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Uslu Y, Fulbrook P, Eren E, Lovegrove J, Cobos-Vargas A, Colmenero M. Assessment of pressure injury risk in intensive care using the COMHON index: An interrater reliability study. Intensive Crit Care Nurs 2024; 83:103653. [PMID: 38382411 DOI: 10.1016/j.iccn.2024.103653] [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: 10/09/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool. DESIGN Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated. SETTING Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey. MAIN OUTCOME MEASURES Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (rs) for ordinal variables. RESULTS All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 - 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score. CONCLUSION The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted. IMPLICATIONS FOR CLINICAL PRACTICE Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes.
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Affiliation(s)
- Yasemin Uslu
- Faculty of Nursing, Istanbul University, Fatih, Istanbul 34452, Turkey
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Esra Eren
- Health Science Faculty, Nursing Department, Medipol University, 34810 Kavacik South Campus, Istanbul, Turkey
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland 4006, Australia
| | - Angel Cobos-Vargas
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada 18016, Spain
| | - Manuel Colmenero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada 18016, Spain
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Fulbrook P, Lovegrove J, Ven S, Schnaak S, Nowicki T. Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study. J Adv Nurs 2024. [PMID: 38969344 DOI: 10.1111/jan.16309] [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: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk-stratified intervention bundle. DESIGN Single-centre, cross-sectional, observational, prospective. METHODS The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation. RESULTS Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient-/carer-focused interventions was particularly poor, with evidence indicating they had been implemented for 3%-10% of patients. Also, nutritional screening-related interventions were implemented poorly. Clinically indicated implementation of heel-elevation devices and bariatric equipment was low for at-risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such. CONCLUSION While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them. IMPLICATIONS FOR PATIENT CARE Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation. IMPACT The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals. REPORTING METHOD The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Therapeutic Sciences, 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
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Schnaak
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tracy Nowicki
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Han L, Wei Y, Pei J, Zhang H, Lv L, Tao H, Yang Q, Su Q, Ma Y. Nomogram model on estimating the risk of pressure injuries for hospitalized patients in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103566. [PMID: 37913713 DOI: 10.1016/j.iccn.2023.103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This study aimed to build and validate a nomogram model to estimate the risk of pressure injuries in intensive care unit patients. DESIGN Multicenter prospective cohort study. SETTING 33 tertiary hospitals in the Gansu Province, China. MEASUREMENTS AND MAIN RESULTS This study included 6420 patients between April 2021 to October 2022 from an information platform of pressure injury risk management called the "Long Hu Hui." Univariate and multivariate logistic regression analyses identified pressure injury risk factors to be included in the nomogram. The resulting nomogram was tested for calibration discrimination, and clinical usefulness. Of the included patients, 77 developed pressure injuries, representing an incidence rate of 1.2 %. Analysis of binary logistic regression revealed that the estimation nomogram included weight loss greater than 5 kg in the last three months, pneumotomy cannula, thoracic catheter, isoproterenol, norepinephrine, abnormal skin color, ruptured erythema, stroke, increased body temperature and nonspecific patients (specific patients include paralysis, unconsciousness, dementia, forced body position). The area under the receiver operating characteristic curve for the training cohort was 0.806 (95 % CI 0.755-0.857), and the AUC of the text cohort was 0.737 (95 % CI 0.574-0.901). The model has excellent calibration in both the training cohort (H-L test: χ2 = 6.34, P = 0.61) and the text cohort (H-L test: χ2 = 4.50, P = 0.81). Furthermore, the decision curve analysis revealed the preferred net benefit and the threshold probability in the estimation nomogram. CONCLUSIONS The nomogram model accurately estimated the risk of pressure injuries among intensive care patients, it should be used to inform risk assessment and facilitate early intervention strategies in future practice. IMPLICATIONS FOR CLINICAL PRACTICE The nomogram allows intensive care providers to dynamically assess the patient's risk of pressure injuries and to implement more targeted interventions accordingly.
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Affiliation(s)
- Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Juhong Pei
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China
| | - Lin Lv
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Hongxia Tao
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qiuxia Yang
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qian Su
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Patient Service Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China.
