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Al-Mamari F, Al-Rawajfah O, Al Sabei S, Al-Wahaibi K. Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study. J Wound Care 2024; 33:S10-S16. [PMID: 39388239 DOI: 10.12968/jowc.2022.0241] [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] [Indexed: 10/12/2024]
Abstract
BACKGROUND Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. METHOD A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman. RESULTS The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). CONCLUSION HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.
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Affiliation(s)
| | - Omar Al-Rawajfah
- College of Nursing, Al al-Bayt University, Jordan
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | - Khalifa Al-Wahaibi
- General and Vascular Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Thomann S, Bernet NS. Pressure injury incidence measurement as a quality improvement strategy: national trends in Switzerland. J Wound Care 2024; 33:660-669. [PMID: 39287034 DOI: 10.12968/jowc.2024.0117] [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] [Indexed: 09/19/2024]
Abstract
OBJECTIVE This study sought to determine the risk-adjusted (controlled for patient characteristics) trend in pressure injury (PI) incidence in Switzerland. METHOD A secondary data analysis was conducted. The data originated from the national PI quality measurement based on a multicentre cross-sectional design with repeated annual measurements. Descriptive statistics, a Cochran-Armitage trend test and logistic (multilevel) regression modelling were applied. RESULTS The analysis sample comprised 123,715 patients from 230 hospitals over 10 survey years (2011-2019 and 2022). The incidence of descriptive PI varied in Switzerland between 3.7% and 5.6% over the survey years. No linear trend could be found when patient characteristics were not considered. A non-linear trend was detected when controlling for patient characteristics and the time effect (repeated measurement). This was also reflected in the plotted risk-adjusted incidence, which revealed a decrease followed by a levelling off. When only considering the incidence of PIs rated category 2 and higher, there was also a non-linear decreasing trend when controlling for patient characteristics and time effects. If the incidence per survey year were estimated on the basis of patient characteristics, an increase in the incidence would have been expected. CONCLUSION Although patients' risk of developing a PI increased between 2011-2022, the incidence of PIs in Switzerland first decreased and then levelled off. The results indicated that care quality in Swiss hospitals has improved regarding PIs. Nevertheless, in view of demographic trends and increasing staff shortages, it is important to continue to monitor PI incidence and to invest in PI prevention.
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Affiliation(s)
- Silvia Thomann
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in Nursing, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Niklaus S Bernet
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in Nursing, Murtenstrasse 10, 3008 Bern, Switzerland
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Craven BC, Bateman EA, Flett H, Farahani F, Wolfe DL, Askari S, Omidvar M, Alavinia M. The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement. Healthcare (Basel) 2024; 12:1084. [PMID: 38891159 PMCID: PMC11171508 DOI: 10.3390/healthcare12111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. METHODS This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. RESULTS Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. CONCLUSIONS PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.
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Affiliation(s)
- Beverley Catharine Craven
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emma A. Bateman
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Heather Flett
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Farnoosh Farahani
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Dalton L. Wolfe
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Faculty of Health Sciences, School of Health Studies, Western University, London, ON N6A 5C1, Canada
| | - Sussan Askari
- Faculty of Physical Medicine and Rehabilitation, Providence Care Hospital, Queen’s University, Kingston, ON K7L 4X3, Canada;
| | - Maryam Omidvar
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Mohammad Alavinia
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
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Bernet NS, Everink IHJ, Hahn S, Müller M, Schols JMGA. Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study. BMJ Open 2024; 14:e082417. [PMID: 38754884 PMCID: PMC11097859 DOI: 10.1136/bmjopen-2023-082417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES This study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors. DESIGN A secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019. SETTING All Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included. PARTICIPANTS All inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included. OUTCOME MEASURE Whether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days? RESULTS Based on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level. CONCLUSIONS A significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.
