Establishing the nursing bundle of preventing pressure injury related with operation: Based on evidence

Abstract

Objective To establish an evidence-based nursing bundle to prevent pressure injury related with operation and observe the clinical application of the bundle. Methods Clinical practice guidelines, systematic reviews/Meta-analysis, and randomized controlled trials (RCT) about prevention of pressure injuries related operation were acquired by searching databases, websites, manual retrieval and retrospective review. Two researchers independently screened and evaluated the literature, and experts′ advice were combined to form the prevention bundle of pressure injury related operation. A convenient sampling method was used to select 70 patients who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University. The pre-test for the clinical application of preventing the bundle was carried out to observe the incidence of pressure injury in patients and the implementation rate of each measure. Results This study included 22 RCTs, 6 systematic reviews/Meta analysis, and 6 clinical practice guidelines. The bundle for preventing pressure injury related operation included: preoperative pressure injury risk assessment, of decompression flat car transporter, using a pressure reducing device to relieve local pressure, of dressing, placing the body reasonably, intraoperative position, normal body temperature and skin cleansing. The frequency of implementation of the four measures of use of decompression flat car transporter , protection of dressing , adjusting intraoperative position , and maintaining intraoperative skin cleansing were 0, 17.1% (12/70) , 87.1% (61/70) , 5.7% (4/70) , respectively. The remaining measures were executed at a frequency of 100%. No pressure injury occurred from the beginning of operation to 6 days after operation among 70 patients. Conclusions The prevention bundle of pressure injury related operation can effectively prevent the occurrence of pressure injury related operation. Each of the measures included in the bundle is evidence-based and the interrelations of the various care measures are more focused, comprehensive, and systematic than the clinical practice guidelines. Key words: Pressure injury related operation; Bundle of care; Evidence-based; Prevention