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Isfahani P, Alirezaei S, Samani S, Bolagh F, Heydari A, Sarani M, Afshari M. Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis. Patient Saf Surg 2024; 18:4. [PMID: 38263177 PMCID: PMC10804626 DOI: 10.1186/s13037-023-00384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. METHODS This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). RESULTS A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). CONCLUSION This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.
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Affiliation(s)
- Parvaneh Isfahani
- Department of Health Services Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Samira Alirezaei
- Research Center for Social Determinants of Health, Saveh University of Medical Sciences, Saveh, Iran
| | - Somayeh Samani
- Department of Occupational Health, School of Public Health, Instructor of Occupational Health Engineering, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Bolagh
- Department of Health Services Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Azadeh Heydari
- Department of Public Health, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Sarani
- Department of Public Health, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahnaz Afshari
- School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran.
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Isfahani P, Alirezaei S, Samani S, Bolagh F, Heydari A, Sarani M, Afshari M. Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis. Patient Saf Surg 2024; 18:1. [PMID: 38167487 PMCID: PMC10763125 DOI: 10.1186/s13037-023-00383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. METHODS This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). RESULTS A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). CONCLUSION This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.
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Affiliation(s)
- Parvaneh Isfahani
- Department of Health Services Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Samira Alirezaei
- Assistant Professor, Research Center for Social Determinants of Health, Saveh University of Medical Sciences, Saveh, Iran
| | - Somayeh Samani
- Department of Occupational Health, Instructor of Occupational Health Engineering, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Bolagh
- Department of Health Services Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Azadeh Heydari
- Department of Public Health, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Sarani
- Department of Public Health, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahnaz Afshari
- Assistant Professor of Health Policy, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran.
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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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Digesa LE, Baru A, Shanko A, Kassa M, Aschalew Z, Moga F, Beyene B, Mulatu T. Incidence and Predictors of Pressure Ulcers among Adult Patients in Intensive Care Units at Arba Minch and Jinka Hospitals, Southern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9361075. [PMID: 37096223 PMCID: PMC10122574 DOI: 10.1155/2023/9361075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/26/2023]
Abstract
Introduction The incidence of a pressure ulcer in intensive care units (ICU) is significantly higher than in noncritical care settings. The patients in the ICU are the most vulnerable group to disruption of the skin's integrity. Prior studies in Ethiopia failed to evaluate pressure ulcers in intensive care units and were limited to general wards. The purpose of this study was to identify the incidence and predictors of pressure ulcers in adult patients admitted to intensive care units in Southern Ethiopia. Methods A single-arm prospective open cohort of 216 patients was used to determine the presence of a pressure ulcer in the intensive care units from June 2021 to April 2022. A consecutive sampling was used until the sample size was reached. The data were collected using a structured questionnaire and analyzed using Stata 14. A cumulative incidence of a pressure ulcer was computed. The life table was used to estimate the cumulative survival. A multivariable Cox proportional hazard regression was used to identify independent predictors of a pressure ulcer. An adjusted hazard ratio with a 95% CI was used to measure the degree of association; a P value ≤ 0.05 was considered significant. Results Twenty-five patients developed a pressure ulcer (PU), making a cumulative incidence of 11.57%. Out of 25 incident cases of pressure ulcers, four-fifths (80%) of the study patients developed PU within 6 days of their admission to the ICUs. The incidence rate was 32.98 PU per 1000 person-days of ICU stay. Pressure ulcers were most commonly found on the sacrum, followed by the shoulder. Among the incident cases, 52% were stage 2 ulcers. The presence of friction or shearing forces, as well as being 40 years of age or older, was independently associated with pressure ulcers. Conclusion The overall cumulative incidence of the pressure ulcer was lower than that in other studies but occurred at a faster rate. Age (40 years of age or older) and the presence of friction or shearing forces were the main predictors of pressure ulcers in the intensive care units. Therefore, nurses working in ICUs should continually anticipate the risk of a pressure ulcer. Moreover, special attention should be given to patients of advanced ages. Furthermore, monitoring the installation of a mattress, keeping bed linens unwrinkled, and keeping patients in a proper position on a bed to prevent or reduce friction or shearing forces are very crucial in the prevention of pressure ulcers.
