Pressure Injury Development Research Articles

Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study.

Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243.

The risk and prevalence of pressure injuries in older people in the home care service: a cross-sectional study.

This study aimed to understand the risk of developing pressure injuries (PIs) and their prevalence rate in older adults in Italy who received public funded home care services and who were often living alone. In May 2019, a cross-sectional study was performed according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. The data collection included demographic variables, a PI risk assessment using the Braden Scale score, the type of mobility devices available, the wound description detailing the PI category, body location and ongoing treatment. Data analysis was conducted using non-parametric descriptive statistics. Of the 2223 patients who participated in the study, the risk of developing a PI as measured with the Braden Scale sore was: 'absent' for 37.7%; 'mild' for 25.8%; 'moderate' for 13.8%; 'high' for 15.5%; and 'severe' for 7.1% of patients. The PI prevalence in the sample of home care service patients was 26%, of which 46% were inpatients with a Braden Scale score of <14. Of the PIs that developed during the study, 65% of these developed in patients in home care and of these, 81% had a Braden Scale score of ≤9. PIs developed not only during hospitalisation but at home. Assessing the commitment of patients and caregivers to PI prevention and treatment strategies in home care services could be key to reducing PI prevalence, hospital admissions for PIs, related complications for older people living at home, and the severity of the PI category.

A Mathematical Model Relating Foam Material Properties to Heightened Interface Pressure between a Human and Mattress Surface

Hospital patients often develop pressure injuries when lying in bed for an extended time due to relatively high contact pressures breaking down skin tissues. Pressure injuries adversely affect patients by potentially leading to infection and creating advanced health risks. Our prior research identified children experience highest risk of pressure ulcer in the head region. Thus, this study aimed to gather pressure data and create a corresponding model relating foam material properties to predicted interface pressure between the head and a foam mattress overlay surface. Research findings provide data guiding clinicians and designers to mattresses with material properties capable of reducing the incidence of pressure ulcers in children and adults.

Repositioning for pressure injury prevention in adults: a commentary on a Cochrane review.

Repositioning is regarded as an important intervention to prevent the development of pressure injuries in patients who are immobile. However, there is uncertainty as to the optimal regimen in terms of frequency and method of repositioning. This commentary summarises and critically appraises a Cochrane systematic review that assessed the clinical and costeffectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.

Poster (Clinical/Best Practice Implementation) ID 1985182

Background Persons with spinal cord injury (SCI) are at increased risk of developing pressure injuries throughout their lifetime. This significant yet preventable secondary complication can have a negative impact on one’s health and well-being. A key aspect of prevention is performing regular daily skin checks; however, a gap in knowledge is apparent among clinicians and patients on how exactly to perform them. Objective To develop a universal and widely available skin check video resource that supports clinicians and patients. Methods Clinicians across the SCI-IEQCC Network from Parkwood Institute, Hamilton Regional Reha-bilitation Centre, Ottawa Hospital Rehabilitation Center, Lyndhurst, Providence Care, and in partnership with SCIO, Cortree and persons with lived experiences, all contributed in an iterative manner to the development of a skin check video resource. Feedback from all relevant stakeholders was gathered after each round of edits to ensure the content would meet the educational needs of persons with lived experience and rehabilitation staff. Results This collaboration allowed for the development of an open-source skin check video resource for both clinicians and persons with lived experience. This video is in process of being integrated within patient skin check education of the various rehabilitation sites across Ontario. The video identifies key factors to consider when completing skin checks and demonstrates the technique on how to complete skin checks independently and with assistance. Conclusion While a successful skin check video resource was created, next steps will look to its sustainable implementation and dissemination at a local and provincial level.

Validity and Reliability Evidence of the Munro Scale for Perioperative Patients, Part I: Correlation, Multiple Regression, and Reliability.

