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L Cortés O, M Vásquez S. Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e07. [PMID: 39083819 PMCID: PMC11290892 DOI: 10.17533/udea.iee.v42n1e07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/14/2024] [Indexed: 08/02/2024]
Abstract
Objective This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.
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Affiliation(s)
- Olga L Cortés
- Nurse, PhD. Associate researcher, Department of Research and Nursing. Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
| | - Skarlet M Vásquez
- Nurse, Master's. Associate professor, Nursing Program, Universidad Autónoma de Bucaramanga, Floridablanca, Colombia.
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Kapp S, Gerdtz M, Gefen A, Padula W, Alves P, Trevellini C, Ghosh A, Shea A, Cross A, Sousa I, Santamaria N. Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial. Int Wound J 2023; 20:3567-3579. [PMID: 37295778 PMCID: PMC10588344 DOI: 10.1111/iwj.14230] [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: 03/28/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 06/12/2023] Open
Abstract
Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.
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Affiliation(s)
- Suzanne Kapp
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, Department of NursingThe University of MelbourneCarltonVictoriaAustralia
| | - Marie Gerdtz
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, Department of NursingThe University of MelbourneCarltonVictoriaAustralia
| | - Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - William Padula
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- University of Southern CaliforniaSchaeffer Center for Health Policy & EconomicsLos AngelesCaliforniaUSA
| | - Paulo Alves
- Universidade Católica Portuguesa, Center for interdisciplinary Research in Health (CIIS) ‐ Institute of Health SciencesPortoPortugal
| | | | - Angaj Ghosh
- The Northern HospitalEppingVictoriaAustralia
| | | | | | - Ines Sousa
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, Department of NursingThe University of MelbourneCarltonVictoriaAustralia
| | - Nick Santamaria
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, Department of NursingThe University of MelbourneCarltonVictoriaAustralia
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Jin Y, Liu J, Shentu Y, Xuan F, Guo H, Li Y. Effect of "micromovement" in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position. Int Wound J 2023; 21:e14408. [PMID: 37849018 PMCID: PMC10824618 DOI: 10.1111/iwj.14408] [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: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023] Open
Abstract
To explore the clinical effect of "micromovement" in preventing intraoperative acquired pressure injures (IAPIs) among patients experiencing surgery in supine position. A total of 200 patients accepting elective surgery in supine position from 10 May 2023 to 4 July 2023 at Shulan (Hangzhou) Hospital were selected and randomized into two groups (experimental group, n = 100; control group, n = 100). For control group patients, soft silicone foam dressing was applied to the sacrococcygeal region. On the basis of the treatment for control group patients, "micromovement" was implemented among experimental group patients. During this process, the operating table was tilted for 15° leftwards and rightwards alternately every 1 h, and the tilt angle was maintained for 5 min to prevent IAPIs. Finally, comparisons between the two groups were made in terms of the sacrococcygeal IAPI incidence, relative temperature differences (ΔT) on sacrococcygeal skin, and job satisfaction of nurses. Compared with control group patients, patients from the experimental group exhibited lower IAPI incidence (2% vs. 10%), reduced ΔT between the sacrococcygeal skin and surrounding normal skin [0 (-0.1, 0.1) vs. 0.2 (-0.2, 0.4)], and elevated job satisfaction of nurses (80% vs. 66%). All the differences were statistically significant (p < 0.05). "Micromovement" implemented intraoperatively among patients receiving surgery in supine position is able to lower the IAPI incidence by five times and elevate job satisfaction of nurses.