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Affiliation(s)
- Lankamo Ena Digesa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Ararso Baru
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Alemayehu Shanko
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Mekidim Kassa
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Fikre Moga
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Bereket Beyene
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Tegegn Mulatu
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
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Kim MS, Ryu JM, Choi BK. Development and Effectiveness of a Clinical Decision Support System for Pressure Ulcer Prevention Care Using Machine Learning: A Quasi-experimental Study. Comput Inform Nurs 2022; 41:00024665-900000000-99171. [PMID: 35266901 DOI: 10.1097/cin.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study was conducted to develop and evaluate the effectiveness of a clinical decision support system for pressure ulcer prevention on clinical (performance, visual discrimination ability, and decision-making ability) and cognitive (knowledge and attitude) workflow. After developing a clinical decision support system using machine learning, a quasi-experimental study was used. Data were collected between January and April 2020. Forty-nine RNs who met the inclusion criteria and worked at seven tertiary and five secondary hospitals participated. A clinical decision support system was provided to the intervention group during the same period. Differences in outcome variables between the two groups were analyzed using t tests. The level of pressure ulcer prevention nursing performance and visual differentiation ability of skin pressure and oral mucosa pressure ulcer showed significantly greater improvement in the experimental group compared with the control group, whereas clinical decision making did not differ significantly. A clinical decision support system using machine learning was partially successful in performance of skin pressure ulcer prevention, attitude, and visual differentiation ability for skin and oral mucosa pressure ulcer prevention. These findings indicated that a clinical decision support system using machine learning needs to be implemented for pressure ulcer prevention.
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Affiliation(s)
- Myoung Soo Kim
- Author Affiliations: Department of Nursing, Pukyong National University (Dr Kim); Department of Nursing, Busan Institute of Science and Technology (Dr Ryu); and Department of Neurosurgery, College of Medicine, Pusan National University (Dr Choi), Busan, South Korea
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Efficacy of Nutritional Support Protocol for Patients with Pressure Ulcer: Comparison of Before andAfter the Protocol. Nutrition 2022; 99-100:111638. [DOI: 10.1016/j.nut.2022.111638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
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Xu J, Chen D, Deng X, Pan X, Chen Y, Zhuang X, Sun C. Development and validation of a machine learning algorithm-based risk prediction model of pressure injury in the intensive care unit. Int Wound J 2022; 19:1637-1649. [PMID: 35077000 PMCID: PMC9615270 DOI: 10.1111/iwj.13764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/03/2023] Open
Abstract
The study aimed to establish a machine learning-based scoring nomogram for early recognition of likely pressure injuries in an intensive care unit (ICU) using large-scale clinical data. A retrospective cohort study design was employed to develop and validate a top-performing clinical feature panel accessibly in the electronic medical records (EMRs), which was in the mode of a quantifiable nomogram. Clinical factors regarding demographics, admission cause, clinical laboratory index, medical history and nursing scales were extracted as risk candidates. The performance improvement was based on the application of the machine learning technique, comprising logistic regression, decision tree and random forest algorithm with five-fold cross-validation (CV) technique. The comprehensive assessment of sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC) was considered in the evaluation of predictive performance. The receiver operating characteristic curves revealed the top performance for the logistic regression model in respect to machine learning improvement, achieving the highest sensitivity and AUC among three types of classifiers. Compared against the 23-point Braden scale routinely recorded online, an incorporated nomogram of logistic regression model and Braden scale achieved the best performance with an AUC of 0.87 ± 0.07 and 0.84 ± 0.05 in training and test cohort, respectively. Our findings suggest that the machine learning technique potentiated the limited predictive validity of routinely recorded clinical data on pressure injury development during ICU hospitalisation. Easily accessible electronic records held the potentials to substitute the traditional Braden score in the prediction of pressure injury in intensive care unit. Preoperative prediction of pressure injury facilitates the exemption from the severe consequences.
