The Effect Of Wound Care With Olive Oil On Pressure Ulcer Healing In Older Adults: A Systematic Review

Pressure ulcers can lead to pain, disfigurement, and slow recovery from comorbid conditions. They interfere with activities of daily living, predispose to osteomyelitis and septicemia, and are stro...

In previous studies about performance or factors affecting pressure ulcer (PU) care, old tools with nonupdated contents about the prevention and intervention of PU have been mainly used. Thus, there is little known how well evidence-based PU care is performed and what its' influencing factors are recently. This study aimed to evaluate the PU care performance, based on evidence-based practice guidelines, and identify factors affecting it while considering nurses' individual and institutional characteristics. We recruited 199 nurses involved in PU care, from August 20 to September 10, 2016, at two PU-related academic conferences in Korea. To examine PU care performance and knowledge as a related factor, we developed tools based on recent guidelines. To identify factors affecting PU care performance, we examined nurses' (individual level) and their institutions' (institutional level) characteristics, and analyzed using a hierarchical multiple regression test. Mean PU care performance of nurses was rated 3.99 out of 5. Performance level in "wound care: debridement"; "pain control"; "prevention skin care"; "incontinence management"; "supporting surface"; and "nutrition in PU prevention and treatment" was below average. Interest in PU care (β=.28, p=<.001), the main PU manager in a ward being a wound, ostomy, continence nurse (β=.22, p=.013), and an institution with a nursing practice guideline for PU care (β=.16, p=.02) were identified as significant factors affecting a good PU care performance. To improve nurses' evidence-based PU care performance, nurses must recognize PU care's importance and take responsibility for improving their own performance. At the institutional level, systematic evidence-based guidelines and support systems, such as activating wound specialists, must be implemented. The academic society can support these initiatives by updating continuously the national guideline on PU prevention and management for ease of use by nurses or institutions.

