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DeMellow JM, Dhillon H, Bhattacharyya M, Pacitto D, Kozik TM. Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:197-202. [PMID: 37146109 DOI: 10.1097/won.0000000000000976] [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: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the incidence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) and placed in a prone position manually or using a specialty bed designed to facilitate prone positioning. A secondary aim was to compare mortality rates between these groups. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised 160 patients with ARDS managed by prone positioning. Their mean age was 61.08 years (SD = 12.73); 58% (n = 96) were male. The study setting was a 355-bed community hospital in the Western United States (Stockton, California). Data were collected from July 2019 to January 2021. METHODS Data from electronic medical records were retrospectively searched for the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the presence of a COVID-19 infection. RESULTS A majority of patients with ARDS were manually placed in a prone position (n = 106; 64.2%), and 54 of these patients (50.1%) were placed using a specialty care bed. Slightly more than half (n = 81; 50.1%) developed HAPIs. Chi-square analyses showed no association with the incidence of HAPIs using manual prone positioning versus the specialty bed (P = .9567). Analysis found no difference in HAPI occurrences between those with COVID-19 and patients without a coronavirus infection (P = .8462). Deep-tissue pressure injuries were the most common type of pressure injury. More patients (n = 85; 80.19%) who were manually placed in a prone position died compared to 58.18% of patients (n = 32) positioned using the specialty bed (P = .003). CONCLUSIONS No differences in HAPI rates were found when placing patients manually in a prone position versus positioning using a specialty bed designed for this purpose.
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Affiliation(s)
- Jacqueline M DeMellow
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Harbir Dhillon
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Mouchumi Bhattacharyya
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Daniel Pacitto
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Teri M Kozik
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
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Thomas AL, Graham K, Davila S, Giuffrida P. Using a Learning System Approach to Improve Safety for Prone-Position Ventilation Patients. J Patient Saf 2023; 19:180-184. [PMID: 36849409 DOI: 10.1097/pts.0000000000001108] [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: 03/01/2023]
Abstract
OBJECTIVES This study aimed to describe how a Patient Safety Organization, to which healthcare organizations submit patient safety event data for both protections and analysis, used a learning system approach to analyze and interpret trends in member data. The data analysis informed evidence-based practice recommendations for improvement of patient outcomes for patients receiving prone-position ventilation. METHODS Patient safety analysts with critical care nursing backgrounds identified a need for increased support of Patient Safety Organization members who were proning patients during the COVID-19 pandemic. Patient safety events from member organizations across the United States were analyzed and aggregated. Primary and secondary taxonomies for safety events experienced by patients receiving prone-position ventilation were created, which provided insight into harm trends in this patient population. RESULTS Analysis of 392 patient safety events resulted in the identification of gaps in the care of these fragile patients, including but not limited to medical device-related pressure injuries, concerns with care delivery, staffing and acuity issues, and medical device dislodgement. Event themes in prone-position ventilation safety events informed a literature search from which an evidence-based action plan was developed and disseminated to Patient Safety Organization members for use in harm reduction efforts. CONCLUSIONS Using a learning system approach, patient safety event data related to prone-position ventilation or any other type of patient safety event can be aggregated and analyzed to identify key areas of safety concerns and gaps in practice, allowing organizations to affect improvement efforts.