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Affiliation(s)
- Niklaus S Bernet
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Sabine Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Marianne Müller
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
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Marshall V, Qiu Y, Jones A, Weller CD, Team V. Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review. J Adv Nurs 2024; 80:1262-1282. [PMID: 37788102 DOI: 10.1111/jan.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
AIM(S) To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. DESIGN Exploratory. METHODS Scoping review. DATA SOURCES Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). RESULTS Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). CONCLUSION Quality of evidence was low for the interventional studies and best practice recommendations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. IMPACT STATEMENT This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. REPORTING METHOD We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people. PROTOCOL REGISTRATION Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
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Affiliation(s)
- Victoria Marshall
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Higgins JT, Charles RD, Fryman LJ. Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care. Am J Nurs 2024; 124:24-34. [PMID: 38511707 DOI: 10.1097/01.naj.0001010176.21591.80] [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: 03/22/2024]
Abstract
BACKGROUND Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. PURPOSE This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. METHODS This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. RESULTS Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care-level bed capacity. CONCLUSIONS The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population.
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Affiliation(s)
- Jacob T Higgins
- Jacob T. Higgins is an assistant professor at the University of Kentucky (UK) College of Nursing, Lexington, as well as a nurse scientist in trauma/surgical services at UK HealthCare, Lexington, where Rebecca D. Charles is a patient care manager and Lisa J. Fryman is the nursing operations director. Contact author: Jacob T. Higgins, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Li Y, Huang Z, Yu K, Li Y. Effects of evidence-based nursing in preventing pressure ulcers in intensive care unit patients: A meta-analysis. Int Wound J 2024; 21:e14489. [PMID: 37973556 PMCID: PMC10898412 DOI: 10.1111/iwj.14489] [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: 10/07/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Abstract
To systematically analyse the effects of evidence-based nursing (EBN) in preventing the development of pressure ulcers (PUs) in intensive care unit (ICU) patients. We conducted a computerised search of the Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials on the prevention of PUs in ICU patients by EBN, published before the respective databases were established until September 2023. Two investigators independently performed literature screening, data extraction and quality assessment. A meta-analysis was performed using Stata 17.0. Eighteen papers were included, comprising 2593 patients, of whom 1297 and 1296 received EBN and conventional nursing, respectively. The incidence of PUs was 2.70% and 12.04% in the EBN and conventional nursing groups, respectively. Meta-analysis showed a statistically significantly lower incidence of PUs in the EBN group than that in the conventional nursing group (risk ratio = 0.22, 95% confidence interval: 0.16-0.32, p < 0.001). EBN interventions are more effective than conventional nursing in preventing PUs in ICU patients. However, since the literature included in this study was from China, the conclusions require further confirmation via higher-quality studies.
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Affiliation(s)
- Yuanli Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Zhifeng Huang
- Department of Trauma OrthopedicsChongqing General HospitalChongqingChina
| | - Keping Yu
- Department of NursingChongqing General HospitalChongqingChina
| | - Ya Li
- Department of Cardiovascular SurgeryChongqing General HospitalChongqingChina
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White K, Fonseca MA, Petzoldt O, Cooper L. Evaluating the Effectiveness of an Alternating Pressure Overlay in Patients Undergoing Cardiothoracic Surgery. Am J Nurs 2024; 124:42-49. [PMID: 38386834 DOI: 10.1097/01.naj.0001008416.24563.5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
LOCAL PROBLEM In 2019 and the first half of 2020, our facility experienced an increase in the number and severity of hospital-acquired pressure injuries (HAPIs) among our cardiothoracic surgery population. Fifty percent of these HAPIs occurred within 72 hours of surgery. A review of the literature revealed that alternating pressure overlays (APOs) have been successfully used to prevent HAPIs in surgical patients. PURPOSE The primary purpose of our quality improvement (QI) project was to measure perioperative HAPI rates in cardiothoracic surgery patients after the addition of APOs to our HAPI prevention protocol. Our secondary purpose was to identify common factors among those patients who developed HAPIs. METHODS This QI project collected both pre- and postintervention data and compared the findings. A nurse-led team was responsible for measuring HAPI rates during the intervention-from July through October 2020-which involved placing an APO under cardiothoracic surgery patients during the 72-hour perioperative period. APOs were placed on all operating room (OR) tables and remained with the patients following surgery. Bed linens and skin care products were standardized for consistency. Lifts were used to reduce friction during repositioning. RESULTS During preintervention data collection, we identified 10 patients who developed HAPIs (seven out of 1,174 cardiothoracic surgery patients in 2019, for a HAPI rate of 0.6%, and three out of 333 patients in the first half of 2020, for a HAPI rate of 0.9%). During the four-month intervention period, in which APOs were used in 331 patients undergoing cardiothoracic surgery, no HAPIs developed. CONCLUSION Use of an APO in cardiothoracic ORs and critical care units may help reduce HAPI rates.