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Affiliation(s)
- Jie Xu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Danxiang Chen
- Department of Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiaofang Deng
- Nursing departmentWenzhou Medical UniversityWenzhouChina
| | - Xiaoyun Pan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Yu Chen
- Nursing DepartmentThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiaoming Zhuang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Caixia Sun
- Nursing DepartmentThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
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Linnen DT, Hu X, Stephens CE. Postimplementation Evaluation of a Machine Learning-Based Deterioration Risk Alert to Enhance Sepsis Outcome Improvements. Nurs Adm Q 2021; 44:336-346. [PMID: 32881805 PMCID: PMC10625790 DOI: 10.1097/naq.0000000000000438] [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] [Indexed: 11/27/2022]
Abstract
Machine learning-based early warning systems (EWSs) can detect clinical deterioration more accurately than point-score tools. In patients with sepsis, however, the timing and scope of sepsis interventions relative to an advanced EWS alert are not well understood. The objectives of this study were to evaluate the timing and frequency of fluid bolus therapy, new antibiotics, and Do Not Resuscitate (DNR) status relative to the time of an advanced EWS alert. We conducted 2 rounds of chart reviews of patients with an EWS alert admitted to community hospitals of a large integrated health system in Northern California (round 1: n = 21; round 2: n = 47). We abstracted patient characteristics and process measures of sepsis intervention and performed summary statistics. Sepsis decedents were older and sicker at admission and alert time. Most EWS alerts occurred near admission, and most sepsis interventions occurred before the first alert. Of 14 decedents, 12 (86%) had a DNR order before death. Fluid bolus therapy and new intravenous antibiotics frequently occurred before the alert, suggesting a potential overlap between sepsis care in the emergency department and the first alert following admission. Two tactics to minimize alerts that may not motivate new sepsis interventions are (1) locking out the alert during the immediate time after hospital admission; and (2) triaging and reviewing patients with alerts outside of the unit before activating a bedside response. Some decedents may have been on a palliative/end-of-life trajectory, because DNR orders were very common among decedents. Nurse leaders sponsoring or leading machine learning projects should consider tactics to reduce false-positive and clinically meaningless alerts dispatched to clinical staff.
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Affiliation(s)
- Daniel T Linnen
- Kaiser Permanente Northern California, Kaiser Foundation Hospitals, Inc, Regional Offices, Oakland, California (Dr Linnen); Duke University, School of Nursing Durham, North Carolina (Dr Hu); and School of Nursing, University of Utah, Salt Lake City (Dr Stephens)
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Galetto SGDS, Nascimento ERPD, Hermida PMV, Busanello J, Malfussi LBHD, Lazzari DD. Medical device-related pressure injury prevention in critically ill patients: nursing care. Rev Bras Enferm 2021; 74:e20200062. [PMID: 33950113 DOI: 10.1590/0034-7167-2020-0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/03/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES to know the care implemented by the nursing team to prevent medical device-related pressure injuries in critically ill patients. METHODS this is a qualitative research conducted with 15 nursing professionals from Intensive Care Unit. Sampling was carried out by theoretical saturation. For data analysis, the Discourse of the Collective Subject technique was used. RESULTS six speeches emerged, whose central ideas were interventions for medical device-related pressure injury prevention: care in fixation; frequent repositioning; protection and padding of body areas in contact; preferences for flexible materials, when available; attention of professionals so that they do not comer under patients; early assessment and removal, when clinically possible. FINAL CONSIDERATIONS nursing care was directed mainly to respiratory devices, catheters in general and monitoring equipment, indicating that professionals have the knowledge to provide safe assistance consistent with the literature.
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Akiki RK, Anand RS, Borrelli M, Sarkar IN, Liu PY, Chen ES. Predicting open wound mortality in the ICU using machine learning. JOURNAL OF EMERGENCY AND CRITICAL CARE MEDICINE (HONG KONG, CHINA) 2021; 5:13. [PMID: 34765871 PMCID: PMC8579960 DOI: 10.21037/jeccm-20-154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Open wounds have a significant impact on the health of patients causing pain, loss of function, and death. Labeled as a comorbid condition, open wounds represent a "silent epidemic" that affect a large portion of the US population. Due to their burden of care, open wound patients face an increased risk of ICU stay and mortality. There is a dearth of studies that investigate mortality among wound patients in the ICU. We sought to develop a model that predicts the risk of mortality among wound patients in the ICU. METHODS Random forest and binomial logistic regression models were developed to predict the risk of mortality among open wound patients in the Medical Information Mart for Intensive Care III (MIMIC-III) database. MIMIC-III includes de-identified data for patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. Six variables were used to develop the model (wound location, gender, age, admission type, minimum platelet count and hyperphosphatemia). The Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index were used to assess model strength. RESULTS A total of 3,937 patients were included with a mean age of 76.57. Of those, 3,372 (85%) survived and 565 (15%) died during their ICU stay. The random forest model achieved an area under the curve (AUC) of 0.924. The CCI and Elixhauser models resulted in AUC of 0.528 and 0.565, respectively. CONCLUSIONS Machine learning models may allow clinicians to provide better care and management to open wound patients in the ICU.