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Affiliation(s)
- Anna L Thomas
- From the ECRI and the Institute for Safe Medication Practices Patient Safety Organization, PlymouthMeeting, Pennsylvania
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Hochberg CH, Card ME, Seth B, Kerlin MP, Hager DN, Eakin MN. Factors Influencing the Implementation of Prone Positioning during the COVID-19 Pandemic: A Qualitative Study. Ann Am Thorac Soc 2023; 20:83-93. [PMID: 35947776 PMCID: PMC9819268 DOI: 10.1513/annalsats.202204-349oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/10/2022] [Indexed: 02/05/2023] Open
Abstract
Rationale: The adoption of prone positioning for patients with acute respiratory distress syndrome (ARDS) has historically been poor. However, in mechanically ventilated patients with coronavirus disease (COVID-19) ARDS, proning has increased. Understanding the factors influencing this change is important for further expanding and sustaining the use of prone positioning in appropriate clinical settings. Objectives: To characterize factors influencing the implementation of prone positioning in mechanically ventilated patients with COVID-19 ARDS. Methods: We conducted a qualitative study using semistructured interviews with 40 intensive care unit (ICU) team members (physicians, nurses, advanced practice providers, respiratory therapists, and physical therapists) working at two academic hospitals. We used the Consolidated Framework for Implementation Research, a widely used implementation science framework outlining important features of implementation, to structure the interview guide and thematic analysis of interviews. Results: ICU clinicians reported that during the COVID-19 pandemic, proning was viewed as standard early therapy for COVID-19 ARDS rather than salvage therapy for refractory hypoxemia. By caring for large volumes of proned patients, clinicians gained increased comfort with proning and now view proning as a low-risk, high-benefit intervention. Within ICUs, adequate numbers of trained staff members, increased team agreement around proning, and the availability of specific equipment (e.g., to limit pressure injuries) facilitated greater proning use. Hospital-level supports included proning teams, centralized educational resources specific to the management of COVID-19 (including a recommendation for prone positioning), and an electronic medical record proning order. Important implementation processes included informal dissemination of best practices through on-the-job learning and team interactions during routine bedside care. Conclusions: The implementation of prone positioning for COVID-19 ARDS took place in the context of evolving clinician viewpoints and ICU team cultures. Proning was facilitated by hospital support and buy-in and leadership from bedside clinicians. The successful implementation of prone positioning during the COVID-19 pandemic may serve as a model for the implementation of other evidence-based therapies in critical care.
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Affiliation(s)
- Chad H. Hochberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Mary E. Card
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Bhavna Seth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Meeta P. Kerlin
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Palliative and Advanced Illness Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David N. Hager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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Schorr CA, Seckel MA, Papathanassoglou E, Kleinpell R. Nursing Implications of the Updated 2021 Surviving Sepsis Campaign Guidelines. Am J Crit Care 2022; 31:329-336. [PMID: 35773196 DOI: 10.4037/ajcc2022324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sepsis is a life-threatening illness that affects millions of people worldwide. Early recognition and timely treatment are essential for decreasing mortality from sepsis. The Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021, the fifth iteration of the guidelines, was released in October 2021 and includes 93 recommendations for the management of sepsis. The evidence-based guidelines include recommendations and rationales for screening and early treatment, initial resuscitation, mean arterial pressure targets, admission to intensive care, management of infection, hemodynamic monitoring, ventilation, and additional therapies. A new section addresses long-term outcomes and goals of care. This article presents several recommendations, changes, and updates in the 2021 guidelines and highlights the important contributions nurses have in delivering timely and evidence-based care to patients with sepsis. Recommendations may be for or against an intervention, according to the evidence. Although many recommendations are unchanged, several new recommendations directly affect nursing care and may require specialized training (eg, venovenous extracorporeal membrane oxygenation). The newest section, long-term outcomes and goals of care, is aimed at using available resources to provide care that is aligned with the patient and the patient's family through goals-of-care discussions and shared decision-making. Interventions aimed at improving recovery across the continuum of care should include attention to long-term outcomes. Nurses are essential in identifying patients with sepsis, administering and assessing response to treatment, supporting the patient and family, and limiting sequelae from sepsis. This article highlights the 2021 recommendations that influence nursing care for patients with sepsis.
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Affiliation(s)
- Christa A Schorr
- Christa A. Schorr is a professor of medicine, Cooper Medical School of Rowan University, and a clinical nurse scientist, Cooper University Health Care, Camden, New Jersey
| | - Maureen A Seckel
- Maureen A. Seckel is a medical critical care quality and safety clinical nurse specialist and a sepsis coordinator, ChristianaCare, Newark, Delaware
| | - Elizabeth Papathanassoglou
- Elizabeth Papathanassoglou is a professor of nursing, University of Alberta, and the scientific director, Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Ruth Kleinpell
- Ruth Kleinpell is the associate dean for clinical scholarship and a professor, Vanderbilt University School of Nursing, Nashville, Tennessee
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