Pressure Injury Management Research Articles

Nursing Students' Knowledge on Pressure Injuries Following a Blended-Learning Unit: A Quasi-experimental Study.

To assess first-year bachelor's degree in nursing students' knowledge about pressure injury (PI) etiology, classification, prevention, and management following blended learning and clinical practice. A quasi-experimental design was used. Nursing students' PI knowledge was measured using the French version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) at three time points: baseline (before a blended-learning unit, consisting of 2 hours of e-learning and 3 hours of practical workshop), after the blended-learning unit, and after clinical practice. A total of 21 students participated over the three time points. At baseline, the mean percentage of correct answers on the PUKAT was 45.8%. This score increased to 59.2% following the blended-learning unit and 65% after completing the clinical practice (F2,58 = 19.08; P = .00). Over the three time points, students scored highest on knowledge of risk assessment and lowest on knowledge of prevention. Blended-learning units combining e-learning and practical workshops are valuable tools to increase students' knowledge about PIs. The PUKAT enables the evaluation of changes in students' knowledge following a teaching unit on PIs. However, more research is needed to assess the long-term evolution of knowledge and the impact of this teaching on clinical practice.

Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries.

Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability. A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices. Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions. Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs. The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally. The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.

Educational interventions on preventing pressure injuries targeted at nurses: systematic review and meta-analysis.

Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease. Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce. The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies. In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries. The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.

Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project.

To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement. This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates. The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020. Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.

Facilitators and barriers to pressure injury prevention, management and education: Perspectives from healthcare professionals-A qualitative study.

This study aims to (1) characterize healthcare professionals' (HCPs') experiences related to the prevention and management of pressure injuries (PIs) and (2) explore the educational needs of individuals with a past or current history of PIs and their caregivers from the perspective of HCPs. This is a qualitative descriptive study. HCPs (n = 18) were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and coded using NVivo. Three overarching themes encompassing various dimensions were identified: (1) Facilitators related to PI prevention and management, (2) Challenges related to PI prevention and management and (3) Recommendations for improving patient and caregiver PI education. HCPs identified a greater number of challenges than facilitators related to PI care. This study emphasizes the importance of a patient-centred and interprofessional approach to patient education for PI prevention and management. Meaningful interventions focused on the patient may improve health literacy and empower patients and caregivers in PI care. Investing in preventive measures and raising awareness are crucial to reducing PI incidence. The findings have implications for HCPs and researchers seeking to enhance patient care and promote effective PI prevention strategies.

Local Use of Colistimethate Sodium as Antimicrobial Dressing Agent in Multidrug-resistant Gram-negative Bacteria-colonised Pressure Injuries in Spinal Cord Injury Patients: A Case Series

Abstract Despite advancements in dressing materials and techniques, the management of pressure injuries (PIs) remains a challenging problem for clinicians across the world. The failure to heal in PIs is multifactorial such as nutritional status of patients, bacterial load, site of ulcer, risk of contamination and presence of comorbidities. Multidrug-resistant (MDR) Gram-negative bacterial (GNB) infections are frequent occurrence in hospitalised patients with PI. The limited chemotherapeutic options available for treating MDR strains of GNB have forced the reintroduction of the cationic cyclic peptide, polymyxin E (colistin). We report a case series of seven patients of traumatic spinal cord injury with PIs and poor healing due to MDR GNB sensitive only to colistin. In view of the worsening condition of the PIs and financial constraints, it was decided to start colistin therapy locally by colistimethate sodium. All patients responded well to the treatment and got clinically better. In our study, we used the Pressure Ulcer Scale for Healing score, Functional Independence Measure and World Health Organization Quality of Life Brief Version score to measure the outcome. We found this novel dressing a very promising and cost-effective treatment option in achieving infection-free healing, especially against MDR strains of bacteria.

