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Pittman J, Black JM, de Jesus A, Padula WV. The Standardized Pressure Injury Prevention Protocol (SPIPP) Checklist 2.0: Content validation. J Adv Nurs 2024; 80:2584-2591. [PMID: 37994188 DOI: 10.1111/jan.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Pressure injury prevention is complex, and rates continue to rise. Checklists reduce human error, improve adherence and standardization with complex processes, focus attention on evidence-based practices derived from clinical practice guidelines and are arranged in a systematic manner to manage the entirety of a patient's risk for preventable outcomes. The original Standardized Pressure Injury Prevention Protocol was created to provide a checklist of pressure injury prevention measures but needed revision and validation. PURPOSE This article describes the revision and content validity testing of the Standardized Pressure Injury Prevention Protocol Checklist 2.0 that took place in 2022. METHODS Using the International 2019 Clinical Practice Guideline as a foundation, items were identified/revised, and expert review of the items was obtained. The Standardized Pressure Injury Prevention Protocol 2.0 underwent three rounds of revision by experts from the National Pressure Injury Advisory Panel. A panel of eight national experts completed the content validity survey. Individual item content validity index and total scale content validity index were used to summarize the content validity survey scores. RESULTS The individual item content validity index scores ranged from 0.5 to 1.0. One item (using a mirror to look at heels) was rated as 0.5, three items were 0.75, 20 items were 0.875 and 23 items were 1.0. The item scoring 0.5 was deleted. Those items scoring 0.75 were revised using the content experts' recommendations. The total scale content validity index was 0.93. CONCLUSION The Standardized Pressure Injury Prevention Protocol 2.0 provides a standardized checklist of evidence-based items that operationalize a rigorous clinical practice guideline for the prevention of pressure injuries. Early intervention using a standardized approach and evidence-based checklist that can be integrated into the workflow of the direct-care nurse and provider provides the best opportunity for successful and sustainable pressure injury prevention.
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Affiliation(s)
- Joyce Pittman
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Joyce M Black
- College of Nursing, University of Nebraska, Omaha, Nebraska, USA
| | | | - William V Padula
- Department of Pharmaceutical & Health Economics, University of Southern California Mann School of Pharmacy & Pharmaceutical Sciences, Los Angeles, California, USA
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Aningalan AM, Gannon BR. Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project. Adv Skin Wound Care 2023; 36:1-6. [PMID: 37861671 DOI: 10.1097/asw.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement. METHODS This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates. RESULTS The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020. CONCLUSIONS Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.
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Affiliation(s)
- Alexis M Aningalan
- At NewYork-Presbyterian Westchester, Bronxville, New York, USA, Alexis M. Aningalan, DNP, RN, CWON, WCC, is Manager of Wound and Ostomy Care; and Brittany (Ray) Gannon, PhD, MSN, AGPCNP-BC, is Nurse Scientist. Acknowledgments : The authors thank Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN; Laurie A. Walsh, DNP, RN; Peggy Quinn, MPH, BSN, RN, CPHQ, NEA-BC; Catherine Lombardi, MSN RN-C, NE-BC, NHDP-BC; and Danielle LeStrange, MSN, MBA, RN, ACNS-BC, NEA-BC, FACHE, for providing leadership support and oversight; and Stephanie Walker, BSN, RN, CWON, WCC; and Hazel Holder, DNP, RN, ACCNS-AG, CCRN, for sharing their time and expertise during the conduct of the project. The authors have disclosed no financial relationships related to this article. Submitted August 15, 2022; accepted in revised form December 1, 2022
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Black J, Cox J, Capasso V, Bliss DZ, Delmore B, Iyer V, Massaro J, Munro C, Pittman J, Ayello EA. Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel. Adv Skin Wound Care 2023; 36:470-480. [PMID: 37590446 DOI: 10.1097/asw.0000000000000032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent. OBJECTIVE To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones. METHODS The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education. CONCLUSIONS This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
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Affiliation(s)
- Joyce Black