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Li J, Li Z, Wu X. The practice and facilitators of, and barriers to, implementing individualized repositioning frequency: A national cross-sectional survey of critical care nurses. J Tissue Viability 2024; 33:89-95. [PMID: 38245399 DOI: 10.1016/j.jtv.2024.01.002] [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: 05/04/2023] [Revised: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
AIMS To understand the clinical status of implementing individualized repositioning frequency-and its barriers and facilitators-among critical care nurses in China, in view of developing targeted intervention strategies and improving guideline implementation. DESIGN A cross-sectional survey. METHODS A self-report questionnaire was developed with reference to the Theoretical Domains Framework and administered to critical care nurses in 15 hospitals across eastern, southern, western, northern, and central geographical areas of China from 20 February 2023 to 16 March 2023. Data were collected for personal demographics, clinical practice status, and from Likert-type responses about barriers to and facilitators of implementing individualized repositioning frequency. RESULTS In total, 574 effective questionnaires were collected. Only 3.8 % of respondents reported that their hospital/ward uses an individualized repositioning frequency rule. Six facilitator domains identified were: social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; and intentions. Seven barrier domains were: knowledge; skills; goals; memory, attention and decision processes; environmental context and resources; social influences; and behavioral regulation. Inferential analysis showed that critical care nurses who had higher degrees, more years of work, more environmental support, and more nursing experience were prone to being more positive in response to the implementation of individualized repositioning frequency. CONCLUSION The clinical practice status of implementing individualized repositioning frequency among critical care nurses in China is unsatisfactory. Implementation is essential but complex and is influenced by several factors. Theory-based suggestions for improving this situation are provided on the basis of identified barriers.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, No. 10 Xitoutiao, Youan Men Wai, Fengtai District, Beijing, 100069, China.
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Rodríguez-Delgado ME, Echeverría-Álvarez AM, Colmenero-Ruiz M, Morón-Romero R, Cobos-Vargas A, Bueno-Cavanillas A. Design of a safety round model for intensive care units. ENFERMERIA INTENSIVA 2023; 34:186-194. [PMID: 37248132 DOI: 10.1016/j.enfie.2023.01.002] [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: 08/08/2022] [Accepted: 01/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). METHODS Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. RESULTS A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85 min, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. CONCLUSIONS Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.
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Affiliation(s)
- M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | - A M Echeverría-Álvarez
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - M Colmenero-Ruiz
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - R Morón-Romero
- Servicio de Farmacia, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - A Cobos-Vargas
- Enfermero, Referente de Seguridad del Paciente, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - A Bueno-Cavanillas
- Cátedra de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
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Kottner J, Coleman S. The theory and practice of pressure ulcer/injury risk assessment: a critical discussion. J Wound Care 2023; 32:560-569. [PMID: 37682783 DOI: 10.12968/jowc.2023.32.9.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different approaches, such as clinical judgement, using standardised risk assessment instruments, skin assessments, or using devices to measure skin or tissue properties. A distinction between PU risk assessment and early detection is important. PU risk measures the individual's susceptibility to developing a PU under a specific exposure (primary prevention), and early detection includes the assessment of early (sub)clinical signs and symptoms to prevent progression and to support healing (secondary prevention). PU risk is measured using prognostic/risk factors or prognostic models. Every risk estimate is a probability statement containing varying degrees of uncertainty. It therefore follows that every clinical decision based on risk estimates also contains uncertainty. PU risk assessment and prevention is a complex intervention, where delivery contains several interacting components. There is a huge body of evidence indicating that risk assessment and its outcomes, the selection of preventive interventions and PU incidence are not well connected. Methods for prognostic model development and testing in PU risk research must be improved and follow state-of-the-art methodological standards. Despite these challenges, we do have substantial knowledge about PU risk factors that helps us to make better clinical decisions. An important next step in the development of PU risk prediction might be the combination of clinical and other predictors for more individualised care. Any prognostic test or procedure must lead to better prevention at an acceptable cost.
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Affiliation(s)
- Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
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Lartigau M, Barateau M, Rosé M, Petricã N, Salles N. Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study. J Wound Care 2023; 32:clxxi-clxxx. [PMID: 37703220 DOI: 10.12968/jowc.2023.32.sup9a.clxxi] [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: 09/15/2023]
Abstract
OBJECTIVE Our aim was to measure the effectiveness of home healthcare pressure ulcer (PU) prevention devices (PUPDs) for at-risk patients after hospital discharge in France. METHOD We conducted a retrospective analysis of PU-associated hospitalisations based on the French medico-administrative database (Système National des Données de Santé, SNDS), which covers the entire French population. All adults >70 years of age, hospitalised from 1 July to 31 December 2015, and equipped with a medical bed at home, were included. Follow-up was for a maximum of 18 months. Propensity score matching allowed the comparison of PUPD equipped and non-equipped groups (No-PUPD), considering sociodemographic characteristics and other factors. RESULTS The study included 43,078 patients. Of this population, 54% were PUPD patients and 46% No-PUPD. After matching, PUPD patients had significantly fewer PUs than No-PUPD patients (5.5% versus 8.9%, respectively; p<0.001). The adoption of PUPD reduced by 39% the risk of a PU in hospital. Patients equipped within the first 30 days at home after hospitalisation had fewer PUs than those equipped later (4.8% versus 5.9%, respectively). The estimated PUPD use costs represented 1% of total healthcare expenditure per patient during the study period. CONCLUSION The study results demonstrated the effectiveness of the adoption of mattress toppers or prevention mattresses in reducing PU occurrence in patients aged >70 years of age. A short delay in PUPD delivery appeared to have a real impact in the medical setting. Future research on a larger population might provide more evidence on the appropriate support and timeframe to choose based on risk assessment.