Background and Purpose: Patients undergoing surgery are at risk of pressure injury development and should be assessed to ensure measures are taken for prevention. The study's purpose was to examine the causal relationships and reliability of the Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale). The Munro Scale is the first dynamic risk scale available for this patient population in the acute clinical setting. Methods: This study was a retrospective review to explore the relationships of the variables in the Munro Scale, identify the strongest predictors, and measure the reliability of previously collected data from two northeastern community hospitals. A total of 630 risk assessments were analyzed to obtain regression, correlation, and reliability evidence for the Munro Scale. Results: The correlation analysis among the 15 risk variables and combined comorbidities revealed commonalities among the variables and significant relationships to the final postoperative injury score. The model as a whole is significant to predict the final level of risk. Coefficient alpha revealed a lower than anticipated reliability when compared to the Chinese, Turkish, and Brazilian versions of the Munro Scale. Conclusions: There are significant relationships among the variables, and the scale is acceptable for use in the acute perioperative practice setting. This study has both clinical and statistical significance.

Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel.

Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent. To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones. The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education. This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.

Safe Patient Handling and Pressure Injury Prevention for Patients With Delayed Sternal Closure.

Pressure injuries are associated with increased morbidity, mortality, and cost. Patients with delayed sternal closure after cardiac surgery are at increased risk of developing pressure injury because of their reduced mobility and inability to undergo complete skin assessment. Safe patient handling of patients with delayed sternal closure is challenging because of mobility restrictions, leading to increased risk for patient and staff harm. An interprofessional team composed of bedside nurses, ergonomic specialists, a wound ostomy continence nurse, and cardiothoracic surgeons developed a patient mobility protocol for patients with delayed sternal closure consisting of levitating the patient for thorough skin assessment and care. A multimodal educational strategy was used to disseminate the new protocol. Patient information was collected on the type of surgery, results of the levitation, completion of the skin assessment, and subsequent interventions. Staff injury related to this work was monitored. After implementation of the protocol, 84 levitations were performed including 50 patients. No staff injuries were reported. Comprehensive skin assessments and care were completed for 98% of patients. Five patients were identified with pressure injury development, and appropriate interventions were applied. A standardized patient mobility protocol for patients with delayed sternal closure that leveraged available equipment was successful in reducing the risk for injury among staff and patients. The protocol allowed assessment and care and thus also reduced the risk for pressure injury development in these patients. Development of an innovative protocol to safely mobilize patients with delayed sternal closure resulted in improved patient care and increased staff safety.

Guidelines in Practice: Prevention of Perioperative Pressure Injury.

Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.

Machine learning-based prediction models for pressure injury: A systematic review and meta-analysis.

Despite the fact that machine learning (ML) algorithms to construct predictive models for pressure injury development are widely reported, the performance of the model remains unknown. The goal of the review was to systematically appraise the performance of ML models in predicting pressure injury. PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Grey literature and other databases were systematically searched. Original journal papers were included which met the inclusion criteria. The methodological quality was assessed independently by two reviewers using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed with Metadisc software, with the area under the receiver operating characteristic curve, sensitivity and specificity as effect measures. Chi-squared and I2 tests were used to assess the heterogeneity. A total of 18 studies were included for the narrative review, and 14 of them were eligible for meta-analysis. The models achieved excellent pooled AUC of 0.94, sensitivity of 0.79 (95% CI [0.78-0.80]) and specificity of 0.87 (95% CI [0.88-0.87]). Meta-regressions did not provide evidence that model performance varied by data or model types. The present findings indicate that ML models show an outstanding performance in predicting pressure injury. However, good-quality studies should be conducted to verify our results and confirm the clinical value of ML in pressure injury development.

Variations in sacral sub-epidermal moisture measurements in hospitalized medical and surgical patients: A longitudinal observational sub-study

BackgroundPressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema. AimsTo assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements. MethodsAs part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement. ResultsA total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days. ConclusionIf only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach. Tweetable abstractSub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.

Data-driven approach to predicting the risk of pressure injury: A retrospective analysis based on changes in patient conditions.

