Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence

Effect of a fall within three months of admission on delirium in critically Ill elderly patients: a population-based cohort study

BACKGROUND

Delirium is common among elderly patients in the intensive care unit (ICU) and is associated with prolonged hospitalization, increased healthcare costs, and increased risk of death. Understanding the potential risk factors and early prevention of delirium is critical to facilitate timely intervention that may reverse or mitigate the harmful consequences of delirium.

AIM

To clarify the effects of pre-admission falls on ICU outcomes, primarily delirium, and secondarily pressure injuries and urinary tract infections.

METHODS

The study relied on data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Statistical tests (Wilcoxon rank-sum or chi-squared) compared cohort characteristics. Logistic regression was employed to investigate the association between a history of falls and delirium, as well as secondary outcomes, while Kaplan-Meier survival curves were used to assess short-term survival in delirium and non-delirium patients.

RESULTS

Study encompassed 22,547 participants. Delirium incidence was 40%, significantly higher in patients with a history of falls (54.4% vs. 34.5%, p < 0.001). Logistic regression, controlling for confounders, not only confirmed that a history of falls elevates the odds of delirium (OR: 2.11; 95% CI: 1.97-2.26; p < 0.001) but also showed it increases the incidence of urinary tract infections (OR:1.50; 95% CI:1.40-1.62; p < 0.001) and pressure injuries (OR:1.36; 95% CI:1.26-1.47; p < 0.001). Elderly delirium patients exhibited lower 30-, 180-, and 360-day survival rates than non-delirium counterparts (all p < 0.001).

CONCLUSIONS

The study reveals that history of falls significantly heighten the risk of delirium and other adverse outcomes in elderly ICU patients, leading to decreased short-term survival rates. This emphasizes the critical need for early interventions and could inform future strategies to manage and prevent these conditions in ICU settings.

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study

AIM

The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation.

DESIGN

A qualitative descriptive phenomenological study.

METHODS

The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method.

RESULTS

The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales.

CONCLUSION

The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Potential for reducing immobility times of a mobility monitor in-bed sensor system - a stepped-wedge cluster-randomised trial

BACKGROUND

Pressure ulcer prophylaxis is a central topic in clinical care. Pressure-relieving repositioning is strongly recommended for all pressure-sensitive patients. The Mobility Monitor (MoMo) is a technical device that records a patient's movements and transmits the data to a monitor. This study investigated the extent to which the MoMo sensor system, which records and visualises patients' movements in bed, supports nurses in performing pressure-relieving repositioning in neurological and neurosurgical intensive care units (ICU).

METHODS

This stepped-wedge cluster-randomised trial involved two clusters: one neurological and one neurosurgical ICU. The study was carried out in two steps over three periods between November 2018 and May 2019, with a two-month interval between each step. At the beginning of the study, we equipped 33 beds across the two ICUs with a MoMo system. Our primary endpoint was the immobility rate, which is defined as the patient's inactive time in bed exceeding two hours without pressure-relieving movements divided by the time the MoMo was in the bed. The immobility rate ranges from 0 to below 1, with higher values indicating lower mobility. Secondary endpoints were the rate of new pressure ulcers and the rate of relevant pressure-relieving repositionings. Relevant repositionings are defined as the number of repositionings identified by the MoMo as a pressure-relieving repositioning divided by the total number of repositionings, RESULTS: 808 patients were included in the study, of whom 403 were in the control group and 405 were in the intervention group. The mean immobility rate was 0.171 during the control phase and 0.144 during the intervention phase. The estimated intervention effect was -0.0018 (95% confidence interval [-0.0471, 0.0436], p=0.94). The number of new pressure ulcers was 5/405 in the intervention phase and 15/403 in the control phase. We noted a small difference in the mean rate of relevant repositioningswith an estimated intervention effect of 0.046 (95% confidence interval [-0.018, 0.110], p=0.16).

CONCLUSION

Our results are insufficient to recommend the standardised use of mobility monitors in neurological or neurosurgical ICUs.

CLINICAL TRIAL REGISTRATION

The primary analysis was prespecified and the trial was registered in the German Clinical Trials Register (DRKS) under the reference number DRKS00015492 (31/10/2018).

Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study

BACKGROUND

Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes.

AIMS

This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain.

METHODS

A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored.

RESULTS

Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased.

LINKING EVIDENCE TO ACTION

The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.