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Affiliation(s)
- Marion Lartigau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
| | - Martine Barateau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
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Lien RY, Wang CY, Hung SH, Lu SF, Yang WJ, Chin SI, Chiang DH, Lin HC, Cheng CG, Cheng CA. Reduction in the Incidence Density of Pressure Injuries in Intensive Care Units after Advance Preventive Protocols. Healthcare (Basel) 2023; 11:2116. [PMID: 37570356 PMCID: PMC10418660 DOI: 10.3390/healthcare11152116] [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: 06/18/2023] [Revised: 07/08/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014-2016) and post-bundle (2017-2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149-0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health.
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Affiliation(s)
- Ru-Yu Lien
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (R.-Y.L.); (S.-H.H.); (S.-F.L.); (W.-J.Y.); (S.-I.C.)
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chien-Ying Wang
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Division of Trauma, Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (R.-Y.L.); (S.-H.H.); (S.-F.L.); (W.-J.Y.); (S.-I.C.)
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Chang Jung Christian University, Tainan 711301, Taiwan
| | - Shu-Fen Lu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (R.-Y.L.); (S.-H.H.); (S.-F.L.); (W.-J.Y.); (S.-I.C.)
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Wen-Ju Yang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (R.-Y.L.); (S.-H.H.); (S.-F.L.); (W.-J.Y.); (S.-I.C.)
| | - Shu-I Chin
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (R.-Y.L.); (S.-H.H.); (S.-F.L.); (W.-J.Y.); (S.-I.C.)
| | - Dung-Hung Chiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
| | - Chun-Gu Cheng
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan;
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Emergency, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chun-An Cheng
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan;
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Cobos-Vargas A, Acosta-Romero M, Alba-Fernández C, Gutierrez-Linares S, Rodriguez-Blanquez R, Colmenero M. Compliance with preventive measures recommended by an international study group for pressure injuries in adult critically ill patients. Int Wound J 2023; 20:1205-1211. [PMID: 36270634 PMCID: PMC10031212 DOI: 10.1111/iwj.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
The objective of this cross-sectional descriptive study is to analyse the degree of compliance with the preventive measures for pressure injuries reported by an International Study Group in a cohort of adult critically ill patients. The level of risk of developing pressure injuries was determined using the Conscious level, Mobility, Hemodynamics, Oxygenation and Nutrition (COMHON) index. According to the level of risk, the preventive measures applied to each patient and scores on the different components of the index were recorded. Number, location and degree of pressure injuries were registered. Seventy-three patients (male: 68%) with an acute physiology and chronic health evaluation (APACHE) II: 12,1 ± 6,2 and 56,1% of them with invasive mechanical ventilation. The prevalence of pressure injuries was 21,9%, with 43,7% of sacral location and 75% of grade II. The level of risk using the COMHON index was distributed between low 30,1%, intermediate 23,3% and high 46,6%. The compliance range from 0% (offloading heel devices) to the use of active mattress and incontinence pads (100%). Regarding repositioning the degree of compliance varies (from 20% to 80%) according if patients with contraindications (4 points in subscale of Mobility) or those with the capacity to mobilise themselves (2 points in subscale of Mobility) are included in the denominator. We have found that in our ICU there is a wide range of compliance with the use of the preventive measures recommended by the International Study Group. Some of them are related not by the general score of the COMHON scale, but to that obtained in its subscale components.