To determine the risk of pressure injury development in the intensive care unit based on changes in patient conditions. This retrospective study was based on secondary data analysis. Patient data from electronic health records were retrospectively obtained and we included 438 and 1752 patients with and without pressure injury, respectively, among those admitted to the medical and surgical intensive care units (ICUs) from January 2017-February 2020. Changes in patient conditions were analysed based on the first and last objective data values from the day of ICU admission to the day before the onset of pressure injury and categorised as follows: improved, maintained normal, exacerbated and unchanged. Logistic regression was performed to identify the significant predictors of pressure injury development based on 11 variables. The 11 selected variables were age, body mass index, activity, acute physiology and chronic health evaluation II score, nursing severity level, pulse and albumin, haematocrit, C-reactive protein, total bilirubin and blood urea nitrogen levels. The risk for a pressure injury was high with exacerbation of or persistently abnormal levels of nursing severity, albumin, haematocrit, C-reactive protein, blood urea nitrogen and pulse >100 beat/min. Periodic monitoring of haematological variables is important for preventing pressure injury in the intensive care unit. The study followed STROBE guidelines. This study contributes to the utilisation of patient data from electronic health records. In addition to other pressure injury risk assessment tools, ICU nurses can help prevent pressure injuries by assessing patients' blood test results, thereby promoting patient safety and enhancing the efficacy of nursing practice.

Effect of a Continuous Bedside Pressure Mapping System for Reducing Interface Pressures

Continuous bedside pressure mapping (CBPM) technology can assist in detecting skin areas with excessive interface pressure and inform efficient patient repositioning to prevent the development of pressure injuries (PI). To evaluate the efficacy of CBPM technology in reducing interface pressure and the incidence of PIs. This parallel, 2-group randomized clinical trial was performed at a tertiary acute care center. The study started to enroll participants in December 2014 and was completed in May 2018. Participants included adults partially or completely dependent for bed mobility. Statistical analysis was performed from September 2018 to December 2022. Nursing staff using visual feedback from CBPM technology for 72 hours. Absolute number of sensing points with pressure readings greater than 40 mm Hg, mean interface pressure across all sensing points under a patient's body, proportion of participants who had pressure readings greater than 40 mm Hg, and pressure-related skin and soft tissue changes. There were 678 patients recruited. After attrition, 260 allocated to the control group (151 [58.1%] male; mean [SD] age, 61.9 [18.5] years) and 247 in the intervention group (147 [59.5%] male; mean [SD] age, 63.6 [18.1] years) were included in analyses. The absolute number of sensing points with pressures greater than 40 mm Hg were 11 033 in the control group vs 9314 in the intervention group (P = .16). The mean (SD) interface pressure was 6.80 (1.63) mm Hg in the control group vs 6.62 (1.51) mm Hg in the intervention group (P = .18). The proportion of participants who had pressure readings greater than 40 mm Hg was 99.6% in both the control and intervention groups. In this randomized clinical trial to evaluate the efficacy of CBPM technology in the reduction of interface pressure and the incidence of PIs in a tertiary acute care center, no statistically significant benefit was seen for any of the primary outcomes. These results suggest that longer duration of monitoring and adequately powered studies where CBPM feedback is integrated into a multifaceted intervention to prevent PI are needed. ClinicalTrials.gov Identifier: NCT02325388.

Incidence and risk factors for pressure injury in hospitalized non-small cell lung cancer patients: A retrospective observational study

AimThis study aimed to identify the incidence and risk factors for pressure injury in patients hospitalized for non-small cell lung cancer (NSCLC). MethodsThis retrospective observational study was conducted in 645 adults who were hospitalized for NSCLC. Clinicopathological characteristics were compared between NSCLC patients with pressure injury and those without pressure injury. ResultsAmong total 645 patients, 180 patients showed pressure injury with an incidence of 27.9%. Patients with pressure injury showed increased serum C-reactive protein (CRP) levels (P < 0.001), increased neutrophil-lymphocyte ratio (P = 0.002), and increased platelet-lymphocyte ratio (P = 0.001) more often. Increase in serum CRP levels at the time of admission was the major risk factor for development of pressure injury in NSCLC patients (OR = 2.20; 95% CI [1.40–3.45]; P = 0.001). Also, among major inflammatory markers, serum CRP levels at the time of admission showed weak negative correlation with the period from admission to the development of pressure injury (r = −0.216, P = 0.004). ConclusionBy checking serum CRP levels at the time of admission, the NSCLC patients at high risk for the development of pressure injury can be identified in advance and the occurrence of pressure injury can be reduced by applying more active preventive nursing care. Clinical trial registration numberKCT0006570.