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Affiliation(s)
- Ronald K. Akiki
- Alpert Medical School, Brown University, Providence, RI, USA
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - Rajsavi S. Anand
- Alpert Medical School, Brown University, Providence, RI, USA
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - Mimi Borrelli
- Department of Plastic Surgery, Rhode Island Hospital, Providence, RI, USA
| | - Indra Neil Sarkar
- Alpert Medical School, Brown University, Providence, RI, USA
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - Paul Y. Liu
- Department of Plastic Surgery, Rhode Island Hospital, Providence, RI, USA
| | - Elizabeth S. Chen
- Alpert Medical School, Brown University, Providence, RI, USA
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
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Campos RS, Blanes L, Nicodemo D, Ferreira LM. “Sem Pressão”: aplicativo com orientações para identificação, estadiamento e prevenção de lesões por pressão. ESTIMA 2020. [DOI: 10.30886/estima.v18.944_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: desenvolver aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos. Método: o método descritivo utilizado iniciou com a busca de aplicativos na área de lesões por pressão nas plataformas Google© e Apple©. Após, foi desenvolvido o conteúdo, baseado, principalmente, nas recomendações da National Pressure Injury Advisory Panel. Foi criado um protótipo em www.fábricadeaplicativos.com.br e enviado para avaliação de forma e conteúdo. Seis profissionais de saúde preencheram um questionário avaliando o aplicativo e dois deles sugeriram alterações. O aplicativo foi adequado às sugestões e reavaliado por três enfermeiros estomaterapeutas que não sugeriram alterações. Resultados: o aplicativo foi desenvolvido no site “fábrica de aplicativos” e denominado “Sem Pressão”, com sete abas. Conclusão: foi criado o aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos, e disponibilizado para download gratuito.
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Affiliation(s)
- Rosana Siqueira Campos
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Leila Blanes
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Denise Nicodemo
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Lydia Masako Ferreira
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
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Campos RS, Blanes L, Nicodemo D, Ferreira LM. “Sem Pressão”: application with guidelines for identification, staging and prevention of pressure injuries. ESTIMA 2020. [DOI: 10.30886/estima.v18.944_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: develop an application with guidance on the identification, staging and prevention of pressure injuries in adults. Method: the descriptive method used started with the search for applications in the area of pressure injuries on the Google © and Apple © platforms. Afterwards, the content was developed, based mainly on the recommendations of the National Pressure Injury Advisory Panel. A prototype was created at www.fábricadeaplicativos.com.br and sent for evaluation of form and content. Six health professionals completed a questionnaire evaluating the application and two of them suggested changes. The application was adequate to the suggestions and reassessed by three stomatherapist nurses who did not suggest changes. Results: the application was developed on the “application factory” website and named “Sem Pressão” (No Pressure), with seven tabs. Conclusion: the application was created with guidelines on identification, staging and prevention of pressure injuries in adults, and made available for free download.
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Affiliation(s)
- Rosana Siqueira Campos
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Leila Blanes
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Denise Nicodemo
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
| | - Lydia Masako Ferreira
- Universidade Federal de São Paulo − Escola Paulista de Medicina − Programa de Pós-Graduação em Ciência, Tecnologia e Gestão Aplicadas à Regeneração Tecidual – São Paulo (SP), Brazil
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Sala JJ, Mayampurath A, Solmos S, Vonderheid SC, Banas M, D'Souza A, LaFond C. Predictors of pressure injury development in critically ill adults: A retrospective cohort study. Intensive Crit Care Nurs 2020; 62:102924. [PMID: 32859479 DOI: 10.1016/j.iccn.2020.102924] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this research was to identify predictors of pressure injury, using data from the electronic health records of critically ill adults. METHODOLOGY A retrospective cohort study was conducted using logistic regression models to examine risk factors adjusted for age, gender, race/ethnicity and length of stay. SETTING The study cohort included 1587 adults in intensive care units within an urban academic medical centre. MAIN OUTCOME MEASURES The presence or absence of a hospital-acquired pressure injury was determined during monthly skin integrity prevalence surveys. All pressure injuries were independently confirmed by two Certified Wound Care Nurses. RESULTS Eighty-one (5.1%) of the 1587 cohort patients developed pressure injuries. After adjusting for confounders, the clinical variables associated with pressure injury development included mean arterial pressure <60 mmHg and lowest Total Braden score up to two weeks prior to the date of HAPI development or date of prevalence survey for the comparison group. CONCLUSIONS This study provides a more comprehensive understanding about pressure injury risk in critically ill adults, identifying extrinsic and intrinsic factors associated with pressure injury development. Prospective multisite studies are needed to further examine these potential contributors to pressure injury development within the context of adherence to prevention interventions.