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Journal of Wound CareVol. 24, No. 4 EducationThe prevention and management of pressure ulcers: summary of updated NICE guidanceL. Cooper, C. Vellodi, G. Stansby, L. AvitalL. Cooper1Department of Plastic Surgery, Royal Free HospitalSearch for more papers by this author, C. Vellodi2Department of Acute Medicine and Medicine for the Elderly, Barnet and Chase Farm Hospitals NHS Trust, LondonSearch for more papers by this author, G. Stansby3Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne. On behalf of the Guideline Development GroupSearch for more papers by this author, L. Avital4National Clinical Guideline Centre, Royal College of Physicians London.Search for more papers by this authorL. Cooper; C. Vellodi; G. Stansby; L. AvitalPublished Online:8 Apr 2015https://doi.org/10.12968/jowc.2015.24.4.179AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References 1 Dealey, C., Posnett, J., Walker, A. The cost of pressure ulcers in the United Kingdom. J Wound Care 2012; 21: 6, 261–262. Link, Google Scholar2 Moore, Z., Johanssen, E., Van Etten, M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). J Wound Care 2013; 22: 7, 364–368 Link, Google Scholar3 Grey, J.E., Harding, K.G., Enoch, S. Pressure Ulcers. Br Med J 2006; 332: 472–425. Crossref, Medline, Google Scholar4 Graves, N., Birrell, F,. Whitby, M. Effect of Pressure Ulcers on Length of Hospital Stay. Infect Control Hosp Epidemiol 2005; 26: 3, 293–297. Crossref, Medline, Google Scholar5 Bennett, G., Dealey, C., Posnett, J. The cost of pressure ulcers in the UK. Age Ageing 2004; 33: 3, 230–235. Crossref, Medline, Google Scholar6 The NHS Outcomes Framework 2014/15, Department of Health 2013. www.gov.uk/government/publications/nhs-outcomes-framework-2014-to-2015 (Accessed June 2014). Google Scholar7 Johansen, E., Moore, Z,. van Etten, M., Strapp, H. Pressure ulcer risk assessment and prevention: what difference does a risk scale make? A comparison between Norway and Ireland. J Wound Care 2014; 23: 7, 369–370. Link, Google Scholar8 Pressure ulcers: prevention and management of pressure ulcers. (2014) National Institute for Health and Care Excellence. www.guidance.nice.org.uk/CG179 (accessed 22/06/2014). Google Scholar9 European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. www.epuap.org/guidelines/Final_Quick_Treatment.pdf. (accessed 19/1/2015). Google Scholar10 NICE Guidelines Manual. (2012) www.nice.org.uk/article/pmg6/chapter/1%20introduction (accessed 31/10/2014). Google Scholar11 Pressure ulcers overview. NICE Pathways 2014. pathways.nice.org.uk/pathways/pressure-ulcers (accessed 22/06/2014). Google Scholar12 Pressure ulcer prevention, treatment and care. NICE Information for the public 2014. www.publications.nice.org.uk/pressure-ulcer-prevention-treatment-and-care-ifp179 (Accessed June 2014). Google Scholar FiguresReferencesRelatedDetailsCited ByDevelopment of customized support for the prevention of Pressure Ulcer (PU) using multi-materials printingJournal of Physics: Conference Series, Vol. 1969, No. 1Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation8 August 2019 | Journal of Clinical Nursing, Vol. 28, No. 21-22Development and validation of the pressure ulcer management self‐efficacy scale for nurses21 April 2019 | Journal of Clinical Nursing, Vol. 28, No. 17-18Pressure heel ulcers in patients with type 2 diabetes: Is it T.I.M.E. to customise wound bed preparation according to different heel areas?17 April 2018 | International Wound Journal, Vol. 15, No. 5Support surfaces for treating pressure ulcers11 October 2018 | Cochrane Database of Systematic Reviews, Vol. 2018, No. 10References and Further Reading3 September 2018Large‐Scale Hospital Mattress Switch‐Out Leads to Reduction Hospital‐Acquired Pressure Ulcers: Operationalization of a Multidisciplinary Task Force8 March 2018 | Worldviews on Evidence-Based Nursing, Vol. 15, No. 3Pressure injuries in intensive care: What is new?Intensive and Critical Care Nursing, Vol. 45Pressure ulcers in critically ill patients – Preventable by non-sedation? A substudy of the NONSEDA-trialIntensive and Critical Care Nursing, Vol. 44Secondary Assessment of Life-Threatening Conditions of Older Patients9 September 2017Cicatrização de úlceras por pressão com extrato Plenusdermax® de Calendula officinalis L.Revista Brasileira de Enfermagem, Vol. 69, No. 2Spinal cord injury5 March 2016Spinal cord injury5 March 2016 2 April 2015Volume 24Issue 4ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics History Published online 8 April 2015 Published in print 2 April 2015 Information© MA Healthcare LimitedPDF download

Wound Healing Society 2015 update on guidelines for pressure ulcers.

To meet the challenge of an aging population, providers andpayors must optimize chronic wound care outcomes and contain costs. To explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols. Modeling study using outcomes from a literature review. The cost of 12 weeks of wound care was modeled for a hypothetical managed-care plan. This included 100 000 covered lives and used a peer-validated wound care protocol. Only modalities with a pooled evidence base of at least 100 wounds were used to populate the model. Costs excluded supportive treatments. 26 studies of three pressure ulcer protocols (n = 519) and three venous ulcer protocols (n = 883) qualified for inclusion in the models. After 12 weeks, the weighted average proportion of ulcers healed, and cost per ulcer healed, ranged from 48 to 61% and from $US910 to $US2179 (2000 values) for pressure ulcers, and from 39 to 51% and $US1873 to $US15 053 for venous ulcers. For a hypothetical managed-care plan, the difference between the least and most cost-effective modalities was $US1.9 million for pressure ulcers and $US5.8 million for venous ulcers. Observed differences were generally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpatient care settings; venous ulcers are managed on an outpatient basis. Physician visit frequencies are once every four weeks for pressure ulcers and once each week for venous ulcers. Wound sizes ranged from 2.5cm2 to 5.6cm2 for pressure ulcers and 5.4cm2 to 10cm2 for venous ulcers. All patients with pressure ulcers required pressure relief, nutritional support and incontinence management; venous ulcers required gradient compression. Costs per patient healed were lowest for pressure ulcers with hydrocolloids and highest with saline gauze (this is a manpower issue). Costs to heal venous ulcers were highest with human skin construct and lowest for 12-week management with hydrocolloid. Despite the limitations of the models (as a result of incomplete study data), this analysis confirms that defining wound care costs solely as cost of products used is inaccurate and can be expensive.

