A, Kumble S, Daley K, Flanagan E, Hoyer E. Using Systematic Functional Measurements in the Acute Hospital Setting to Combat the Immobility Harm. Arch Phys Med Rehabil 2020; 103:S162-S167. [PMID: 33373600 DOI: 10.1016/j.apmr.2020.10.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an interdisciplinary approach to measurement and communication using a common language of function. Here we provide a framework for systematic functional measurement in the hospital. We also provide 3 specific examples of how this framework has been used to improve care: (1) targeting specialized rehabilitation providers to the patients most likely to need their services, (2) generating a daily mobility goal for all patients, and (3) identifying patients early who are likely to require postacute care.
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Affiliation(s)
- Daniel Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Sapna R Kudchadkar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eleni Flanagan
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
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Sayan HE, Girgin NK, Asan A. Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study. J Eval Clin Pract 2020; 26:1669-1676. [PMID: 32040245 DOI: 10.1111/jep.13354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Pressure ulcers (PUs), which are preventable complications, increase the cost of health care and the risk of prolonged hospital stay, as well as morbidity and mortality. In this study, we aimed to describe the prevalence, clinical features, and risk factors for PUs among hospitalized patients. METHOD This study was cross-sectional and conducted over a single day in all the care units. Data were recorded on a patient observation form that included demographic data, diagnosis of admission to the hospital or intensive care unit (ICU), comorbidity and chronic diseases, location, stage of PU, and Braden Scale score. Acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma score (GCS), PaO2 /FiO2 ratio, and albumin level were recorded for ICU patients. RESULTS A total of 1548 adult patients participated in the study. Of these patients, 177 (11.43%) had PU. The patients with PU had more advanced age, lower body mass index (BMI), and longer duration of hospital and ICU stay (for all P = .001). Evaluation of PU in the first 24 hours after hospital admission and the last PU evaluation time also showed a significant effect (both P = .001). Braden Scale score less than or equal to 13 in the first evaluation after hospital admission increased the risk of PU. Albumin was 2.78 ± 0.57 gm/dL in ICU patients, and albumin level was significantly lower in patients with PU (P = .001). PUs were located mainly in the sacrum (47.59%) and were classified as stage II (42.76%) for all patients. CONCLUSIONS The prevalence of PU is related to the age and severity of patient clinical status, as predicted by the Braden Scale score and APACHE II score, and length of hospital and ICU stay. Low albumin level is also related to development of PUs in ICU patients.
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Affiliation(s)
- Halil Erkan Sayan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Nermin Kelebek Girgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Alonso-Sardón M. Can an early mobilisation programme prevent hospital-acquired pressure injures in an intensive care unit?: A systematic review and meta-analysis. Int Wound J 2020; 18:209-220. [PMID: 33236855 PMCID: PMC8244014 DOI: 10.1111/iwj.13516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022] Open
Abstract
A systematic review and meta-analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital-acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital-acquired pressure injuries (five quasi-experimental and two random comparative). The five quasi-experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I2 ), and the odds ratio was 0.97 (95% CI: 0.49-1.91) with a non-significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.
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Affiliation(s)
| | - Adela Carpio-Pérez
- Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain.,Internal Medicine Service, University Hospital of Salamanca, Salamanca, Spain
| | | | - Montserrat Alonso-Sardón
- Preventive Medicine and Public Health Area, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
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Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, Apóstolo J, Kirkpatrick P, Loveday H. Barriers and enablers to implementation of pressure injury prevention in hospitalized adults: a mixed methods systematic review protocol. JBI Evid Synth 2020; 18:2134-2139. [PMID: 32813459 DOI: 10.11124/jbisrir-d-19-00265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the proposed systematic review is to determine the barriers and enablers (or facilitators) to the implementation of pressure injury prevention among adults receiving care in the hospital setting. INTRODUCTION Hospital-acquired pressure injuries are preventable; however, they remain an ongoing safety and quality health care concern in many countries. There are various evidence-based preventative interventions for pressure injuries, but their implementation in clinical practice is limited. An understanding of the different factors that support (enablers or facilitators) and inhibit (barriers) the implementation of these interventions from different perspectives is important, so that targeted strategies can be incorporated into implementation plans. INCLUSION CRITERIA This review will include quantitative, qualitative, and mixed methods studies that investigate barriers and/or enablers in relation to hospital-acquired pressure injury prevention in hospitalized adults. Only English publications will be considered, with no publication date restrictions. METHODS The systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic review. Published studies will be searched in PubMed, CINAHL, Embase, PsycINFO and Scopus. Gray literature will also be considered. Critical appraisal and data extraction will be performed using standardized tools, followed by data transformation. Data synthesis will follow the convergent integrated approach.