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Affiliation(s)
- Kristen White
- Kristen White is a clinical nurse specialist at Morristown Medical Center, Morristown, NJ, where Maria Alcina Fonseca is a nurse manager, Gagnon 5/CPACU/CVICU and inpatient cardiac rehabilitation, Olivia Petzoldt is a project manager, quality improvement, and Lise Cooper is a nurse researcher, Center for Nursing Innovation and Research. Contact author: Kristen White, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Azizoğlu F, Terzi B. Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer. Intensive Crit Care Nurs 2024; 80:103557. [PMID: 37804817 DOI: 10.1016/j.iccn.2023.103557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field. RESEARCH METHODOLOGY/DESIGN Descriptive and bibliometric analysis method study. SETTING Data were obtained from the "Web of Science Core Collection" database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords "intensive care unit," "pressure injury," "prevention," "risk assessment tools," and critical care." Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications. MAIN OUTCOME MEASURES Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools. RESULTS As a result of the analysis, the most used keywords were "pressure injury," "pressure ulcer," "critical care," "pressure ulcers," "intensive care unit," and "pressure injuries." The journal with the highest number of publications (n = 55) was "Journal of Wound Ostomy Continence Nursing", the highest number of articles (n = 47) was published in 2022, the most active institution was "Queensland University of Technology Qut" (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the "National Institutes of Health NIH USA" (20 articles), and Cox J. was the author who published the most articles. CONCLUSION This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
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Affiliation(s)
- Fatma Azizoğlu
- Haliç University, Faculty of Health Sciences, 5.Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No: 14/12 34060, Eyüpsultan/İstanbul, Turkey
| | - Banu Terzi
- Akdeniz University, Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz Üniversitesi Dumlupınar Bulvarı, Akdeniz Üniversitesi Yerleşkesi Konyaaltı, 07070 Antalya, Turkey.
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Bobbink P, Gschwind G, Charbonneau L, Guex C, Chabal L, Probst S. Nursing Students' Knowledge on Pressure Injuries Following a Blended-Learning Unit: A Quasi-experimental Study. Adv Skin Wound Care 2023; 36:636-641. [PMID: 37983576 DOI: 10.1097/asw.0000000000000066] [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: 11/22/2023]
Abstract
OBJECTIVE To assess first-year bachelor's degree in nursing students' knowledge about pressure injury (PI) etiology, classification, prevention, and management following blended learning and clinical practice. METHODS A quasi-experimental design was used. Nursing students' PI knowledge was measured using the French version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) at three time points: baseline (before a blended-learning unit, consisting of 2 hours of e-learning and 3 hours of practical workshop), after the blended-learning unit, and after clinical practice. RESULTS A total of 21 students participated over the three time points. At baseline, the mean percentage of correct answers on the PUKAT was 45.8%. This score increased to 59.2% following the blended-learning unit and 65% after completing the clinical practice (F2,58 = 19.08; P = .00). Over the three time points, students scored highest on knowledge of risk assessment and lowest on knowledge of prevention. CONCLUSIONS Blended-learning units combining e-learning and practical workshops are valuable tools to increase students' knowledge about PIs. The PUKAT enables the evaluation of changes in students' knowledge following a teaching unit on PIs. However, more research is needed to assess the long-term evolution of knowledge and the impact of this teaching on clinical practice.