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Affiliation(s)
- Ya‐Xian Jin
- ORN, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
| | - Jing Liu
- ORN, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
| | - Yan‐Qin Shentu
- ORN, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
| | - Fei‐Fei Xuan
- ORN, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
| | - Hua Guo
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
| | - Yu‐Hong Li
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical CollegeZhejiang Shuren CollegeHangzhouChina
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Singh C, Shoqirat N, Thorpe L, Villaneuva S. Sustainable pressure injury prevention. BMJ Open Qual 2023; 12:bmjoq-2022-002248. [PMID: 37286297 DOI: 10.1136/bmjoq-2022-002248] [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: 12/30/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
The quality department used adaptive leadership and the plan-do-study-act cycle to decrease pressure injury (PI) rates. After identifying gaps, the pressure injury prevention bundle was developed and implemented to bring evidence-based nursing practice to frontline nurses. Organisational rates of PI was followed for 4 years (2019-2022) and a smaller subset of 88 patients were followed in the prospective arm. Using statistical analysis, the decrease in PI rates (90%) and severity is significant (p<0.5) and sustained compared with the year prior to interventions.
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Affiliation(s)
- Charleen Singh
- Nursing, University of California Davis Betty Irene Moore School of Nursing, Sacramento, California, USA
- Wound Care, Regional Medical Center of San Jose, San Jose, California, USA
- General Surgery, Cottage Hospital, Santa Barbara, California, USA
| | - Noordeen Shoqirat
- Nursing, Mu'tah University College of Nursing, Mu'tah, Jordan
- Health Sciences, Higher Colleges of Technology, Sharjah, UAE
| | - Lee Thorpe
- Quality, Regional Medical Center of San Jose, San Jose, California, USA
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Ippolito M, Cortegiani A, Biancofiore G, Caiffa S, Corcione A, Giusti GD, Iozzo P, Lucchini A, Pelosi P, Tomasoni G, Giarratano A. The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:7. [PMID: 37386656 DOI: 10.1186/s44158-022-00035-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND The aim of this document is to support clinical decision-making concerning positioning and mobilization of the critically ill patient in the early identification and resolution of risk factors (primary prevention) and in the early recognition of those most at risk (secondary prevention). The addresses of this document are physicians, nurses, physiotherapists, and other professionals involved in patient positioning in the intensive care unit (ICU). METHODS A consensus pathway was followed using the Nominal Focus Group and the Delphi Technique, integrating a phase of focused group discussion online and with a pre-coded guide to an individual phase. A multidisciplinary advisory board composed by nine experts on the topic contributed to both the phases of the process, to reach a consensus on four clinical questions positioning and mobilization of the critically ill patient. RESULTS The topics addressed by the clinical questions were the risks associated with obligatory positioning and therapeutic positions, the effective interventions in preventing pressure injuries, the appropriate instruments for screening for pressure injuries in the ICU, and the cost-effectiveness of preventive interventions relating to ICU positioning. A total of 27 statements addressing these clinical questions were produced by the panel. Among the statements, nine provided guidance on how to manage safely some specific patients' positions, including the prone position; five suggested specific screening tools and patients' factors to consider when assessing the individual risk of developing pressure injuries; five gave indications on mobilization and repositioning; and eight focused on the use of devices, such as positioners and preventive dressings. CONCLUSIONS The statements may represent a practical guidance for a broad public of healthcare professionals involved in the management of critically ill patients.
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Affiliation(s)
- Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
| | - Gianni Biancofiore
- UOC Anestesia e Rianimazione Trapianti Dipartimento di Patologia chirurgica, medica, molecolare e dell'Area Critica, Università di Pisa. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132, Genoa, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Naples, Italy
| | | | - Pasquale Iozzo
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Alberto Lucchini
- General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Gabriele Tomasoni
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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Sousa I, Kapp S, Santamaria N. Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose-designed positioning device and usual care equipment: An observational feasibility study. Int Wound J 2020; 17:1028-1038. [PMID: 32304347 DOI: 10.1111/iwj.13365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side-lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose-designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose-designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high-risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z-Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side-lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°-26°, the foam wedge 29°-27°, and the pillow 23°-21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°-71°, a difference of 7°) and the pillow alone (79°-74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°-86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.
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Affiliation(s)
- Ines Sousa
- Intensive Care Unit, Northern Hospital, Melbourne, Victoria, Australia
| | - Suzanne Kapp
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nick Santamaria
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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