(Invited) soft, Wireless Pressure-Sensor-Integrated Smart Bandage for the Management of Wound Healing

Soft, flexible electronics are promising for many applications including health monitoring, soft robotics, and other intelligent systems. In this talk, I will discuss our recent efforts in developing flexible electronic devices with previously inaccessible capabilities. I will start with our work on soft, wireless pressure-sensor-integrated smart bandage for the management of diabetic foot ulcers. Diabetic foot ulcers (DFUs) have affected millions of people in the U.S. and posed heavy burdens to patients and the healthcare system due to their being slow to heal, high recurrence rate, and potential risk of amputation and even premature death. A mainstay of DFU therapy is mechanical offloading to mitigate pressure at the ulcer, which, however, is usually not effective due to patients’ diminished sensation capabilities on the foot and low adherence to offloading recommendations. I will present our recent effort in developing a soft, flexible, wireless pressure-sensor-integrated smart bandage system for continuously monitoring the pressure on the foot and alerting the users to offload under exceeded pressure. The pressure sensor exhibits high linearity, negligible hysteresis, fast response time, and excellent water-proof properties relevant for this application. Wireless data transmission onto a smartphone via Bluetooth enables the display and interpretation of the measured pressure with the option of a preset pressure threshold, when exceeded, an alert will be generated for immediate notifications. Trials on healthy subjects demonstrate reliable monitoring performance and effectiveness in aiding offloading. The developed smart bandage system represents a significant advance in the prevention and management of DFUs and other pressure injuries as well as compression therapy corrections.

Strategies to preventing pressure injuries among intensive care unit patients mechanically ventilated in prone position: a systematic review and a Delphi study.

Although the incidence of pressure injury in the prone position is high for the mechanically ventilated patients in the intensive care unit, evidence-based strategies are still lacking. To conduct a systematic review of current evidence, and to propose a series of strategies to prevent pressure injuries among mechanically ventilated patients with prone position in the intensive care unit. The study was guided by the Medical Research Council framework. After a systematic review of current evidence of original articles, guidelines, expert consensus and theories, a strategy draft was developed. Then we invited 20 experts to modify and refine these strategies through two rounds of Delphi consensus method. After two rounds of Delphi process, the importance of coefficient of variation (Cv) and Kendall's coefficient of concordance in the strategies repository were 0.067 and 0.311, respectively. And the operability of Cv and Kendall's coefficient of concordance in the strategy draft was 0.055 and 0.294, respectively. Ultimately, we established 31 strategies for including 7 themes (assess risk factors, assess skin and tissue, body position management, skin care, nutrition, preventing medical device-related pressure injuries, education and supervision). In addition, we also developed a strategy framework to clarify our strategies. According to the Medical Research Council framework, we developed 7 themes and 31 strategies to prevention prone-position pressure injuries among the intensive care unit mechanically ventilated patients. This study was considered to improve the clinical management of pressure injuries among prone position patients in the intensive care unit settings.

How experienced wound care nurses conceptualize what to do in pressure injury management

BackgroundConceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management.MethodsA qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants’ experience of pressure injury management.ResultsThe analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: “comparison”, “consideration”, and “monitoring” in assessment, and “creation”, “conversation” and “judgement” in intervention.ConclusionsThis study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses’ pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.