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Affiliation(s)
- Paul Bobbink
- Paul Bobbink, MScN, is Lecturer, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Geneva, Switzerland, and PhD Candidate at the University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne. Also at Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Géraldine Gschwind, MScN, is Assistant; and Lucie Charbonneau, MSc; Carole Guex, BScN, and Laurent Chabal, BScN, ETN, are Assistant Lecturers. Sebastian Probst, DClinPrac, MNS, RN, is Full Professor of Tissue Viability and Wound Care, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts; Care Directorate, University Hospital Geneva; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia; and College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland. Acknowledgment: The authors thank their colleagues from the University of Applied Sciences and Arts, Geneva School of Health Sciences, and the clinical nurse specialists who were involved in this new scenario for their support. They give special thanks to Celina Marques Teixeira who designed the e-learning unit and Prof Dimitri Beeckman for the permission to translate and use the questionnaire. The work cannot be changed in any way or used commercially without permission from the journal. The authors have disclosed no financial relationships related to this article. Submitted February 6, 2023; accepted in revised form March 16, 2023
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McAuliffe PB, Winter EE, Talwar AA, Desai AA, Broach RB, Fischer JP. Pressure Ulcer Trends in the United States: A Cross-Sectional Assessment from 2008-2019. Am Surg 2023; 89:5609-5618. [PMID: 36825400 DOI: 10.1177/00031348231158691] [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] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Decubitus ulcers are a morbid and costly problem faced by healthcare systems and patients across the country. We aim to examine current patterns and characteristics of patients admitted to the hospital with a pressure ulcer. MATERIALS AND METHODS From a nationally representative sample of hospital discharge records, the Nationwide Inpatient Sample (NIS), patients with a diagnosis of pressure ulcer 2008-2019 were identified. Patient volume, demographic and clinical data were analyzed for change over time. RESULTS The volume of pressure ulcer patients as a proportion of all hospital patients remained constant from 2008 to 2019 (P = .479). During the study period, the proportion of ulcer patients that underwent an ulcer-related procedure significantly decreased (P < .001) while the proportion of ulcers considered severe significantly increased (P < .001). CONCLUSIONS Our analysis suggests the prevalence of decubitus ulcers remained stable during the time period, with increased severity but reduced frequency of operative intervention.
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Affiliation(s)
- Phoebe B McAuliffe
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Eric E Winter
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Ankoor A Talwar
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Abhishek A Desai
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Robyn B Broach
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - John P Fischer
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA USA
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Tzen YT, Sambandam S, Delmore B, Wang J, Chu A, Wukich DK. Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture. Adv Skin Wound Care 2023; 36:642-650. [PMID: 37983577 DOI: 10.1097/asw.0000000000000068] [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: 11/22/2023]
Abstract
OBJECTIVE To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications. METHODS In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications. RESULTS Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation. CONCLUSIONS Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
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Affiliation(s)
- Yi-Ting Tzen
- Yi-Ting Tzen, PhD, is Assistant Professor, Department of Applied Clinical Research, and Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Senthil Sambandam, MD, is Assistant Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, and Division of Orthopedic Surgery, Veterans Affairs North Texas Health Care System, Dallas. Barbara Delmore, PhD, RN, CWCN, MAPWCA, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York. Jijia Wang, PhD, is Assistant Professor, Department of Applied Clinical Research, University of Texas Southwestern Medical Center. Andy Chu, MS, RD, CDN, CNSC, is Registered Dietitian, Food and Nutrition Services, NYU Langone Health. Dane K. Wukich, MD, is Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center. Conflict of Interest: Dr Wukich serves as consultant with Orthofix Medical Inc, Stryker, and Wright Medical and receives royalties from Arthrex Inc. The authors have disclosed no other financial relationships related to this article. Submitted August 5, 2022; accepted in revised form January 4, 2023
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Jin Y, Back JS, Im SH, Oh JH, Lee SM. Data-driven approach to predicting the risk of pressure injury: A retrospective analysis based on changes in patient conditions. J Clin Nurs 2023; 32:7273-7283. [PMID: 37303250 DOI: 10.1111/jocn.16795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