To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs). Descriptive. Eight NHs. One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated. Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined. The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation. The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.

We present a multimodal sensor system for wound assessment and pressure ulcer care. Multiple imaging modalities including RGB, three- dimensional (3-D) depth, thermal, multispectral, and chemical sensing are integrated into a portable hand-held probe for real-time wound assessment. Analytic and quantitative algorithms for various assessments including tissue composition, wound measurement in 3-D, temperature profiling, spectral, and chemical vapor analysis are developed. After each assessment scan, 3-D models of the wound are generated on the fly for geometric measurement, while multimodal observations are analyzed to estimate healing progress. Collaboration between developers and clinical practitioners was conducted at the Charlie Norwood VA Medical Center for in-field data collection and experimental evaluation. A total of 133 assessment sessions from 23 enrolled subjects were collected, on which the multimodal data were analyzed and validated with respect to clinical notes associated with each subject. The system can be operated by nontechnical caregivers on a regular basis to aid wound assessment and care. A web portal front-end was developed for clinical decision and telehealth support, where all historical patient data including wound measurements and analysis can be organized online.

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To describe and provide baseline data from The National Pressure Ulcer Long-Term Care Study (NPULS). Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling. One hundred nine long-term care facilities throughout the United States. Two thousand four hundred twenty adult residents aged 18 and older, with a length of stay of 14 days or longer and who were at risk of developing a pressure ulcer, as defined by a Braden Scale for Predicting Pressure Sore Risk More than 500 characteristics were obtained for each resident over a 12-week period. This paper describes the NPULS database with respect to the resident (sex, age, diagnoses, severity of illness scores, Braden Scale score, activities of daily living, cognitive ability, mobility, bowel or bladder incontinence, laboratory values, nutritional assessment, and pressure ulcer assessment documentation), treatment (nutritional interventions, pressure relieving devices, incontinence interventions, protective devices, turning schedules, and pressure ulcer treatments), and outcome variables (pressure ulcer development and healing, pressure ulcer and systemic infection, changes in nutritional status, and discharge disposition) associated with pressure ulcers. Descriptive statistics and bivariate associations were used for preliminary analyses of resident, treatment, and outcome characteristics. The average age +/- standard deviation was 79.7 +/- 14.2; 70% of the residents were female. Fifty-three percent of residents (n = 1,293) were at risk of developing a pressure ulcer but never developed one during the study (Group 1), 19% developed a new pressure ulcer during the study (n = 457) (Group 2), 22% had an existing pressure ulcer (n = 534) (Group 3), and 6% had an existing pressure ulcer and developed a new ulcer during the study (n = 136) (Group 4). Residents who developed a new pressure ulcer (Group 2) were more likely to be female, older, cognitively impaired, and immobile than residents who had an existing pressure ulcer (Group 3). This baseline study describes the NPULS database with respect to the resident, treatment, and outcome variables associated with pressure ulcers. Future studies will focus on multivariate analyses for risk factor prediction of pressure ulcer development and pressure ulcer healing. Research-based pressure ulcer prevention and treatment protocols can then be developed.