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Fitzgerald S, McTier L, Whitehead C, Masters K, Wynne R. Inter-rater reliability of descriptors for the classification of mucosal pressure injury: A prospective cross-sectional study. Aust Crit Care 2023; 36:179-185. [PMID: 34991951 DOI: 10.1016/j.aucc.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Mucosal pressure injuries (PIs) are usually caused by pressure from essential medical devices. There is no universally accepted criterion for assessment, monitoring, or reporting mucosal PI. Reliable descriptors are vital to benchmark the frequency and severity of this hospital-acquired complication. OBJECTIVES The objective of this study was to determine whether modified Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) descriptors improved the reliability of mucosal PI assessment. Secondary aims were to explore nurses' knowledge of and attitudes toward mucosal PI. METHODS A prospective cross-sectional survey was distributed to nurses from two tertiary affiliated intensive care units via REDCap® to capture demographic data, knowledge, attitudes, and inter-rater reliability (IRR) measures. Nurses were randomised at a 1:1 ratio to original or modified ROMPIS descriptors and classified 12 images of mucosal PI. IRR was assessed using percentage agreement, Fleiss' kappa, and intraclass correlation coefficients. RESULTS The survey response rate was 20.9% (n = 98/468), with 73.5% (n = 72/98) completing IRR measures. Agreement was higher with modified (75%) than original ROMPIS descriptors (69.4%). IRR was fair for the original (κ = 0.30, 95% confidence interval [CI] [0.28, 0.33], z 26.5, p < 0.001) and modified ROMPIS (κ = 0.29, 95% CI [0.26, 0.31], z 25.0, p < 0.001). Intraclass correlation coefficient findings indicated ratings were inconsistent for the original (0.33, 95% CI [0.18, 0.59], F 18.8 (11 df), p < 0.001) and modified ROMPIS (0.31, 95% CI [0.17, 0.57], F 17.6 (11 df), p < 0.001). PI-specific education and risk factor recognition were common. CONCLUSION Modified descriptors had marginally better agreement. Participants understand management and prevention but need to strengthen their perceived capacity for mucosal PI risk assessment. This work provides a foundation for future benchmarking and a platform from which further research to refine and test descriptors specific to mucosal PI can be generated.
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Affiliation(s)
- Simone Fitzgerald
- School of Nursing & Midwifery, Deakin University, 1 Geringhap Street, Geelong, Victoria, Australia; Intensive Care Unit, Austin Health, Studley Road, Heidelberg, Victoria, Australia
| | - Lauren McTier
- School of Nursing & Midwifery, Deakin University, 1 Geringhap Street, Geelong, Victoria, Australia; Centre for Quality & Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - Kristy Masters
- Intensive Care Unit, Nepean Hospital, Penrith, NSW, Australia
| | - Rochelle Wynne
- School of Nursing & Midwifery, Deakin University, 1 Geringhap Street, Geelong, Victoria, Australia; Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Marcel Crescent Blacktown, NSW, Australia.
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Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:4482201. [PMID: 34925541 PMCID: PMC8683176 DOI: 10.1155/2021/4482201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022]
Abstract
Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score (20.15 ± 2.17) in the dressing group after intervention was higher than that (17.42 ± 3.62) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score (31.41 ± 3.15) of the dressing group was higher than that (26.92 ± 3.43) of the regular group. The trust score (29.57 ± 2.61) of the dressing group was higher than the score (24.28 ± 2.29) of the regular group. The score of physiological problems in the dressing group (34.69 ± 3.82) is higher than that in the regular group (29.88 ± 3.54). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that (80.59 ± 5.43) of the regular group. The nursing satisfaction score (94.53 ± 3.72) of the dressing group was higher than that (81.79 ± 4.61) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.