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Affiliation(s)
| | - Anoop Mayampurath
- Center for Research Informatics, The University of Chicago, United States; Department of Pediatrics, The University of Chicago Medicine, United States
| | - Susan Solmos
- The University of Chicago Medicine, United States
| | | | | | - Alexandria D'Souza
- Center for Research Informatics, The University of Chicago, United States
| | - Cynthia LaFond
- The University of Chicago Medicine, United States; Rush University Medical Center, United States.
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Remy KE, Verhoef PA, Malone JR, Ruppe MD, Kaselitz TB, Lodeserto F, Hirshberg EL, Slonim A, Dezfulian C. Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists. Pediatr Crit Care Med 2020; 21:607-619. [PMID: 32420720 PMCID: PMC7331597 DOI: 10.1097/pcc.0000000000002429] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN Narrative review/perspective. SETTING Not applicable. PATIENTS Not applicable. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.
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Affiliation(s)
- Kenneth E Remy
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Philip A Verhoef
- Department of Internal Medicine, University of Hawaii-Manoa, Manoa, HI
- Kaiser Permanente Hawaii, Honolulu, HI
| | - Jay R Malone
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Michael D Ruppe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Healthcare, University of Louisville, Louisville, KY
| | - Timothy B Kaselitz
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Frank Lodeserto
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, PA
- Department of Pediatrics, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Eliotte L Hirshberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine and Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Anthony Slonim
- University of Nevada, Reno School of Medicine, Renown Health System, Reno, NV
| | - Cameron Dezfulian
- Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA
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15
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Ribeiro DDFC, Barros FS, Fernandes BL, Nakato AM, Nohama P. Nasal Prongs: Risks, Injuries Incidence and Preventive Approaches Associated with Their Use in Newborns. J Multidiscip Healthc 2020; 13:527-537. [PMID: 32606724 PMCID: PMC7311096 DOI: 10.2147/jmdh.s252017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/14/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess the incidence of nasal injury in newborns submitted to non-invasive ventilation (NIV) via binasal prongs, to identify risks that come with using this interface, and to present actions for nasal injury prevention. Patients and Methods Observational and descriptive study performed in neonatal intensive care unit (NICU) of a public hospital in the south of Brazil. This research was divided into three stages. In the first one, nasal injury incidence was assessed in 148 newborns, using data collection from medical records. In the second stage, injury incidence, severity and a preliminary analysis of risks associated with the prescription of binasal prongs were analyzed in 33 newborns who required NIV. In the third stage. recommendations were presented to prevent nasal injury during NIV with short binasal prong. Results The incidence of nasal injury in the first stage was 37.16%, and 63.64% in the second one. As for severity, 68.42% of the injuries showed Stage I severity, and 31.58% Stage II. The main risks associated with the use of binasal prongs were inappropriate prong size, inappropriate prong model, interface reuse, prolonged NIV use exclusively with binasal prongs, incorrect prong position and NIV circuit pulled. A total of 17 preventive approaches were recommended: 13 related to newborns care and not dependent on prior investment. Among them: to choose appropriate prong size; to keep the prong and the NIV circuit well positioned and periodically massages with circular movements in the nasal septum and columella. Conclusion The inappropriate prong size, interface reuse, prong model, prolonged NIV use with binasal prong and incorrect prong and NIV circuit position may be associated with the high occurrence of injury in the NICU studied. Simple approaches concerning clinical staff care actions towards the newborn in NIV, which do not require a financial investment, can prevent nasal injury.