AIMS To determine the risk of pressure injury development in the intensive care unit based on changes in patient conditions. DESIGN This retrospective study was based on secondary data analysis. METHODS Patient data from electronic health records were retrospectively obtained and we included 438 and 1752 patients with and without pressure injury, respectively, among those admitted to the medical and surgical intensive care units (ICUs) from January 2017-February 2020. Changes in patient conditions were analysed based on the first and last objective data values from the day of ICU admission to the day before the onset of pressure injury and categorised as follows: improved, maintained normal, exacerbated and unchanged. Logistic regression was performed to identify the significant predictors of pressure injury development based on 11 variables. RESULTS The 11 selected variables were age, body mass index, activity, acute physiology and chronic health evaluation II score, nursing severity level, pulse and albumin, haematocrit, C-reactive protein, total bilirubin and blood urea nitrogen levels. The risk for a pressure injury was high with exacerbation of or persistently abnormal levels of nursing severity, albumin, haematocrit, C-reactive protein, blood urea nitrogen and pulse >100 beat/min. CONCLUSION Periodic monitoring of haematological variables is important for preventing pressure injury in the intensive care unit. REPORTING METHOD The study followed STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION This study contributes to the utilisation of patient data from electronic health records. RELEVANCE TO CLINICAL PRACTICE In addition to other pressure injury risk assessment tools, ICU nurses can help prevent pressure injuries by assessing patients' blood test results, thereby promoting patient safety and enhancing the efficacy of nursing practice.
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Affiliation(s)
- Yinji Jin
- School of Nursing, Yanbian University, Jilin, China
| | - Ji-Sun Back
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Ho Im
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hyo Oh
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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Fulbrook P, Lovegrove J. Reporting accuracy of pressure injury categorisation in an acute tertiary hospital: A four-year analysis. J Clin Nurs 2023; 32:6403-6414. [PMID: 36823714 DOI: 10.1111/jocn.16662] [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: 06/21/2022] [Revised: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIM To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. BACKGROUND Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision-making and use of resources, and severe hospital-acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. DESIGN Secondary analysis of hospital pressure injury incident and validation data. METHODS All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter-rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. RESULTS Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter-rater agreement by category (Κ = .567, p < .001). Of those found to be non-pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. CONCLUSIONS This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. RELEVANCE TO CLINICAL PRACTICE These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. PATIENT OR PUBLIC CONTRIBUTION Neither patients nor the public were directly involved in the project.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Berlowitz D, Forget JG, Saindon K. The 2022 Update on Pressure Injuries: A Review of the Literature. Adv Skin Wound Care 2023; 36:463-469. [PMID: 37603315 DOI: 10.1097/asw.0000000000000025] [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: 08/22/2023]
Abstract
GENERAL PURPOSE To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates.
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Efteli E. Frequency of Minor Shifts in Body Position and Pressure Injury Development: A Comparative Descriptive Study. J Wound Ostomy Continence Nurs 2023; 50:285-288. [PMID: 37144877 DOI: 10.1097/won.0000000000000982] [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: 05/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of minor shifts in body position on the development of pressure injuries. DESIGN A prospective, comparative, descriptive study. SUBJECTS AND SETTING The sample comprised 78 bedridden patients aged 18 years or older, free of pressure injuries, and hospitalized in the Neurology and Internal Medicine clinics and intensive care units. The study setting was a state hospital in Burdur Province, Southwest Turkey; data were collected between March and September 2018. METHODS Patients were monitored once weekly until the end of their stay or until pressure injury development. Data were collected using a researcher-designed data collection form. Patients' ability to make minor shifts in body position was categorized between 0 and 3 per movement group. RESULTS Twenty-one (26.9%) of 78 participants developed a pressure injury; 90.4% (n = 19) were stage 1 pressure injuries. Pressure injuries occurred in 94.1% of the patients who did not make shifts in body position versus 80% of the patients who performed shifts every 4 hours. No pressure injuries developed in those patients who moved every hour ( P = .00). CONCLUSIONS Study findings support the importance of making minor shifts in body position for prevention of pressure injury in bedridden patients.