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Poldrugovac M, Padget M, Schoonhoven L, Thompson ND, Klazinga NS, Kringos DS. International comparison of pressure ulcer measures in long-term care facilities: Assessing the methodological robustness of 4 approaches to point prevalence measurement. J Tissue Viability 2021; 30:517-526. [PMID: 33558099 PMCID: PMC11000144 DOI: 10.1016/j.jtv.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities. MATERIAL AND METHODS A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements. RESULTS The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems. CONCLUSIONS Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning.
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Affiliation(s)
- Mircha Poldrugovac
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
| | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom
| | - Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Niek S Klazinga
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Dionne S Kringos
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
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Dube A, Sidambe V, Verdon A, Phillips E, Jones S, Lintern M, Radford M. Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review. J Tissue Viability 2021; 31:84-103. [PMID: 34742635 DOI: 10.1016/j.jtv.2021.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022]
Abstract
AIMS The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect. BACKGROUND Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum. DESIGN Quantitative systematic review. METHODS Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. STUDY ELIGIBILITY CRITERIA Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. PARTICIPANTS patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion. RESULTS Thirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies. CONCLUSIONS There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation. PROSPERO ID PROSPERO International prospective register of systematic reviews: CRD42017071459.
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Affiliation(s)
- Alisen Dube
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK; School of Health, Science, and Wellbeing, Staffordshire University, Staffordshire, UK; University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
| | - Viola Sidambe
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Amy Verdon
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Sarahjane Jones
- School of Health, Science, and Wellbeing, Staffordshire University, Staffordshire, UK
| | - Maxine Lintern
- Faculty of Business, Law and Social Sciences, Birmingham City University, Birmingham, UK
| | - Mark Radford
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK; Health Education England, Birmingham, UK; NHS England and NHS Improvement, Birmingham, UK
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Everink IHJ, Gordon AL, Rijcken S, Osmancevic S, Schols JMGA. Learning and improving in long-term care internationally: the International Prevalence Measurement of Care Quality (LPZ). GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Long-term care (LTC) for older adults is an essential part of how health and social care systems respond to population ageing. Different long-term care systems in different countries have taken differing approaches to quality assurance, ranging from inspection-based regulatory systems to data and reporting-based regulatory systems. The significant variability in the ability of long-term care facilities to respond to the COVID-19 pandemic has led to increased recognition of the role of standardized data in informing structured approaches to quality assurance. The International Prevalence Measurement of Care Quality (in Dutch: Landelijke Prevalentiemeting Zorgkwaliteit – LPZ) was developed to guide continuous quality improvement in long-term care facilities. This special article describes the LPZ tool, developed to provide input for the learning and improvement cycle of multidisciplinary teams in the LTC sector and to help improve care quality.
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Van Tiggelen H, Kottner J, Campbell K, LeBlanc K, Woo K, Verhaeghe S, Van Hecke A, Beeckman D. Measurement properties of classifications for skin tears: A systematic review. Int J Nurs Stud 2020; 110:103694. [DOI: 10.1016/j.ijnurstu.2020.103694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
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Pressure ulcer/injury classification today: An international perspective. J Tissue Viability 2020; 29:197-203. [DOI: 10.1016/j.jtv.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
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8
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Hahnel E, El Genedy M, Tomova‐Simitchieva T, Hauß A, Stroux A, Lechner A, Richter C, Akdeniz M, Blume‐Peytavi U, Löber N, Kottner J. The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: a randomized controlled parallel‐group trial. Br J Dermatol 2019; 183:256-264. [DOI: 10.1111/bjd.18621] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Affiliation(s)
- E. Hahnel
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - M. El Genedy
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - T. Tomova‐Simitchieva
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - A. Hauß
- Department of Clinical Quality and Risk Management Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Stroux
- Department of Biometry and Clinical Epidemiology Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Lechner
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - C. Richter
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - M. Akdeniz