Sodium Danshensu Cream Promotes the Healing of Pressure Ulcers in Mice through the Nrf2/HO-1 and NF-κB Pathways

On the basis of the mice pressure ulcers (PU) model, the protective effect and potential mechanism of sodium Danshensu (SDSS) cream against PU were investigated. The mice were randomly divided into three groups: the negative control group (cream without 0.5 g SDSS), the SDSS group (cream containing 0.5 g SDSS), and the positive group (0.5 g Hirudoid®). After 7 and 14 days of ointment application, the wound-healing rate of the SDSS and positive groups was significantly higher than that of the control group (p < 0.05). The results of hematoxylin−eosin staining also indicated that SDSS has the potential to promote the healing of PU. In addition, the serum IL-6, IL-1β, TNF-α, and MDA levels decreased significantly (p < 0.01) after 14 days of SDSS treatment, while the SOD, CAT, and GSH-Px activities increased significantly (p < 0.01). In addition, SDSS cream was able to significantly increase the expression of Nrf2, HO-1, GCLM, NQO1, NF-κB p65, NF-κB p50, IKKα, and IKKβ while decreasing the expression of Keap1 and IκBαin the Nrf2/HO-1 and NF-κB pathways. Our research will provide a foundation for the future clinical prevention and treatment of PU with SDSS cream.

Documentation of pressure ulcers in medical records at an internal medicine ward in university hospital in western Sweden

OBJECTIVES

Pressure ulcers cause suffering, prolong care periods, and increase mortality. The aim was to describe and analyze the documentation of pressure ulcers and focused on the medical records from an internal medicine ward in a university hospital in western Sweden.

METHODS

A quantitative, retrospective review of medical records was conducted for all care events (n = 1,458) with descriptive statistics.

RESULTS

Documentation of the pressure ulcers in care plans was 2.1% (n = 31) compared to 6.7 % (n = 46) within final notes written by registered nurses (RN), a lower result compared to PPM (n = 3/14, 21.4%). Risk assessments were carried out in 68 (4.7%) care events, and 31 care plans included pressure ulcers. Moreover, 198 cases of tissue damage were documented, 43 (21.7%) defined as pressure ulcers, the other 147 (74.2%) lacked definition.

CONCLUSIONS

Differences (2.1%-21.4%) highlight improvements; knowledge and communication of pressure ulcers ensure reliable documentation in medical records.

Difference between self-reported adherence to standard precautions and surveillance and factors influencing observed adherence: a quantile regression approach

Background

Standard precautions are minimum healthcare-associated infection prevention practices applied in all healthcare settings. The aim of this study was to investigate adherence to standard precautions using a survey and surveillance. Factors affecting observed adherence to standard precautions were also determined.

Methods

This cross-sectional observational study included 163 clinical nurses who were directly involved in patient care. Differences in adherence according to investigative methods are represented as a boxplot. Quantile regression was used to identify factors affecting observed adherence, including organizational factors (such as department, safety environment, and patient safety climate) and personal factors (such as knowledge and awareness). Stata SE version 14.2 was used for all statistical analyses.

Results

The observed adherence to standard precautions was 76.8 out of 100, whereas the self-reported adherence was approximately 95. Hand hygiene adherence received the lowest score of less than 70. Factors influencing observed adherence were self-reported adherence (p = 0.043) in 25% and 50% quantiles, work experience (p = 0.002) in the 25% quantile, and working department (p = 0.030) in the 50% quantile. There were no significant factors in the 75% quantile.

Conclusion

Inadequate adherence to standard precautions might increase healthcare-associated infections. Thus, an organizational environment such as nurse staffing needs to be established so that clinical nurses with high competency can comply with standard precautions in clinical settings.

Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis

Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.

Effects of Attitude, Barriers/Facilitators, and Visual Differentiation on Oral Mucosa Pressure Ulcer Prevention Performance Intention

Oral mucosa pressure ulcers (PUs) can result in frequent pain and discomfort, and have negative effects on quality of life. We aimed to examine attitude, barriers/facilitators of oral mucosa PU prevention, the ability to differentiate oral mucosa PU, and to identify factors influencing PU prevention performance intention. This was a cross-sectional descriptive study of 112 nurses in seven tertiary hospitals and three secondary hospitals. The data collection period was from August to December 2018. For data analysis, descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression were used. The mean score of attitudes toward oral mucosa PU prevention was 3.74 ± 0.39. Barriers to oral mucosa PU prevention were 5.65 ± 1.66, and facilitators were 5.35 ± 1.34. The mean correct answer rate of visual differentiation ability was 13%. The factors affecting intention to perform oral mucosa PU prevention were facilitators of oral mucosa PU prevention (β = 0.32, p = 0.001) and attitude (β = 0.26, p = 0.005). To increase intention to perform oral mucosa PU prevention, positive attitudes and enhanced facilitators should be encouraged. Therefore, standardized guidelines and strategies, such as educational opportunities and allocation of resources and personnel focused on oral mucosa PU prevention, need to be provided.