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Affiliation(s)
- Débora de Fátima Camillo Ribeiro
- Neonatal Services, Waldemar Monastier Hospital, Campo Largo, Paraná, Brazil.,Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Frieda Saicla Barros
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil
| | - Beatriz Luci Fernandes
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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16
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Goodman L, Khemani E, Cacao F, Yoon J, Burkoski V, Jarrett S, Collins B, Hall TNT. A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative. BMJ Open Qual 2018; 7:e000425. [PMID: 30397664 PMCID: PMC6202997 DOI: 10.1136/bmjoq-2018-000425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/22/2018] [Accepted: 09/18/2018] [Indexed: 11/04/2022] Open
Abstract
Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries. Humber River Hospital (HRH), a large community hospital in Toronto, Canada, has a daily census of approximately 500 patients. The aim of this project was to reduce the prevalence of HAPI within the intensive care unit (ICU) and non-ICU setting at HRH within a 1-year period. Using the International Pressure Injury/Ulcer Prevalence (IPUP) Survey we established a baseline prevalence of HAPI of 27.6% (n=315) for non-ICU and 30% for ICU (n=33) patients at our institution in 2015. Using the Plan-Do-Study-Act (PDSA) method for quality improvement, we implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Over multiple PDSA cycles, our prevalence of HAPI reduced to 16% for non-ICU patients with no changes to the HAPI prevalence in ICU patients in 2016. Sustainability continues with HAPI prevalence currently at 10% in 2017 for non-ICU patients, which outperforms the Canadian prevalence (13.7%) by census size for 2017. However, the prevalence of HAPI in the ICU increased to 45% in 2017 despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing HAPI for these patients at our institution.
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Affiliation(s)
- Laurie Goodman
- Professional Practice, Humber River Hospital, Toronto, Ontario, Canada
| | - Ekta Khemani
- Department of Quality and Patient Safety, Humber River Hospital, Toronto, Ontario, Canada.,Department of Anesthesia, Niagara Health, St. Catherines, Ontario, Canada
| | - Francis Cacao
- Critical Care, Humber River Hospital, Toronto, Ontario, Canada
| | - Jennifer Yoon
- Professional Practice, Humber River Hospital, Toronto, Ontario, Canada
| | - Vanessa Burkoski
- Senior Administration, Humber River Hospital, Toronto, Ontario, Canada
| | - Scott Jarrett
- Senior Administration, Humber River Hospital, Toronto, Ontario, Canada
| | - Barbara Collins
- Senior Administration, Humber River Hospital, Toronto, Ontario, Canada
| | - Trevor N T Hall
- Department of Quality and Patient Safety, Humber River Hospital, Toronto, Ontario, Canada
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17
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Otero TMN, Canales C, Yeh DD, Elsayes A, Belcher DM, Quraishi SA. Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients. Nutr Clin Pract 2018; 34:142-147. [PMID: 30101993 DOI: 10.1002/ncp.10184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients. METHODS We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit. RESULTS A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL. CONCLUSION In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.
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Affiliation(s)
- Tiffany M N Otero
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts.,Department of Medicine, Carney Hospital, Boston, Massachusetts
| | - Cecilia Canales
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Medicine, University of California, Irvine, California
| | - D Dante Yeh
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Ali Elsayes
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Donna M Belcher
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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18
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Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk. Nurs Res 2018; 67:314-323. [PMID: 29870519 DOI: 10.1097/nnr.0000000000000287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research investigating risk factors for hospital-acquired pressure injury (HAPI) has primarily focused on the characteristics of patients and nursing staff. Limited data are available on the association of hospital characteristics with HAPI. OBJECTIVE We aimed to quantify the association of hospital characteristics with HAPI and their effect on residual hospital variation in HAPI risk. METHODS We employed a retrospective cohort study design with split validation using hierarchical survival analysis. This study extends the analysis "Hospital-Acquired Pressure Injury (HAPI): Risk Adjusted Comparisons in an Integrated Healthcare Delivery System" by Rondinelli et al. (2018) to include hospital-level factors. We analyzed 1,661 HAPI episodes among 728,266 adult hospitalization episodes across 35 California Kaiser Permanente hospitals, an integrated healthcare delivery system between January 1, 2013, and June 30, 2015. RESULTS After adjusting for patient-level and hospital-level variables, 2 out of 12 candidate hospital variables were statistically significant predictors of HAPI. The hazard for HAPI decreased by 4.8% for every 0.1% increase in a hospital's mean mortality ([6.3%, 2.6%], p < .001), whereas every 1% increase in a hospital's proportion of patients with a history of diabetes increased HAPI hazard by 5% ([-0.04%, 10.0%], p = .072). Addition of these hierarchical variables decreased unexplained hospital variation of HAPI risk by 35%. DISCUSSION We found hospitals with higher patient mortality had lower HAPI risk. Higher patient mortality may decrease the pool of patients who live to HAPI occurrence. Such hospitals may also provide more resources (specialty staff) to care for frail patient populations. Future research should aim to combine hospital data sets to overcome power limitations at the hospital level and should investigate additional measures of structure and process related to HAPI care.
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