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - U. Blume‐Peytavi
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
| | - N. Löber
- Department of Clinical Quality and Risk Management Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Kottner
- Clinical Research Center for Hair and Skin Science Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Berlin Germany
- Department of Public Health and Primary Care Skin Integrity Research Group (SKINT) University Centre for Nursing and Midwifery Ghent University Ghent Belgium
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9
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Kottner J, Kröger K, Gerber V, Schröder G, Dissemond J. [Recognition and correct classification of pressure ulcers: a position paper]. Hautarzt 2019; 69:839-847. [PMID: 30014436 DOI: 10.1007/s00105-018-4230-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pressure ulcers comprise serious skin and tissue damage. The correct diagnosis and classification into different categories is often difficult in daily practice. QUESTION What procedure can be recommended to correctly diagnose and classify pressure ulcers in practice? MATERIALS AND METHODS The society Initiative Chronische Wunden (ICW) e. V. established a group of experts who developed practical recommendations for the diagnosis and classification of pressure ulcers based on the current literature and their own expertise. RESULTS Pressure ulcers should only be diagnosed if skin and/or tissue damage is most likely due to prolonged pressure or pressure associated with shear forces. A complete anamnesis must be performed to detect periods of previous prolonged immobility. Pressure ulcers are usually located at typical predilection sites. For category I and "suspected deep tissue damage" the tissue damage occurs under (initially) intact skin. However, the diagnosis is uncertain and the classification should be made later. The category II pressure ulcer is usually an exclusion diagnosis. The categories III and IV are pressure ulcers in the proper sense. As long as the distinction between category III and IV is not possible, the lower category should be coded. CONCLUSIONS Currently, a relevant classification should be used uniformly for the respective setting. In accordance with the clinical picture, a most suitable diagnosis is to be made. It does not matter which classification system is used. The future WHO ICD-11 version will allow better classification of pressure ulcers.
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Affiliation(s)
- J Kottner
- Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - K Kröger
- Klinik für Angiologie, HELIOS Klinikum Krefeld GmbH, Krefeld, Deutschland
| | - V Gerber
- Initative Chronische Wunden e. V., Quedlinburg, Deutschland
| | - G Schröder
- Akademie für Wundversorgung, Göttingen, Deutschland
| | - J Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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Interdisciplinary care of hip fractures.: Orthogeriatric models, alternative models, interdisciplinary teamwork. Best Pract Res Clin Rheumatol 2019; 33:205-226. [PMID: 31547979 DOI: 10.1016/j.berh.2019.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.
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O'Brien G, Moore Z, Patton D, O'Connor T. The relationship between nurses assessment of early pressure ulcer damage and sub epidermal moisture measurement: A prospective explorative study. J Tissue Viability 2018; 27:232-237. [DOI: 10.1016/j.jtv.2018.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/20/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
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12
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Barakat-Johnson M, Lai M, Barnett C, Wand T, Lidia Wolak D, Chan C, Leong T, White K. Hospital-acquired pressure injuries: Are they accurately reported? A prospective descriptive study in a large tertiary hospital in Australia. J Tissue Viability 2018; 27:203-210. [DOI: 10.1016/j.jtv.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/20/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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Squitieri L, Waxman DA, Mangione CM, Saliba D, Ko CY, Needleman J, Ganz DA. Evaluation of the Present-on-Admission Indicator among Hospitalized Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates. Health Serv Res 2018; 53 Suppl 1:2970-2987. [PMID: 29552746 PMCID: PMC6056601 DOI: 10.1111/1475-6773.12822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. DATA SOURCES/STUDY SETTING Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). STUDY DESIGN Retrospective cross-sectional study. DATA COLLECTION/EXTRACTION METHODS We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011. Admissions were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU rates were calculated by varying patient exclusion criteria. PRINCIPAL FINDINGS Among admissions with a pressure ulcer diagnosis, we observed a large discrepancy in the proportion of admissions with a HAPU based on hospital-reported POA data (5.2 percent) and the proportion with a new pressure ulcer diagnosis based on patient history in billing claims (49.7 percent). Applying quality measure exclusion criteria resulted in removal of 91.2 percent of admissions with a pressure injury diagnosis from HAPU rate calculations. CONCLUSIONS As payers and health care organizations expand the use of quality measures, it is important to consider how the measures are implemented, coding revisions to improve measure validity, and the impact of patient exclusion criteria on provider performance evaluation.