- Joyce Black, PhD, RN, FAAN, is President, National Pressure Injury Advisory Panel, and Florence Niedfelt Professor of Nursing, College of Nursing, University of Nebraska, Lincoln, USA. Jill Cox, PhD, RN, APN-C, CWOCN, FAAN, is Member, Board of Directors, National Pressure Injury Advisory Panel; Clinical Professor, Rutgers University School of Nursing, New Jersey; and Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Health, New Jersey. Virginia Capasso, PhD, CNP, CNS, CWS, FAAN, is Member, Board of Directors, National Pressure Injury Advisory Panel; Instructor in Surgery, Harvard Medical School, Boston, Massachusetts; and Advanced Practice Nurse and Nurse Scientist, Massachusetts General Hospital, Boston. Donna Z. Bliss, PhD, RN, FAAN, is School of Nursing Foundation Professor of Nursing Research, and Chair, Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis. Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC, FAAN, is Alumna, Board of Directors, National Pressure Injury Advisory Panel, and Senior Nurse Scientist and Clinical Assistant Professor, NYU Langone Health, New York. Vignesh Iyer, MS, is Director, Medical Affairs, Bruin Biometrics, Los Angeles, California. Jacqueline Massaro, MSN, RN, CWOCN, is Wound/Ostomy/Continence Nurse, Brigham and Women's Hospital, Boston, Massachusetts. Cassendra Munro, PhD, RN, CNOR, is Nurse Scientist, Office of Research Patient Care Services, Stanford Health Care, Palo Alto, California. Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, is Alumna, Board of Directors, National Pressure Injury Advisory Panel, and Associate Professor, College of Nursing, University of South Alabama, Mobile. Elizabeth A. Ayello, PhD, RN, CWON, MAPWCA, FAAN, is Alumna, Board of Directors, and Past President, National Pressure Injury Advisory Panel, and President, Ayello, Harris & Associates, Inc, New York
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Banks MD, Webster J, Bauer J, Dwyer K, Pelecanos A, MacDermott P, Nevin A, Coleman K, Campbell J, Hickling D, Byrnes A, Capra S. Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study. J Wound Care 2023; 32:292-300. [PMID: 37094924 DOI: 10.12968/jowc.2023.32.5.292] [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] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. METHOD Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. RESULTS Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. CONCLUSION This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.
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Affiliation(s)
- Merrilyn D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Joan Webster
- Centre for Clinical Nursing, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Judy Bauer
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Kathleen Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Anita Pelecanos
- Metro North Hospital and Health Service Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Paula MacDermott
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Amy Nevin
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kerrie Coleman
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Donna Hickling
- Department of Nutrition & Dietetics, The Prince Charles Hospital, Chermside, Australia
| | - Angela Byrnes
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Sandra Capra
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Congress Takes a Positive Swing at an Unsung Public Health Crisis: Preventing Pressure Injuries in Veterans Affairs Facilities. Adv Skin Wound Care 2023; 36:123-124. [PMID: 36806272 DOI: 10.1097/01.asw.0000903964.14644.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Kennepp L. 2023 Resolutions: It's time to revamp your pressure injury prevention programs. Healthc Manage Forum 2023; 36:5-14. [PMID: 36510467 DOI: 10.1177/08404704221137542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The success of any quality improvement project begins with acknowledging problems, defining and addressing each issue in detail, and setting goals. In the case of pressure injuries, the answer is fairly simple. Reduce the number of pressure injuries. Yet, the process yielding a "means to the end" is quite complex. It not only requires a team of interdisciplinary healthcare providers and leaders to ensure success; it requires continuous effort. The intention of this article is to highlight the importance of a comprehensive Pressure Injury Prevention (PIP) program and offer guidance based on evidence. Utilizing an organized framework for planning will help healthcare providers ensure all critical steps are completed. The Standardized Pressure Injury Prevention Protocol (SPIPP) provides detail surrounding the necessary steps toward compliance with best practice guidelines. A comprehensive checklist provided within the SPIPP article is designed to discuss specific details of the PIP program. The author of this article offers a broader framework and checklist, The Pressure Injury Prevention Implementation Checklist (PIPIC) based on blending several quality improvement methodologies. Challenges associated with pressure injuries continue to affect the lives of both patients and caregivers. Entering a new year, new month, or even new day brings the opportunity for change and improvement. Revamping a PIP program requires careful thought, planning, and dedication, but it is not insurmountable. Organizing a team to address the issues and approach the task with an organized, evidence-based plan will improve the overall PIP program success.