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Affiliation(s)
- Elçin Efteli
- Elçin Efteli, PhD, RN, Faculty of Health Sciences, Mehmet Akif Ersoy University, Burdur, Turkey
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Hou P, Xue H, Chang S, Xie P, Chen Y, Wang Y, Miura D, Fan J, Liang J, Kitayama A, Fang F, Yuan H, Wu X, Zhang X, Wang J, Ding N, Zhang C, Sun X, Takashi E. Thermal preconditioning can reduce the incidence of intraoperatively acquired pressure injuries. J Therm Biol 2023; 115:103617. [PMID: 37352595 DOI: 10.1016/j.jtherbio.2023.103617] [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: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
Intraoperatively acquired pressure injuries (IAPIs) occur frequently among patients who undergo surgical procedures that last longer than 3 h. Several studies indicated that heat shock proteins (HSPs) play an important role in the protection of stress-induced damages in skin tissues. Hence, the aim of this study was to investigate the potential preventive effect of thermal preconditioning (TPC) on IAPIs in surgical patients and rats and to identify the differentially expressed HSP genes in response to the above treatment. TPC was performed on one group of hairless rats before the model of pressure injuries was established. Subsequently, the size of skin lesions was measured and the expression levels of mRNA and protein of HSPs of the pressured skin were detected by real-time polymerase chain reaction (RT-PCR), western blot, and immunohistochemical staining. For human studies, 118 surgical patients were randomly divided into the TPC group (n = 59) and the control group (n = 59), respectively. The temperature and pressure of sacral skin, as well as the incidence of pressure injury (PI) were detected and compared. In animal studies, TPC significantly reduced both the size and incidence of PI in rats on the second, third and fourth days post treatment. In addition, the expression levels of both mRNA and protein of HSP27 were increased in the TPC group, compared with the control group. Immunohistochemical staining showed that HSP27 was distributed in various types of dermal cells and increased in basal cells. In human studies, a significant reduction (75%) of IAPIs was observed among the patients in the TPC group. TPC can reduce the incidence of PI in rats and humans, and the upregulation of HSP27 may play an important role in this biological progress. Further studies are warranted to explore the molecular mechanism of the preventive effect in PI mediated by HSP27.
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Affiliation(s)
- Ping Hou
- Nagano College of Nursing, 399-4117, Nagano, Japan; School of Nursing and School of Public Health, Yangzhou University, 225000, Yangzhou, China
| | - Huiping Xue
- Nagano College of Nursing, 399-4117, Nagano, Japan; Emergency Intensive Care Unit, Affiliated Hospital of Nantong University, 226000, Nantong, China
| | - Shuwen Chang
- Nagano College of Nursing, 399-4117, Nagano, Japan; Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ping Xie
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China.
| | - Yajie Chen
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Yanwei Wang
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Daiji Miura
- Nagano College of Nursing, 399-4117, Nagano, Japan
| | - Jianglin Fan
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, 409-3898, Yamanashi, Japan
| | - Jingyan Liang
- Health Science Center, Yangzhou University, 225000, Yangzhou, China.
| | | | - Fang Fang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Haijuan Yuan
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaoling Wu
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiaolin Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Jing Wang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Ning Ding
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Can Zhang
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - Xiuyun Sun
- Nursing Department, Northern Jiangsu People's Hospital, 225000, Yangzhou, China
| | - En Takashi
- Nagano College of Nursing, 399-4117, Nagano, Japan.
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Awad SS, Stern JD, Milne CT, Dowling SG, Sotomayor R, Ayello EA, Feo Aguirre LJ, Khalaf BZ, Gould LJ, Desvigne MN, Chaffin AE. Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group. Adv Skin Wound Care 2023; 36:249-258. [PMID: 37079788 PMCID: PMC10144322 DOI: 10.1097/01.asw.0000922708.95424.88] [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: 12/06/2022] [Accepted: 02/07/2022] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction. METHODS An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds. RESULTS Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention. CONCLUSIONS The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.