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Affiliation(s)
- Lee Squitieri
- UCLA Robert Wood Johnson Clinical Scholars ProgramDepartment of MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
- Division of Plastic and Reconstructive SurgeryDepartment of SurgeryKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Daniel A. Waxman
- Health UnitRANDSanta MonicaCA
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
| | - Carol M. Mangione
- UCLA Robert Wood Johnson Clinical Scholars ProgramDepartment of MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
- Division of General Internal Medicine and Health Services ResearchDepartment of MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCA
| | - Debra Saliba
- UCLA Robert Wood Johnson Clinical Scholars ProgramDepartment of MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
- Health UnitRANDSanta MonicaCA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
- JH Borun CenterUCLALos AngelesCA
| | - Clifford Y. Ko
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCA
- Department of SurgeryDavid Geffen School of Medicine at UCLALos AngelesCA
- Department of SurgeryVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
| | - Jack Needleman
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCA
| | - David A. Ganz
- Health UnitRANDSanta MonicaCA
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCA
- Geriatric Research, Education and Clinical CenterVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
- Division of GeriatricsDepartment of MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
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Jørgensen LW, Søndergaard K, Melgaard D, Warming S. Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients. Clin Nutr ESPEN 2017; 22:85-91. [DOI: 10.1016/j.clnesp.2017.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/10/2017] [Indexed: 12/14/2022]
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Kottner J, Hahnel E, Lichterfeld-Kottner A, Blume-Peytavi U, Büscher A. Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators. Int Wound J 2017; 15:218-224. [PMID: 29178544 DOI: 10.1111/iwj.12854] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term "quality indicator" regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence-based and internationally comparable indicators to help improve patient care and safety worldwide.
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Affiliation(s)
- Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Lichterfeld-Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Büscher
- German Network for Quality Development in Care (DNQP), University of Applied Sciences, Osnabrück, Germany
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Reaper S, Green C, Gupta S, Tiruvoipati R. Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale (ROMPIS): A novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa. Aust Crit Care 2017; 30:167-171. [PMID: 27401598 DOI: 10.1016/j.aucc.2016.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/13/2016] [Accepted: 06/25/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients who are intubated in the ICU are at risk of developing pressure injuries to the mouth and lips from endotracheal tubes. Clear documentation is important for pressure wound care; however, no validated instruments currently exist for the staging of pressure injuries to the oral mucosa. Instruments designed for the assessment of pressure injuries to other bodily regions are anatomically unsuited to the lips and mouth. OBJECTIVES This study aimed to develop and then assess the reliability of a novel scale for the assessment of pressure injuries to the mouth and oral mucosa. METHODS The Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) was developed in consultation with ICU nurses, clinical nurse educators, Intensivists, and experts in pressure wound management. ICU nurses and portfolio-holders in pressure wound care from Peninsula Health (Victoria, Australia) were invited to use the ROMPIS to stage 19 de-identified clinical photographs of oral pressure injuries via secure online survey. Inter-rater reliability (IRR) was calculated using Krippendorff's alpha (α). RESULTS Among ICU nurses (n=52), IRR of the ROMPIS was α=0.307; improving to α=0.463 when considering only responses where injuries were deemed to be stageable using the ROMPIS (i.e. excluding responses where respondents considered an injury to be unstageable). Among a cohort of experts in pressure wound care (n=8), IRR was α=0.306; or α=0.443 excluding responses indicating that wounds were unstageable. CONCLUSIONS An instrument for the assessment and monitoring of pressure injuries to the mouth and lips has practical implications for patient care. This preliminary study indicates that the ROMPIS instrument has potential to be used clinically for this purpose; however, the performance of this scale may be somewhat reliant on the confidence or experience of the ICU nurse utilising it. Further validation is required.