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Affiliation(s)
- Angel Cobos-Vargas
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Patient safety coordinator, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - María Acosta-Romero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Carmen Alba-Fernández
- Nursing Care coordinator, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | - Manuel Colmenero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria, Granada, Spain
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Development of a Wound Assessment Tool for Use in Adults at End of Life: A Modified Delphi Study. Adv Skin Wound Care 2023; 36:142-150. [PMID: 36812079 DOI: 10.1097/01.asw.0000911992.83362.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Some patients at end of life (EOL) develop wounds known as Kennedy terminal ulcers, terminal ulcers, and Skin Changes At Life's End. However, there is ambiguity around the defining wound characteristics of these conditions and a lack of validated clinical assessment tools available to identify them. OBJECTIVE To gain consensus on the definition and characteristics of EOL wounds and establish the face and content validity of a wound assessment tool for use in adults at EOL. METHODS Using a reactive online Delphi technique, international wound experts reviewed the 20 items in the tool. Over two iterative rounds, experts assessed item clarity, relevance, and importance using a four-point content validity index. The content validity index scores were calculated for each item, with a level of 0.78 or higher signifying panel consensus. RESULTS Round 1 included 16 panelists (100.0%). The agreement for item relevance and importance ranged from 0.54% to 0.94%, and item clarity scored between 0.25% and 0.94%. Following round 1, four items were removed, and seven others reworded. Other suggestions included changing the tool name and including Kennedy terminal ulcer, terminal ulcer, and Skin Changes At Life's End in the EOL wound definition. In round 2, the now 13 panel members agreed with the final 16 items included and suggested minor wording changes. CONCLUSIONS This tool could provide clinicians with an initially validated tool to accurately assess EOL wounds and gather much needed empirical prevalence data. Further research is needed to underpin accurate assessment and the development of evidence-based management strategies.
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Levido A, Fulbrook P, Barakat-Johnson M, Campbell J, Delaney L, Latimer S, Walker RM, Wynne R, Doubrovsky A, Coyer F. Pressure injury prevention practice in Australian intensive care units: A national cross-sectional survey. Aust Crit Care 2023; 36:186-194. [PMID: 34955332 DOI: 10.1016/j.aucc.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs. MATERIALS AND METHODS An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location. RESULTS Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026). DISCUSSION AND CONCLUSION This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.
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Affiliation(s)
- Annabel Levido
- Intensive Care Services, Royal Brisbane and Women's Hospital, Australia.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Australia; Research & Practice Development Unit, The Prince Charles Hospital, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Michelle Barakat-Johnson
- Hospital-Acquired Complication Operational Coordinator for Pressure Injury, Sydney Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Australia.
| | - Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Lori Delaney
- School of Nursing, Queensland University of Technology, Australia.
| | - Sharon Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Gold Coast Hospital and Health Service, Australia.
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Menzies Health Institute QLD, and the Division of Surgery, Princess Alexandra Hospital, Australia.
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Marcel Crescent Blacktown, NSW, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Fiona Coyer
- Joint Appointment School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK.
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12
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Rodríguez-Delgado M, Echeverría-Álvarez A, Colmenero-Ruiz M, Morón-Romero R, Cobos-Vargas A, Bueno-Cavanillas A. Diseño de un modelo de ronda de seguridad para unidades de cuidados intensivos. ENFERMERIA INTENSIVA 2023. [DOI: 10.1016/j.enfi.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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13
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Bedford JP, Garside T, Darbyshire JL, Betts TR, Young JD, Watkinson PJ. Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study. J Intensive Care Soc 2022; 23:414-424. [PMID: 36751347 PMCID: PMC9679893 DOI: 10.1177/17511437211022132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study. Methods We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness. Results Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables. Conclusions We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.
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Affiliation(s)
- Jonathan P Bedford
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,Jonathan P Bedford, Kadoorie Centre for
Critical Care Research and Education, Level 3, John Radcliffe Hospital, Headley
Way, Headington, Oxford OX3 9DU, UK.
| | - Tessa Garside
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Julie L Darbyshire
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Timothy R Betts
- Radcliffe Department of Medicine, University of Oxford, Oxford,
UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, Oxford, UK
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14
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Lovegrove J, Fulbrook P, Miles SJ, Steele M, Liu XL, Zhang L, Cobos Vargas A. Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool (the COMHON Index). Int J Nurs Sci 2022; 9:169-178. [PMID: 35509692 PMCID: PMC9052269 DOI: 10.1016/j.ijnss.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- Corresponding author.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra J. Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
| | - Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Lin Zhang
- Nursing Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Angel Cobos Vargas
- Critical Care Department, San Cecilio University Hospital, Granada, Spain
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15
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Lovegrove J, Fulbrook P, Miles S, Steele M. Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2022; 35:186-203. [PMID: 34144865 DOI: 10.1016/j.aucc.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, noninvasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and noninvasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I2 = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I2 = 0%) and heel (risk ratio = 0.31, p = 0.02; I2 = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2000, South Africa.
| | - Sandra Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, 1100 Nudgee Road, Banyo, Queensland, Australia 4014.