Preventing Medical Device-Related Pressure Injuries

Pressure injuries (PIs) are a common, yet preventable complication of patient care. 1 Dang W Liu Y Zhou Q et al. Risk factors of medical device-related pressure injury in intensive care units. J Clin Nurs. 2022; 31: 1174-1183https://doi.org/10.1111/jocn.15974 Crossref Scopus (14) Google Scholar ,2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar Regulatory, quality, and health care bodies view the frequency of hospital-acquired pressure injuries (HAPIs) as indicative of the quality of nursing care and take the issue of HAPIs very seriously in terms of patient safety. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar Every year, approximately 2.5 million people develop HAPIs, and approximately 60,000 people die as a result of these injuries. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar ,4 Padula WV Delarmente BA The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019; 16: 634-640https://doi.org/10.1111/iwj.13071 Crossref PubMed Scopus (207) Google Scholar The total cost of HAPI care per patient ranges from $29,900 to $151,700, resulting in an estimated annual cost of $26.8 billion. 3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar ,5 Tschannen D Anderson C The pressure injury predictive model: a framework for hospital-acquired pressure injuries. J Clin Nurs. 2020; 29: 1398-1421https://doi.org/10.1111/jocn.15171 Crossref Scopus (14) Google Scholar Despite the introduction of new technology and HAPI prevention strategies, the occurrence of HAPI is still on the rise. 2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar ,3 Pittman J Otts JA Riley B Mulekar MS Pressure injury prevention and management: a gap analysis using key stakeholder engagement. J Wound Ostomy Continence Nurs. 2022; 49: 416-427https://doi.org/10.1097/WON.0000000000000906 Crossref Scopus (0) Google Scholar People suffering from this injury can experience severe discomfort, a decrease in their overall quality of life, reduced activity, decreased productivity, social alienation, depression, and increased length of stay. 2 Hajhosseini B Longaker MT Gurtner GC Pressure injury. Ann Surg. 2020; 271: 671-679https://doi.org/10.1097/sla.0000000000003567 Crossref PubMed Scopus (0) Google Scholar

Getting Ready for Foot Care Certification: Implementing Off-loading Interventions to Prevent or Manage Injury.

Getting Ready for Foot Care Certification: Implementing Off-loading Interventions to Prevent or Manage Injury.

Management of deep sacral and ischial pressure injuries with free-style local perforator flaps: A D+P+DPD model

Previous reports on the treatment of sacral and ischial pressure injuries have not provided clear algorithms for surgical therapies. The objective of this study was to establish a reconstruction algorithm to guide the selection of an ideal free-style perforator flap that can be tailored to the defect in question. We used 23 perforator flaps to reconstruct 14 sacral and 8 ischial defects in 22 patients over 5 years. A reconstruction algorithm system was developed based on the anatomical features of the perforator vessels (diameter, D; pulsatility [++∼+++], P) and their position in the skin island (DPD) (ie, D+P+DPD). A perforator-based propeller flap was applied as the first-line choice; if this plan was not feasible, we applied an altered V-Y advancement model or another second-choice technique. All flaps survived, and only 1 patient experienced partial wound dehiscence, which healed by secondary intention. After an average follow-up period of 11.2 months, no patient experienced recurrence or infection. Free-style perforator flap selection is determined by pressure injury and the desired advantage of a specific approach. The use of free-style perforator-based propeller flaps allows a surgeon to transfer healthy tissue into the defect, shifts the suture line away from the bony prominence, and preserves additional future donor sites. In cases where unexpected variations are encountered, the V-Y advancement model or another technique can be used. The simplified surgical algorithm (D+P+DPD) can provide versatility and reliability, achieve a durable, natural esthetic outcome, and minimize injuries to future donor sites.

Factors influencing the severity of medical device-related pressure injuries: Pressure injury staging comparison.

Medical device-related pressure injuries are receiving increased attention because their social and economic costs are increasing. This study aimed to analyse the stages for each risk factor, and to assess which has a greater impact on severity. We performed a retrospective analysis of 237 patients. Severity was evaluated by pressure injury stages, and the following categories were considered as risk factors: perceptual functioning, malnutrition, reduced mobility, comorbidities, extrinsic factors, medical devices, anatomical areas, and hospital stay. The stages of pressure injury stages were more for vascular access devices than for respiratory devices. The following were related to severity: mental deterioration-related diseases, mental status, albumin level, haemoglobin level, total cholesterol level, intensive care unit care, days of hospitalisation, and time to develop pressure injuries after admission. Decreased mental status, anaemia, hypoalbuminemia, and low total cholesterol levels were particularly critical. However, factors such as anatomical areas, age, malignancy, diabetes mellitus, diseases related to malnutrition, abnormal body mass index, immobility-related diseases, physical restraints, and Braden scale scores were not. A different approach to the management of medical device-related pressure injuries is necessary because they have distinctive characteristics and causative factors than other pressure injury types.