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Affiliation(s)
- Samir S Awad
- Samir S. Awad, MD, MPH, FACS, is Professor of Surgery, Baylor College of Medicine and Chief of Surgery, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. James D. Stern, MD, FACS, is Plastic Surgeon, Memorial Regional Hospital, Hollywood, Florida. Cathy T. Milne, APRN, MSN, ANP/ACNS-BC, CWOCN-AP, is Co-owner, Connecticut Clinical Nursing Associates, Bristol, Connecticut. Shane G. Dowling, MSPAS, PA-C, CWS, is Medical Science Liaison, Aroa Biosurgery Limited, Auckland, New Zealand. Ron Sotomayor, BA, RN, CWOCN, is a wound, ostomy, and continence nurse, Advent Health, Orlando, Florida. Elizabeth A. Ayello, PhD, MS, RN, ETN, CWON, FAAN, is Editor-in-Chief, Advances in Skin & Wound Care and President, Ayello, Harris and Associates Incorporated, Copake, New York. Leandro J. Feo Aguirre, MD, FACS, is Colorectal Surgeon, Palm Beach Health Network, Del Ray Beach, Florida. Basil Z. Khalaf, MD, is Wound Care Physician, The MEDIKAL Group, Houston, Texas. Lisa J. Gould, MD, is Plastic Surgeon, South Shore Health, Weymouth, Massachusetts. Michael N. Desvigne, MD, FACS, CWS, is Plastic Surgeon, Desvigne Plastic Surgery and Abrazo Health, Scottsdale, Arizona. Abigail E. Chaffin, MD, FACS, CWSP, is Associate Professor of Surgery and Chief, Division of Plastic Surgery, Tulane University and Medical Director, MedCentris Wound Healing Institute, New Orleans, Louisiana
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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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Crumley C. Not Happy With Our HAPI Prevention Efforts? A View From Here. J Wound Ostomy Continence Nurs 2023; 50:102-103. [PMID: 36867030 DOI: 10.1097/won.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Carolyn Crumley
- Carolyn Crumley, DNP, RN, ACNS-BC, CWOCN, Saint Luke's East Hospital, Lee's Summit, Missouri; University of Missouri Sinclair School of Nursing, Columbia, Missouri; Section Editor JWOCN Evidence-Based Report Card
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Cox J, Thomas Hawkins C. Racial Disparities and Pressure Injuries Among Hospitalized Patients. Adv Skin Wound Care 2023; 36:78-84. [PMID: 36662040 DOI: 10.1097/01.asw.0000904460.94583.51] [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: 01/21/2023]
Abstract
OBJECTIVE To describe the demographic factors, hospitalization-related factors, comorbid states, and social determinants of health among racial groups in a sample of patients with a primary or secondary diagnosis of pressure injury (PI) admitted to New Jersey hospitals during the year 2018. METHODS Researchers conducted a retrospective analysis of the Health Care Utilization Project's 2018 New Jersey State Inpatient Database. Patients with a primary or secondary diagnosis of PI (sacrum, buttocks, or heels; N = 17,781) were included in the analytic sample. Analysis compared patients who identified as Black (n = 3,515) with all other racial groups combined (n = 14,266). RESULTS A higher proportion of Black patients were admitted for a PI (P < .001) and had higher proportions of stage 4 PIs (P < .001) but a lower proportion of stage 1 PIs (P < .001). Higher proportions of Black patients were younger, resided in lower income communities, and identified Medicaid as their primary payor source. CONCLUSIONS Results highlight the racial disparities that exist among patients with PIs in this diverse state and may represent a much larger problem. Clinical research examining the impact of skin tone rather than by racial group is needed. The impact of racial disparities on social determinants of health with regard to PIs remains largely unknown, but its importance cannot be underestimated.