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Affiliation(s)
- Sue Reaper
- Department of Intensive Care, Peninsula Health, Australia
| | - Cameron Green
- Department of Intensive Care, Peninsula Health, Australia.
| | - Sachin Gupta
- Department of Intensive Care, Peninsula Health, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care, Peninsula Health, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Kottner J, Haesler E. Dressings for Preventing Pressure Ulcers: A Meta-analysis by Huang et al. Adv Skin Wound Care 2016; 29:440-1. [DOI: 10.1097/01.asw.0000491105.16216.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Staggs VS, Cramer E. Reliability of Pressure Ulcer Rates: How Precisely Can We Differentiate Among Hospital Units, and Does the Standard Signal-Noise Reliability Measure Reflect This Precision? Res Nurs Health 2016; 39:298-305. [PMID: 27223598 PMCID: PMC5089619 DOI: 10.1002/nur.21727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/09/2022]
Abstract
Hospital performance reports often include rankings of unit pressure ulcer rates. Differentiating among units on the basis of quality requires reliable measurement. Our objectives were to describe and apply methods for assessing reliability of hospital‐acquired pressure ulcer rates and evaluate a standard signal‐noise reliability measure as an indicator of precision of differentiation among units. Quarterly pressure ulcer data from 8,199 critical care, step‐down, medical, surgical, and medical‐surgical nursing units from 1,299 US hospitals were analyzed. Using beta‐binomial models, we estimated between‐unit variability (signal) and within‐unit variability (noise) in annual unit pressure ulcer rates. Signal‐noise reliability was computed as the ratio of between‐unit variability to the total of between‐ and within‐unit variability. To assess precision of differentiation among units based on ranked pressure ulcer rates, we simulated data to estimate the probabilities of a unit's observed pressure ulcer rate rank in a given sample falling within five and ten percentiles of its true rank, and the probabilities of units with ulcer rates in the highest quartile and highest decile being identified as such. We assessed the signal‐noise measure as an indicator of differentiation precision by computing its correlations with these probabilities. Pressure ulcer rates based on a single year of quarterly or weekly prevalence surveys were too susceptible to noise to allow for precise differentiation among units, and signal‐noise reliability was a poor indicator of precision of differentiation. To ensure precise differentiation on the basis of true differences, alternative methods of assessing reliability should be applied to measures purported to differentiate among providers or units based on quality. © 2016 The Authors. Research in Nursing & Health published by Wiley Periodicals, Inc.
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Affiliation(s)
- Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO, 64108
| | - Emily Cramer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
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García-Fernández FP, Soldevilla Agreda JJ, Pancorbo-Hidalgo PL, Verdu-Soriano J, López Casanova P, Rodríguez-Palma M. Classification of dependence-related skin lesions: a new proposal. J Wound Care 2016; 25:26, 28-32. [DOI: 10.12968/jowc.2016.25.1.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- F. P. García-Fernández
- Care Strategy Unit. University Hospital of Jaen, Spain
- Executive Member of Spanish Pressure Ulcers and Chronic Wounds Advisory Panel
| | | | - P. L. Pancorbo-Hidalgo
- Executive Member of Spanish Pressure Ulcers and Chronic Wounds Advisory Panel
- Head of Department of Nursing. University of Jaen, Spain
| | - J. Verdu-Soriano
- Executive Member of Spanish Pressure Ulcers and Chronic Wounds Advisory Panel
- University of Alicante, Spain
| | - P. López Casanova
- Executive Member of Spanish Pressure Ulcers and Chronic Wounds Advisory Panel
- Health Department of Alcoy, Spain
| | - M. Rodríguez-Palma
- Executive Member of Spanish Pressure Ulcers and Chronic Wounds Advisory Panel
- Home Care of Cádiz, Spain