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Affiliation(s)
- Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Judith Carrier
- The Wales Centre For Evidence Based Care: A JBI Centre of Excellence, Cardiff, Wales
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | - Kendra Rieger
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Salmond
- The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Newark, NJ, USA
| | - João Apóstolo
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
| | - Pamela Kirkpatrick
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, Scotland
| | - Heather Loveday
- The University of West London Centre for Evidence-Based Healthcare: A JBI Affiliated Group, London, UK
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Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J 2020; 17:1924-1934. [PMID: 32830460 DOI: 10.1111/iwj.13482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital-acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital-acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score-adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in-hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30-, 60-, and 90-day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital-acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.
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41
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Young S, Narang J, Kumar S, Kwizera E, Malik P, Billings SD, Ko JS, Fernandez AP. Large sacral/buttocks ulcerations in the setting of coagulopathy: A case series establishing the skin as a target organ of significant damage and potential morbidity in patients with severe COVID-19. Int Wound J 2020; 17:2033-2037. [PMID: 32767632 PMCID: PMC7436712 DOI: 10.1111/iwj.13457] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sarah Young
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jatin Narang
- Department of Medical Education, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sany Kumar
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elise Kwizera
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Priya Malik
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven D Billings
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer S Ko
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
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Hydrosurgical Debridement Allows Effective Wound Bed Preparation of Pressure Injuries: A Prospective Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2921. [PMID: 32766068 PMCID: PMC7339320 DOI: 10.1097/gox.0000000000002921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022]
Abstract
Background: Pressure injuries (PIs) are common in hospitalized patients, with incidence exceeding 50% in high-risk patients. Immobilization causes a prolonged compression of vascular networks in tissues overlying bony prominences, leading to ischemia and ulceration. Traditionally, PIs are treated with a combination of surgical debridement and reconstruction. This approach can be invasive for debilitated patients who cannot tolerate prolonged surgeries and extensive tissue resection. Hydrosurgery uses high-pressure irrigation to low-invasively debride and cleanse wounds; its use has shown positive outcomes in burn and chronic wounds care. Here, we hypothesize that hydrosurgery allows low-invasive yet effective wound bed preparation in truncal PIs. Methods: We conducted a single-center, prospective, uncontrolled case series. Inclusion criteria for this study were presence of a truncal PI (stage III or IV) and an American Society of Anesthesiologists physical status of ≥2 (no exclusion criteria). Measured outcomes included duration of hydrosurgery, postsurgical local (dehiscence, infection, seroma) or systemic complications in the first 30 days, and PI recurrence rate (6-month follow-up). Results: Seven patients (3 sacral, 2 greater trochanteric, and 2 ischial tuberosity PIs) were enrolled for this study. Average duration of hydrosurgery was 12 minutes (±3.1). No local or systemic complications were observed at a 30-day follow-up (0/7, 0%). All flaps (6/7, 86%) and graft (1/7, 14%) reconstructions successfully survived, and no PI recurrence was reported within a 6-month follow-up (0/7, 0%). Conclusions: Hydrosurgery seems to allow safe, low-invasive, and effective wound bed preparation in truncal PIs. Larger controlled trials are needed to confirm this preliminary evidence, to guide its broader adoption for improved care of high-risk patients with PIs.