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16
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Fulbrook P, Mbuzi V, Miles S. Incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care: A systematic review and meta-analysis. Int J Nurs Stud 2021; 114:103826. [PMID: 33352437 DOI: 10.1016/j.ijnurstu.2020.103826] [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: 09/07/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. OBJECTIVES To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care. DESIGN Systematic review and meta-analysis of incidence and prevalence REVIEW METHODS: Articles published in English between 2009 and 2018, reporting pressure injury as a primary outcome were selected based on inclusion criteria. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted. Sub-group meta-analyses were conducted to investigate potential causes of heterogeneity. RESULTS Fifteen studies met the criteria for inclusion in the systematic review, of which 14 were incidence studies. Heterogeneity was significant and there was large observed variance between studies. The 95% confidence interval of cumulative incidence across all 14 studies, with an overall sample size of 6371, was 9.8-25.6%. In 11 studies that included all-stage pressure injury the 95% confidence interval was 8.3-28.3%. In seven studies in which Stage 1 pressure injury was excluded, the 95% confidence interval was 5.8-22.7%. In the single prevalence study included, which excluded Stage 1 pressure injury, prevalence was 8.8%. CONCLUSIONS The incidence of pressure injury in cardiac intensive care patients was similar to that found in general intensive care patients. However, our results suggest that the incidence may be significantly higher in cardiac surgical patients admitted to intensive care. There were significant differences across the various studies in the ways in which data were collected and reported. Further well-designed studies are required to better understand incidence in this population, using standardised methods of data collection and reporting.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Vainess Mbuzi
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.
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17
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Lovegrove J, Fulbrook P, Miles S. Authors' response to comment on "International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study". Int Wound J 2020; 18:738-741. [PMID: 33200527 PMCID: PMC8450788 DOI: 10.1111/iwj.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & ParamedicineFaculty of Health Sciences, Australian Catholic UniversityBrisbaneQueenslandAustralia,Nursing Research and Practice Development CentreThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Paul Fulbrook
- School of Nursing, Midwifery & ParamedicineFaculty of Health Sciences, Australian Catholic UniversityBrisbaneQueenslandAustralia,Nursing Research and Practice Development CentreThe Prince Charles HospitalBrisbaneQueenslandAustralia,Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sandra Miles
- School of Nursing, Midwifery & ParamedicineFaculty of Health Sciences, Australian Catholic UniversityBrisbaneQueenslandAustralia,Nursing Research and Practice Development CentreThe Prince Charles HospitalBrisbaneQueenslandAustralia
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18
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Kottner J, Cuddigan J, Balzer K, Haesler E. Comment on "International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study". Int Wound J 2020; 18:742-743. [PMID: 33169540 PMCID: PMC8450801 DOI: 10.1111/iwj.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jan Kottner
- Charite Center 1 for Health and Human SciencesCharité‐Universitätsmedizin BerlinBerlinGermany,Faculty of Medicine and Health SciencesGhent UniversityGentBelgium
| | - Janet Cuddigan
- College of NursingUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Emily Haesler
- School of Nursing, Midwifery and ParamedicineCurtin UniversityPerthWestern AustraliaAustralia,Australian Centre for Evidence Based Aged Care, School of Nursing and MidwiferyLaTrobe UniversityMelbourneVictoriaAustralia,ANU Medical School, Academic Unit of General PracticeAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
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19
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Lovegrove J, Fulbrook P, Miles S. International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study. Int Wound J 2020; 17:1112-1127. [PMID: 33591631 PMCID: PMC7948917 DOI: 10.1111/iwj.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive-care-specific risk-assessment-scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2-hours of admission; 8-hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate- and high-risk patients should receive: a reactive mattress support surface and a heel off-loading device. High-risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure-redistributing cushion for sitting. Repositioning is required at least 4-hourly for low-risk, and 2-hourly for moderate- and high-risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sandra Miles
- School of Nursing, Midwifery and Paramedicine, Faculty of Health SciencesAustralian Catholic UniversityBanyoQueenslandAustralia
- Nursing Research and Practice Development CentreThe Prince Charles HospitalChermsideQueenslandAustralia
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