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Clendenin M, Jaradeh K, Shamirian A, Rhodes SL. Inter-operator and inter-device agreement and reliability of the SEM Scanner. J Tissue Viability 2015; 24:17-23. [DOI: 10.1016/j.jtv.2015.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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Young DL, Borris-Hale C, Falconio-West M, Chakravarthy D. A Single Long-Term Acute Care Hospital Experience with a Pressure Ulcer Prevention Program. Rehabil Nurs 2014; 40:224-34. [PMID: 25224816 DOI: 10.1002/rnj.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE The occurrence of pressure ulcers (PrUs) challenges care facilities. Few studies report PrU reduction efforts in long-term acute care (LTAC). This study described the PrU reduction efforts of a single, LTAC facility using the Medline Pressure Ulcer Prevention Program (mPUPP). DESIGN This study was a quasi-experimental, quality improvement project, with pre- and postmeasurement design. METHODS Outcomes were tracked for 24 months. The mPUPP was implemented in month 11. Education for caregivers was provided through an interactive web-based suite. In addition, all Patient Care Technicians attended a 4-week 1-hour inservice. New skin care products were implemented. The facility also implemented an algorithm for treatment of wounds. FINDINGS There was a significant reduction in the mean monthly hospital-acquired PrU (nPrU) rate when preprogram is compared to postprogram. CONCLUSIONS Sustainable nPrU reduction can be achieved with mPUPP. CLINICAL RELEVANCE LTAC hospitals could expect to reduce nPrU with education and incentive of caregivers.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, NV, USA
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Lilly D, Estocado N, Spencer-Smith JB, Englebright J. Validation of the NE1 Wound Assessment Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses. J Nurs Meas 2014; 22:438-50. [DOI: 10.1891/1061-3749.22.3.438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: There is a need for a simple bedside tool to improve the ability of nurses to identify skin alterations, describe wounds, and stage pressure ulcers for proper care management and present on admission documentation. This study tests the test–retest reliability and criterion validity of the NE1 Wound Assessment Tool (NE1 WAT), a single-use tool featuring wound pictures and stage descriptions according to National Pressure Ulcer Advisor Panel criteria. Methods: Registered nurses (N = 94) identified and staged 30 wound photographs under 3 test conditions: (a) without NE1 WAT, (b) with NE1 WAT after viewing a 10-min instructional presentation, (c) with NE1 WAT but no additional instruction after a 7–14-day delay. Results: Out of a possible 90 points, scores increased 12.3 points between Tests 1 and 2 (p <.001) and 14.1 points between Tests 1 and 3 (p <.001). Test–retest reliability was high: intraclass correlation coefficient (ICC; 3, 1) = .892 (95% confidence interval [CI]: 0.840–0.927). Conclusions: The NE1 WAT is a simple tool that, with little training, improved the skin assessment ability of registered nurses.
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Farsaei S, Khalili H, Farboud ES, Karimzadeh I, Beigmohammadi MT. Efficacy of topical atorvastatin for the treatment of pressure ulcers: a randomized clinical trial. Pharmacotherapy 2013; 34:19-27. [PMID: 23940000 DOI: 10.1002/phar.1339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of topical atorvastatin on the healing process of pressure ulcers in critically ill patients. DESIGN Randomized, double-blind, placebo-controlled clinical trial. SETTING Medical-surgical intensive care unit of a university-affiliated teaching hospital in Tehran, Iran. PATIENTS One hundred four patients with stage I or II pressure ulcers, graded according to the 2-digit Stirling Pressure Sore Severity Scale. INTERVENTION Patients were randomized to receive topical atorvastatin 1% ointment (51 patients [atorvastatin group]) or placebo ointment (53 patients [control group]) applied once/day to pressure ulcers for 14 days in addition to standard care for pressure ulcers. MEASUREMENTS AND MAIN RESULTS The efficacy of each treatment was assessed on days 7 and 14. Efficacy was determined based on the degree of healing of the existing pressure ulcer by using the 2-digit Stirling scale. The baseline stage of the pressure ulcers did not differ significantly between the control and atorvastatin groups. However, the mean ± SD stage of pressure ulcers significantly decreased in the atorvastatin group compared with the control group on day 7 (0.97 ± 0.76 vs 1.74 ± 0.75, p<0.01) and day 14 (0.42 ± 0.67 vs 1.71 ± 0.78, p<0.01) of treatment. In addition, the mean ± SD surface areas of ulcers in the atorvastatin group were significantly declined compared with the control group after 7 days (5.55 ± 4.55 vs 9.41 ± 5.03 cm², p<0.01) and 14 days (3.72 ± 4.45 vs 10.41 ± 6.41 cm², p<0.01) of treatment. CONCLUSION Topical application of atorvastatin ointment 1% for 14 days in addition to standard care significantly accelerated the healing of stage I or II pressure ulcers in critically ill patients.