Characteristics and risk factors of facial pressure injuries in acute inpatients using noninvasive positive pressure ventilation: A retrospective case control study

ObjectiveTo explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation. Setting and samplePatients who developed facial pressure injuries due to non-invasive positive pressure ventilation at a teaching hospital in Taiwan from January 2016 to December 2021 were selected, resulting in a total of 108 patients in our case group. A control group was formed by matching each case by age and gender to three acute inpatients who had used non-invasive ventilation but had not developed facial pressure injuries, resulting in 324 patients in the control group. Research methodologyThis study was a retrospective case-control study. The characteristics of the patients who developed pressure injuries at different stages in the case group were compared, and the risk factors of non-invasive ventilation-related facial pressure injuries were then determined. ResultsHigher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale score, and lower albumin levels in the former group. The results of multivariate analysis from binary logistic regression involving the duration of non-invasive ventilation usage demonstrated that the patients who used this device for 4–9 days and 16 days were at greater risk of facial pressure injuries than those who used it for 3 days; in terms of the Braden scale score, higher Braden scale scores were correlated with a higher risk of facial pressure injuries. In addition, albumin levels lower than the normal range were correlated with a higher risk of facial pressure injuries. ConclusionPatients with pressure injuries at higher stages had a higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale scores, and lower albumin levels. Thus, a longer duration of non-invasive ventilation use, lower Braden scale scores, and lower albumin levels were also risk factors for non-invasive ventilation-related facial pressure injuries. Implications for clinical practiceOur results serve as a useful reference for hospitals, both in creating training programs for their medical teams to prevent and treat facial pressure injuries and in drafting guidelines for assessing risk in order to prevent facial pressure injuries caused by non-invasive ventilation. The duration of device usage, Braden scale scores, and albumin levels in particular should be seriously monitored to reduce the occurrence of facial pressure injuries in acute inpatients treated with non-invasive ventilation.

Frequency of Minor Shifts in Body Position and Pressure Injury Development: A Comparative Descriptive Study.

The purpose of this study was to evaluate the influence of minor shifts in body position on the development of pressure injuries. A prospective, comparative, descriptive study. The sample comprised 78 bedridden patients aged 18 years or older, free of pressure injuries, and hospitalized in the Neurology and Internal Medicine clinics and intensive care units. The study setting was a state hospital in Burdur Province, Southwest Turkey; data were collected between March and September 2018. Patients were monitored once weekly until the end of their stay or until pressure injury development. Data were collected using a researcher-designed data collection form. Patients' ability to make minor shifts in body position was categorized between 0 and 3 per movement group. Twenty-one (26.9%) of 78 participants developed a pressure injury; 90.4% (n = 19) were stage 1 pressure injuries. Pressure injuries occurred in 94.1% of the patients who did not make shifts in body position versus 80% of the patients who performed shifts every 4 hours. No pressure injuries developed in those patients who moved every hour (P = .00). Study findings support the importance of making minor shifts in body position for prevention of pressure injury in bedridden patients.

Risk Factors Associated With Pressure Injury in Critically Ill Children With Congenital Heart Disease