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Affiliation(s)
- Jill Cox
- Jill Cox, PhD, RN, APN-C, CWOCN, FAAN, is Clinical Professor, Rutgers University School of Nursing, and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Health, Englewood, New Jersey. Charlotte Thomas Hawkins, PhD, RN, FAAN, is Associate Professor, Rutgers University School of Nursing, and Associate Dean, Nursing Science. Acknowledgment: Funding was provided by Rutgers University Center for Health Services Research and Policy. The authors have disclosed no other financial relationships related to this article. Submitted May 2, 2022; accepted in revised form June 15, 2022
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Fulbrook P, Lovegrove J, Butterworth J. Incidence and characteristics of hospital-acquired mucous membrane pressure injury: A five-year analysis. J Clin Nurs 2022. [PMID: 35932156 DOI: 10.1111/jocn.16473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings. AIM To analyse MMPI incidence and characteristics in a tertiary acute general hospital. METHODS A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed. RESULTS There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital-acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital-acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube-related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube-related devices were most often associated with MMPI (84.8%), whereas in non-intensive care MMPI it was the urinary catheter (51.4%). CONCLUSIONS While hospital-acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non-intensive care settings. The most common sites are the lips and mouth. RELEVANCE TO CLINICAL PRACTICE Mucous membrane pressure injuries represent a significant proportion of all hospital-acquired pressure injuries. PATIENT OR PUBLIC CONTRIBUTION Neither patients nor the public were directly involved in this project.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jacob Butterworth
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
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Farid J, Amin R, Sheikh MA, Irfan M, AlRuwaili R, Alruwaili M, Ali NH, Albarrak AM, Rahman S. Prevalence and prediction of pressure ulcers in admitted stroke patients in a tertiary care hospital. J Tissue Viability 2022; 31:768-775. [DOI: 10.1016/j.jtv.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
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Australian First-Year Nursing Student Knowledge and Attitudes on Pressure Injury Prevention: A Three-Year Educational Intervention Survey Study. NURSING REPORTS 2022; 12:431-445. [PMID: 35894032 PMCID: PMC9326559 DOI: 10.3390/nursrep12030042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Pressure injury prevention is a significant issue as pressure injuries are difficult to heal, painful, and create clinical complications for patients. The aim of this study was to investigate knowledge and attitudes of first-year nursing students to pressure injury prevention, and to explore whether additional educational interventions augmented learning. A previously validated online survey was administered to three cohorts of first-year nursing students in 2016, 2017 (after additional online education), and 2018 (after further simulation education), and a subsequent comparative analysis was undertaken. Overall, the knowledge of students about pressure injury was low with measures to prevent pressure injury or shear achieving the lowest score (<50%). Students aged over 25 years (p < 0.001) and men (p = 0.14) gained higher attitude scores. There were significant differences for mean knowledge scores between the 2016 and 2018 cohorts (p = 0.04), including age group (p = 0.013) and number of clinical training units undertaken (p = 0.23). The 2016 cohort scored consistently lower in the attitude survey than both other cohorts (p < 0.001). Online resources and simulation experiences marginally improved knowledge and improved attitudes towards prevention of pressure injury. Nursing curricula should include targeted education to ensure student nurses are adequately prepared to prevent pressure injury through understanding of aetiology and risk assessment.
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Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:211-219. [PMID: 35523235 PMCID: PMC9093720 DOI: 10.1097/won.0000000000000878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units. RESULTS Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups. CONCLUSION Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.
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Affiliation(s)
- Laura E. Edsberg
- Correspondence: Laura E. Edsberg, PhD, Center for Wound Healing Research, Daemen University, 4380 Main St, Amherst, NY 14226 ()
| | - Jill Cox
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Kimberly Koloms
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Catherine A. VanGilder-Freese
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
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Cox J, Edsberg LE, Koloms K, VanGilder CA. Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:21-28. [PMID: 35040812 PMCID: PMC9200225 DOI: 10.1097/won.0000000000000834] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.
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Affiliation(s)
- Jill Cox
- Correspondence: Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, 180 University Ave. Newark, NJ 07102 ()
| | - Laura E. Edsberg
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Kimberly Koloms
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Catherine A. VanGilder
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
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