Effect of a Team Approach to Pressure Injury Management over 5 Years in a Tertiary Hospital.

The authors' facility established a novel integrated wound care team (IWCT), which included the implementation of a strict treatment algorithm by the patients' attending providers and a specialized wound care team led by a plastic surgeon. Investigators then retrospectively analyzed clinical outcomes of pressure injury (PI) management by the IWCT over 5 years. The authors performed a retrospective chart review and periodic statistical analysis of the data for all patients with PI referred to the IWCT in the authors' center from May 2015 to April 2019. Data including patients' demographic information, first and last consultation dates, referring department, PI stage, site of PI, and Braden Scale scores were collected and analyzed. Patients (N = 15,556) did not differ significantly in age, sex, or Braden Scale score. A preimplementation/postimplementation analysis of PI data before and after establishing the IWCT showed that the incidence of stage 3 or 4 PIs had significantly decreased during the study period (19.1% vs 15.2%, P < .05). Conversely, the incidence of stage 1 PIs significantly increased in the same period (38.0% vs 57.4%, P < .05). The proportion of completely healed PIs also increased, and the median treatment period was significantly shortened (P < .05). Implementation of the IWCT in a tertiary hospital setting led to a significant increase in early-stage PI detection and a decrease in severe PIs.

Soft, Wireless Pressure‐Sensor‐Integrated Smart Bandage for the Management of Diabetic Foot Ulcers

AbstractDiabetic foot ulcers (DFUs) have affected millions of people in the U.S. and posed heavy burden to patients and the healthcare system due to their being slow to heal, high recurrence rate, and potential risk of amputation and even premature death. A mainstay of DFU therapy is mechanical offloading to mitigate pressure at the ulcer, which, however, is usually not effective due to patients’ diminished sensation capabilities on the foot and low adherence to offloading recommendations. This work reports a soft, flexible, wireless pressure‐sensor‐integrated smart bandage system for continuously monitoring the pressure on the foot and alerting the users to offload under exceeded pressure. The pressure sensor exhibits high linearity, negligible hysteresis, fast response time, and excellent water‐proof properties relevant for this application. Wireless data transmission onto a smartphone via Bluetooth enables the display and interpretation of the measured pressure with the option of a preset pressure threshold, when exceeded, an alert will be generated for immediate notifications. Trials on healthy subjects demonstrate reliable monitoring performance. The developed smart bandage system represents a significant advance in the prevention and management of DFUs and other pressure injuries as well as compression therapy corrections.

The predictive effect of different machine learning algorithms for pressure injuries in hospitalized patients: A network meta-analyses