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Affiliation(s)
- Shadi Farsaei
- Faculty of Pharmacy, Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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Designing trials for pressure ulcer risk assessment research: Methodological challenges. Int J Nurs Stud 2013; 50:1136-50. [DOI: 10.1016/j.ijnurstu.2013.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 02/07/2023]
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Farsaei S, Khalili H, Farboud ES, Khazaeipour Z. Sildenafil in the treatment of pressure ulcer: a randomised clinical trial. Int Wound J 2013; 12:111-7. [PMID: 23731453 DOI: 10.1111/iwj.12104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/29/2013] [Indexed: 12/12/2022] Open
Abstract
Pressure ulcer (PrU)-related hospitalisation and mortality are critical issues in medical and surgical patients. Although animal studies have suggested the beneficial effects of sildenafil on wound healing, related clinical data are lacking. This is the first clinical study that has evaluated the effects of topical sildenafil on PrU healing in human subjects. Enrolled patients were randomly allocated to receive topical sildenafil (10%) ointment or placebo daily. Wound healing was assessed visually and photographically by the change in wound score according to two-digit Stirling scale. Decreases in grades of the PrUs were significantly higher in sildenafil group compared with placebo group (P < 0·001). In addition, surface areas of ulcers in sildenafil group were significantly reduced compared to the control group at day 14 of intervention (P = 0·007). It appears that these effects may be mediated by improvement of microvascular reperfusion in the skin and soft tissue. Further study to emphasise the role of topical sildenafil in the prevention or treatment of PrUs in hospitalised patients is required.
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Affiliation(s)
- Shadi Farsaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Surgical Treatment of 55 Patients with Pressure Ulcers at the Department of Plastic and Reconstructive Surgery Kosovo during the Period 2000-2010: A Retrospective Study. PLASTIC SURGERY INTERNATIONAL 2013; 2013:129692. [PMID: 23509622 PMCID: PMC3590641 DOI: 10.1155/2013/129692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/14/2013] [Accepted: 01/20/2013] [Indexed: 11/30/2022]
Abstract
Objective. The objective of this study is to determine the incidence of PUs, the distribution of PUs, common injuries contributing to the occurrence of PUs in patients admitted to the Department of Plastic and Reconstructive Surgery Kosovo for surgical interventions of PUs, localization of PUs in body, the topical treatment of pressure ulcers before surgical intervention, the methods of surgical interventions, number of surgical interventions, duration of treatment, complications, and mortality. Materials and Methods. This study includes 55 patients with PUs treated surgically in 2000–2010 period in the Department of Plastic and Reconstructive Surgery Kosovo. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package In Stat 3. From statistical parameters arithmetic median and standard deviation were calculated. Data testing is done with χ2-test and the difference is significant if P < 0.05. Conclusion. Despite preventive measures against PUs, the incidence of Pus remains high.