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Karadağ A, Çakar V. Evidence-Based Prevention and Management of Pressure Injuries in Home Care: A Scoping Review. Adv Skin Wound Care 2022; 35:172-179. [PMID: 35188484 DOI: 10.1097/01.asw.0000815484.50141.5d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the presence of evidence-based practice protocols for the prevention and management of pressure injuries (PIs) in home care settings, whether the contents of existing protocols were based on current evidence, and adherence to these protocols. DATA SOURCES Comprehensive and structured literature searches were conducted using PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Ovid, Scopus, Web of Science, and Joanna Briggs Institute Evidence-Based Practice Database. STUDY SELECTION A literature search retrieved 2,929 articles. Investigators evaluated the titles, abstracts, and full texts of the articles retrieved from the literature search in accordance with the review questions and eligibility criteria. The authors included four studies in this scoping review. DATA EXTRACTION The researchers extracted details of the full-text articles, including author(s)/year of publication/country, aim(s), study population and sample size, study design, intervention type, outcomes, and key findings. DATA SYNTHESIS The four articles included in this scoping review are descriptive cross-sectional studies published between 2005 and 2010. Although the articles provided significant data on the quality of practices for the prevention and management of PIs in home care, no studies reported on the achievement of objective results. CONCLUSIONS The use of protocols for the prevention and management of PIs, including evidence-based interventions in home care, and adherence to existing protocols were low. Comprehensive observational and randomized controlled studies are necessary to improve evidence-based prevention and management of PIs in home care settings.
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Affiliation(s)
- Ayişe Karadağ
- At Koç University, Istanbul, Turkey, Ayişe Karadağ, PhD, RN, ET/WOCN, is Professor, School of Nursing; and Vildan Çakar, MS, RN, is Research Assistant, Graduate School of Health Sciences. Acknowledgments: The authors thank Ertaç Nebioğlu, librarian at Koç University Suna Kıraç Library for his assistance, support, and contributions. The authors have disclosed no financial relationships related to this article. Submitted February 18, 2021; accepted in revised form April 16, 2021
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Team V, Jones A, Teede H, Weller CD. Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework. Front Public Health 2021; 9:634669. [PMID: 34778157 PMCID: PMC8581233 DOI: 10.3389/fpubh.2021.634669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.