BackgroundPressure injury has always been a focus and difficulty of nursing. With the development of nursing informatization, a large amount of structured and unstructured data has been generated, and it is difficult for traditional methods to utilize these data. With the intersection of artificial intelligence and nursing, it has become a new trend to apply machine learning algorithms to build pressure injury prediction models to manage pressure injuries. However, there is no evidence on the effectiveness of the method and which of a large number of algorithms for machine learning is more applicable to pressure injuries. ObjectiveThis review aims to systematically synthesize existing evidence to determine the effectiveness of applying machine learning algorithms for pressure injury management, to further evaluate and compare pressure injury prediction models constructed by numerous machine learning algorithms, and to derive evidence for the best algorithms for predicting and managing pressure injuries. DesignSystematic review and network meta-analysis. MethodsA systematic electronic search was conducted in the EBSCO, Embase, PubMed, and Web of Science databases. We included all retrospective diagnostic accuracy trials and prospective diagnostic accuracy trials constructing a predictive model by machine learning for pressure injuries up to December 2021. Two review authors independently selected relevant studies and extracted data using the Cochrane handbook for systematic reviews of diagnostic test accuracy. The network meta-analysis was conducted using statistical software R and STATA. The certainty of the evidence was rated using the QUADAS-2 tool. ResultTwenty-five clinical diagnostic trials with a total of 237397 participants were identified in this review. The results of our study revealed that pressure injury machine learning models can effectively predict these injuries. Combining the algorithms separately yields the main results: decision trees (sensitivity: 0.66, 95% CI: 0.42 to 0.84, specificity: 0.90, 95% CI: 0.78 to 0.96, diagnostic odds ratio [DOR]: 18, 95% CI: 7 to 49, AUC: 0.88, 95% CI: 0.85 to 0.91), logistic regression (sensitivity: 0.71, 95% CI: 0.60 to 0.80, specificity: 0.83, 95% CI: 0.75 to 0.89, DOR: 12, 95% CI: 9 to 17, AUC: 0.84, 95% CI: 0.81 to 0.87), neural networks (sensitivity: 0.73, 95% CI: 0.55 to 0.86, specificity: 0.78, 95% CI: 0.65 to 0.87, DOR: 9, 95% CI: 5 to 19, AUC: 0.82, 95% CI: 0.79 to 0.85), random forests (sensitivity: 0.72, 95% CI: 0.26 to 0.95, specificity: 0.96, 95% CI: 0.80 to 0.99, DOR: 56, 95% CI: 3 to 1258, AUC: 0.95, 95% CI: 0.93 to 0.97), support vector machines (sensitivity: 0.81, 95% CI: 0.69 to 0.90, specificity: 0.81, 95% CI: 0.59 to 0.93, DOR: 19, 95% CI: 6 to 54, AUC: 0.88, 95% CI: 0.85 to 0.90). According to the analysis of ROC and AUC values, random forest is the best algorithm for the prediction model of pressure injury. ConclusionsThis review revealed that machine learning algorithms are generally effective in predicting pressure injuries, and after data merging, the random forest algorithm is the best algorithm for pressure injury prediction. Further well-designed diagnostic controlled trials are recommended to strengthen the current evidence. Registration number (PROSPERO)CRD42021276993.

Expression levels of NPPB, ITGB6, CPNE4, EML5, and ITSN1 in fresh exudates swabbed from critically colonised and infected full-thickness wounds in rats.

Pressure injury management requires reliable identification of critical colonisation due to lack of infection signs. Our research group previously proposed the mRNAs natriuretic peptide B (Nppb), integrin subunit beta 6 (Itgb6), copine 4 (Cpne4), echinoderm microtubule-associated protein like 5, and intersectin 1 as candidate markers in pooled exudates of critically colonised wounds. However, it is unclear whether mRNAs or proteins of the candidate genes would be suitable as biomarkers in fresh exudate. Therefore, this study aimed to evaluate the validity of the mRNAs and proteins as fresh exudate markers for critical colonisation. Three wound models of normal healing, critical colonisation, and infection were created in rats. Fresh swab-collected exudates were collected, and mRNA and protein expression levels were measured. In the fresh wound exudates, the detection frequency of Itgb6 tended to decrease in the critically colonised and infected wounds (P=.067), and those of Cpne4 and Nppb tended to be lower in the infected wounds than in the normal healing and critically colonised wounds (P=.006 and .067, respectively). In contrast, there was no difference in protein expression in the exudates. This study suggests that Itgb6 mRNA in fresh exudates is a promising biomarker for critical colonisation.

Application Value of Management Model Based on "Zero Tolerance" Concept in Pressure Ulcer Management.