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Team V, Tuck M, Reeves J, Way M, Enticott J, Evans S, Weller CD. Pressure injury data in Australian acute care settings: A comparison of three data sets. Int Wound J 2020; 17:578-586. [PMID: 32027094 PMCID: PMC7948723 DOI: 10.1111/iwj.13320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Hospital-acquired pressure injuries (HAPIs) represent a serious clinical and economic problem. The cost of treating HAPIs in Australian public hospitals was recently reported at AUS$983 million per annum. There are three main sources of data for documenting pressure injury (PI) occurrence in Australian hospitals: incident reporting, medical record coded data, and real-time surveys of pressure injury. PI data reported at hospital level and to external agencies using these three different sources are variable. This reporting issue leads to inaccurate data interpretation and hinders improvement in accuracy of PI identification and PI prevention. This study involved a comparison of the three different data sources in selected Australian hospitals, to improve the accuracy and comparability of data. Findings from this study provide benchmark areas for improvement in PI documenting and reporting. Better understanding the agreement between the three data sets could lead to a more efficient and effective sharing of data sources.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
| | - Michelle Tuck
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Judy Reeves
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Margaret Way
- Safety and QualityBarwon HealthGeelongVictoriaAustralia
| | - Joanne Enticott
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health Care, Southern Synergy, Department of PsychiatryMonash UniversityMelbourneVictoriaAustralia
| | - Susan Evans
- Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 105:103546. [DOI: 10.1016/j.ijnurstu.2020.103546] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
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45
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Team V, Bouguettaya A, Richards C, Turnour L, Jones A, Teede H, Weller CD. Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis. Int Wound J 2020; 17:370-379. [PMID: 31850664 PMCID: PMC7948898 DOI: 10.1111/iwj.13281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Ayoub Bouguettaya
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Catelyn Richards
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Louise Turnour
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
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Yunding M, Yusuf S, Darwis M. Intrarater reliability of multipad interface pressure sensor in clinical setting. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bowers B. Improving practice and informing policy development: The impact of gerontological nursing research. Geriatr Nurs 2020; 41:32-37. [PMID: 32024595 DOI: 10.1016/j.gerinurse.2020.01.010] [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: 10/25/2022]
Abstract
Nurses have always approached the clinical care challenges they encounter with a combination of critical observation and a profound concern for human suffering. Beginning in earnest in the early 1980s, nurse researchers have pursued the answers to questions about the wellbeing of older adults, particularly those suffering from serious, chronic conditions. This paper offers three exemplars of nursing research domains that illustrate the creativity and commitment of nurse researchers seeking to understand and improve pervasive clinical problems experienced by older adults and to demonstrate the profound influence these activities have had on the evolution of the science and the quality of care for older adults. The impact of this work is reflected in practice protocols, institutional policies, government oversight, and improved outcomes for patients.
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Affiliation(s)
- Barbara Bowers
- University of Wisconsin-Madison, School of Nursing, 5133 Signe Skott Cooper Hall, Madison, WI 53705, United States.
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Shin S, Park J, Bae S. Nurse staffing and hospital‐acquired conditions: A systematic review. J Clin Nurs 2019; 28:4264-4275. [DOI: 10.1111/jocn.15046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/29/2019] [Accepted: 08/18/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Sujin Shin
- College of Nursing Ewha Womans University Seoul Korea
| | - Jin‐Hwa Park
- College of Nursing Daegu Catholic University Daegu Korea
| | - Sung‐Heui Bae
- College of Nursing Ewha Womans University Seoul Korea
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50
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Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle) 2019; 8:309-322. [PMID: 31832278 PMCID: PMC6906754 DOI: 10.1089/wound.2018.0925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent Advances: Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Critical Issues: Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Future Directions: Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.
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Affiliation(s)
- Sandra W. Citty
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Linda J. Cowan
- Nursing Service and Research, Tampa VA Center of Innovation for Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Zandra Wingfield
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Joyce Stechmiller
- Department of Behavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
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