Children with congenital heart disease have unique risk factors associated with the pathophysiology of an abnormal heart; hence, this population is most likely at increased risk of acquiring a pressure injury during hospitalization. Few studies have included patients with congenital heart disease or examined the factors unique to these patients. To identify risk factors associated with pressure injury development in children with congenital heart disease. This retrospective study used a convenience sample from hospital-acquired data at an urban, tertiary, free-standing children's hospital. Patients were admitted to the intensive care unit between 2011 and 2018 with a diagnosis of congenital heart disease. Chi-square analysis was done to compare risk factors between patients, and logistic regression analysis was used to predict the probability that a patient would acquire a pressure injury. Eighty-two (30.5%) of the 269 patients in this study acquired pressure injuries. Sixty-six patients with pressure injuries met the inclusion criteria for analysis; 82% of those patients had had corticosteroids prescribed, and 71% were receiving anticoagulants. The overall predictive model for acquiring a pressure injury indicated an odds ratio of 3.25 (95% CI, 1.58-6.65) with an anticoagulant and an odds ratio of 9.98 (95% CI, 4.68-21.3) with a prescribed corticosteroid (P < .001 for both factors). Inpatient mortality was significantly associated with pressure injuries. Corticosteroid and anticoagulant use were contributing factors in the development of pressure injuries in children with congenital heart disease.

Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study.

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. Retrospective review of electronic medical records. 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. 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. 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). 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.

A simplified BRADEN scale for the risk of developing pressure injuries.

Pressure injuries (PIs) are a major problem for healthcare providers, impacting both care costs and patients' quality of life, although they are predominately preventable. These injuries are especially present in Intensive Care Units (ICUs) as a result of the severity of the clinical conditions of patients in this unit. To develop a simplified version of the Braden scale by removing two of the most subjective subscores-Nutrition and Sensory Perception-in an attempt to reduce the chance of errors by the nursing team during the application of the scale. A cross-sectional study was conducted on data collected from patients admitted to the ICU of a private Brazilian tertiary hospital. The resulting data consisted of 5194 patients, 6353 hospital admissions, and 6974 ICU stays. The overall prevalence of PI was 1.09%. The T-test showed that both the Braden and the simplified Braden scores were significantly different between patients with and without PI (p < .001). Patients who developed PIs scored lower than those who did not. The area under the Receiver Operating Characteristic curve of the Braden Scale was 74.21% (95% CI: 68.61%-79.8%) and of the simplified scale was 72.54% (95% CI: 66.87%-78.22%). The Positive Predictive Value of the Braden Scale was 3.17% when interpolated at the same sensitivity as the simplified scale (47.37%), which achieved 3.26%. By removing two of the six subscores of the Braden scale we propose a new tool for identifying patients at risk of developing PI in a more objective and fast way. Our results show that classification performance had little negative impact. A simplified, less subjective scale allows for more precise and less time-consuming risk classification.

Health Care Workers' Expectations of the Mercury Advance SMARTcare Solution to Prevent Pressure Injuries: Individual and Focus Group Interview Study.

The transformation in global demography and the shortage of health care workers require innovation and efficiency in the field of health care. Digital technology can help improve the efficiency of health care. The Mercury Advance SMARTcare solution is an example of digital technology. The system is connected to a hybrid mattress and is able to detect patient movement, based on which the air pump either starts automatically or sends a notification to the app. Barriers to the adoption of the system are unknown, and it is unclear if the solution will be able to support health care workers in their work. This study aims to gain insight into health care workers' expectations of factors that could either hamper or support the adoption of the Mercury Advance SMARTcare unit connected to a Mercury Advance mattress to help prevent patients from developing pressure injuries in hospitals and long-term care facilities. We conducted a generic qualitative study from February to December 2022. Interviews were conducted, and a focus group was established using an interview guide of health care workers from both the United Kingdom and the Netherlands. Thematic analysis was performed by 2 independent researchers. A total of 14 participants took part in the study: 6 (43%) participants joined the focus group, and 8 (57%) participants took part in the individual interviews. We identified 13 factors based on four themes: (1) factors specifically related to SMARTresponse, (2) vision on innovation, (3) match with health care activities, and (4) materials and resources involved. Signaling function, SMARTresponse as prevention, patient category, representatives, and implementation strategy were identified as facilitators. Perception of patient repositioning, accessibility to pressure injury aids, and connectivity were identified as barriers. Several conditions must be met to enhance the adoption of the Mercury Advance SMARTcare solution, including the engagement of representatives during training and a reliable wireless network. The identified factors can be used to facilitate the implementation process.