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Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D. Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Coyer F. Silicone adhesive multilayered foam dressings for pressure ulcer prevention. Br J Dermatol 2021; 185:4-5. [PMID: 33661525 DOI: 10.1111/bjd.19873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- F Coyer
- School of Nursing, Queensland University of Technology and the Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Nivestam A, Westergren A, Petersson P, Haak M. Factors associated with good health among older persons who received a preventive home visit: a cross-sectional study. BMC Public Health 2020; 20:688. [PMID: 32410651 PMCID: PMC7227102 DOI: 10.1186/s12889-020-08775-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 04/24/2020] [Indexed: 12/28/2022] Open
Abstract
Background The ageing population is increasing worldwide, and this trend is bringing challenges both for the older person and for society. In order to meet the challenges a comprehensive approach is needed involving both health promotion and risk prevention. The preventive home visit is a public health intervention used around the world with the purpose of promoting health and preventing risk among older persons. However, most preventive home visits are focused on questions asking about risks. In order to strengthen the health promotion perspective during the preventive home visits, factors associated with good health need to be identified. The aim of this study was therefore to determine which factors were associated with good self-rated health among older persons who received preventive home visit. Methods This was a register study with a cross-sectional design, including older persons (≥75 years old), living in their own homes, and that had received preventive home visit. Data were collected during a period of 9 months, in two municipalities in the south of Sweden. A questionnaire covered mental, physical and lifestyle factors were used at home visit. Binary logistic regression was used to analyse the data. Results In total, 619 older persons were included in the study; 55.4% were women, and the mean age was 80.6 years (standard deviation 2.2 years). The following items were significantly associated with good health (after adjustment for age and gender): being able to do things that make one feel valuable, having no physical problems affecting participation in social activities, not feeling sad, not having reduced energy, and not having impaired endurance. Conclusions The main conclusion of this study is that questions focusing on risks could be seen from a health promotion perspective and could thus be turned into assets with a positive impact on older persons’ health. Furthermore, the mental and physical factors identified in the results as associated with good health have implications for the person’s ability to feel valuable and participate in social activities. The results suggest that issues regarding both health promotion as well as risk prevention must be brought up during the preventive home visit.
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Affiliation(s)
- Anna Nivestam
- Department of Nursing and Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden. .,Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.
| | - Albert Westergren
- Department of Nursing and Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Pia Petersson
- Department of Nursing and Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Abstract
Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how the system can improve to reduce the number and severity of pressure injuries. The process of RCA begins with being certain the wound is a pressure injury using differential diagnoses of similar appearing skin disease and injury, followed by an examination of the processes of care (human roots) for missed actions or inactions that are linked to development of a particular pressure injury. The final step of RCA is a critical examination of the system (including people and processes) to look for modifiable trends or patterns are identified that are used to prevent recurrences.
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Padula WV, Chen YH, Santamaria N. Five-layer border dressings as part of a quality improvement bundle to prevent pressure injuries in US skilled nursing facilities and Australian nursing homes: A cost-effectiveness analysis. Int Wound J 2019; 16:1263-1272. [PMID: 31475434 PMCID: PMC6900030 DOI: 10.1111/iwj.13174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/26/2019] [Indexed: 01/16/2023] Open
Abstract
The BORDER III trial found that five-layer silicone border dressings effectively prevented pressure injuries in long-term care, but the value of this approach is unknown. Our objective was to analyse the cost-effectiveness of preventing facility-acquired pressure injuries with a quality improvement bundle, including prophylactic five-layer dressings in US and Australian long-term care. Markov models analysed the cost utility for pressure injuries acquired during long-term care from US and Australian perspectives. Models calibrated outcomes for standard care compared with a dressing-inclusive bundle over 18 monthly cycles or until death based on BORDER III outcomes. Patients who developed a pressure injury simulated advancement through stages 1 to 4. Univariate and multivariate probabilistic sensitivity analyses tested modelling uncertainty. Costs in 2017 USD and quality-adjusted life years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). Dressing use yielded greater QALYs at slightly higher costs from perspectives. The US ICER was $36 652/QALY, while the Australian ICER was $15 898/QALY, both of which fell below a willingness-to-pay threshold of $100 000/QALY. Probabilistic sensitivity analysis favoured dressings as cost-effective for most simulations. A quality improvement bundle, including prophylactic five-layer dressings, is a cost-effective approach for pressure injury prevention in all US and Australia long-term care residents.
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Affiliation(s)
- William V. Padula
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCalifornia
- The Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Yutong H. Chen
- Department of EconomicsUniversity of VirginiaCharlottesvilleVirginia
| | - Nick Santamaria
- Department of NursingUniversity of MelbourneMelbourneVictoriaAustralia
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