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Demarré L, Beeckman D, Vanderwee K, Defloor T, Grypdonck M, Verhaeghe S. Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: A randomised-controlled clinical trial. Int J Nurs Stud 2012; 49:416-26. [DOI: 10.1016/j.ijnurstu.2011.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/03/2011] [Accepted: 10/06/2011] [Indexed: 10/15/2022]
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The Reliability of the National Database of Nursing Quality Indicators Pressure Ulcer Indicator. J Nurs Care Qual 2011; 26:292-301. [DOI: 10.1097/ncq.0b013e3182169452] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Pilot Study Providing Evidence for the Validity of a New Tool to Improve Assignment of National Pressure Ulcer Advisory Panel Stage to Pressure Ulcers. Adv Skin Wound Care 2011; 24:168-75. [DOI: 10.1097/01.asw.0000396304.90710.ea] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIMS AND OBJECTIVES The aim of this study was to examine interrater reliability and agreement of the diagnosis of moisture lesions as defined by the European Pressure Ulcer Advisory Panel. BACKGROUND Differentiation between superficial pressure ulcers and moisture-related skin damages is difficult. To enhance the precision of the identification of moisture lesions, the European Pressure Ulcer Advisory Panel provided wound- and patient-related characteristics. Empirical evidence regarding interrater reliability and agreement among nurses for the detection of moisture-related skin damages in clinical practice is lacking. DESIGN Observational. METHODS Home care clients (n = 339) were independently assessed twice by trained nurses. A head to toe skin inspection was conducted. RESULTS For the diagnosis of moisture lesion (yes/no), nurses exactly agreed in 95% of all assessed clients. Interrater reliability was intraclass correlation coefficient (1,1) = 0.67 (95% CI 0.61-0.73). CONCLUSIONS Nurses were able to differentiate between home care clients with and without moisture lesions but assessment results contained a high degree of measurement error. It seems that the descriptions for the identification of moisture lesions provided by the European Pressure Ulcer Advisory Panel do support the diagnostic process but reliability must be enhanced. RELEVANCE TO CLINICAL PRACTICE Because of low interrater reliability, it is questionable whether the diagnosis of moisture lesions in clinical practice is valid. Measurement error is too high to make adequate inferences for individuals. Definitions and descriptions provided by the European Pressure Ulcer Advisory Panel, provisions of a single training and images are not sufficient to achieve acceptable interrater reliability in clinical practice.
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Affiliation(s)
- Jan Kottner
- Centre for Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, Roberts C, Shoukri M, Streiner DL. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 2010; 64:96-106. [PMID: 21130355 DOI: 10.1016/j.jclinepi.2010.03.002] [Citation(s) in RCA: 1233] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 01/25/2010] [Accepted: 03/02/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies. STUDY DESIGN AND SETTING Eight experts in reliability and agreement investigation developed guidelines for reporting. RESULTS Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications. CONCLUSION The proposed guidelines intend to improve the quality of reporting.
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Affiliation(s)
- Jan Kottner
- Department of Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Kottner J, Dassen T, Lahmann N. Prevalence of deep tissue injuries in hospitals and nursing homes: Two cross-sectional studies. Int J Nurs Stud 2010; 47:665-70. [PMID: 19962700 DOI: 10.1016/j.ijnurstu.2009.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/20/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
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Affiliation(s)
| | - David Voegeli
- Nursing, University of Southampton, School of Health Sciences, Southampton
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Kottner J, Dassen T, Lahmann N. Comparison of two skin examination methods for grade 1 pressure ulcers. J Clin Nurs 2009; 18:2464-9. [DOI: 10.1111/j.1365-2702.2009.02832.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kottner J, Halfens R, Dassen T. An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting. Int J Nurs Stud 2009; 46:1307-12. [PMID: 19406400 DOI: 10.1016/j.ijnurstu.2009.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/12/2009] [Accepted: 03/28/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. OBJECTIVES Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden scale and the EPUAP system. DESIGN AND SETTING Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. PARTICIPANTS Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys. METHODS The Braden scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. RESULTS In 2007 and 2008, Intraclass Correlation Coefficients for Braden scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. CONCLUSIONS The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
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Affiliation(s)
- Jan Kottner
- Centre for Humanities and Health Sciences, Department of Nursing Science, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
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