Background Pressure injuries are the most prevalent health problem worldwide. Improving the quality of hospital pressure injury management is an important indicator to improve the quality of hospital management. Objective To explore the application value of the management model centered on the concept of “zero tolerance” in the management of pressure ulcers (PU). Methods The effects of conventional management mode and management mode centered on the concept of “zero tolerance” on PU patients and nursing staff were retrospectively analyzed. The patients were evaluated by the general comfort questionnaire (GCQ), Generic Quality of Life Inventory 74 (GQOL-74), and pressure ulcer healing scale (PUSH). At the same time, the satisfaction of PU patients and nursing staff with different management modes was investigated. Results When comparing the conditions of patients under different management modes, it was found that the “zero tolerance” management mode can improve the comfort and quality of life of patients during hospitalization. Compared with the conventional management mode, the “zero tolerance” management mode can significantly improve the degree of pressure ulcer healing in patients. In addition, the “zero tolerance” management model can not only improve the satisfaction of patients with management but also improve the satisfaction of nursing staff with management. Conclusion Standardized management of PU patients with the concept of “zero tolerance” as the core can improve the health status and quality of life of patients, promote wound healing, and improve the satisfaction of patients and nurses with the management plan.

Measuring Repositioning in Home Care for Pressure Injury Prevention and Management.

Despite the widespread agreement on the need for the regular repositioning of at-risk individuals for pressure injury prevention and management, adherence to repositioning schedules remains poor in the clinical environment. The situation in the home environment is likely even worse. Our team has developed a non-contact system that can determine an individual’s position in bed (left-side lying, supine, or right-side lying) using data from a set of inexpensive load cells placed under the bed. This system was able to detect whether healthy participants were left-side lying, supine, or right-side lying with 94.2% accuracy in the lab environment. The objective of the present work was to deploy and test our system in the home environment for use with individuals who were sleeping in their own beds. Our system was able to detect the position of our nine participants with an F1 score of 0.982. Future work will include improving generalizability by training our classifier on more participants as well as using this system to evaluate adherence to two-hour repositioning schedules for pressure injury prevention or management. We plan to deploy this technology as part of a prompting system to alert a caregiver when a patient requires repositioning.

Pressure Injury Prevention and Management: A Gap Analysis Using Key Stakeholder Engagement.

PURPOSE:The purpose of this study was to examine pressure injury prevention and management (PIPM) practices in an academic acute care setting. Specific aims were to (1) develop and examine key stakeholder engagement regarding PIPM practices, (2) develop a valid/reliable gap analysis instrument, and (3) conduct a gap analysis of current PIPM practices.DESIGN:Mixed-methods convergent design and participatory action research.SUBJECTS AND SETTING:A nurse-led council (Council) of key stakeholders from a large academic university healthcare setting was developed. The gap analysis was conducted in a southern gulf coast level I trauma academic acute care hospital in the Southeastern United States.METHODS:A multidisciplinary key stakeholder Council with 27 members was developed to accomplish study aims using the participatory action research approach to train, promote, and foster key stakeholder engagement in all aspects of the research process. The Pressure Injury Prevention Gap Analysis Instrument (PIPGAI) was developed and psychometrically tested. A gap analysis of PIPM practices across a level I trauma academic acute care hospital was conducted using the PIPGAI.RESULTS:The PIPGAI was developed using 2019 Pressure Ulcer/Injury Clinical Practice Guideline recommendations, an integrative literature review/appraisal, a concept map, and Council input. The overall PIPGAI content validity index of 0.95 demonstrated excellent content validity. The individual item content validity index scores ranged from 0.62 to1.0. Low-scoring items (0.62-0.75) were deleted or revised. Interrater reliability was demonstrated by percentage of agreement (62%-79%). Using a modified Delphi approach, items of disagreement were summarized and discussed until 100% consensus was achieved. A gap analysis of PIPM practices was conducted resulting in a cumulative score of 267/553 (48%), indicating gaps in PIPM practices. Fifty (73%) items had content present; 37 of 58 (64%) items had minimal detail, and 36 of 58 (62%) items were difficult or required notable effort to accomplish. Fifty items (63%) had a total score of 4 or less and were identified as a gap (range: 0-7).CONCLUSIONS:The main outcome of this study was an innovative and evidence-based gap analysis process. The study provides (1) a model for key stakeholder engagement, (2) a valid/reliable gap analysis instrument, and (3) a method to evaluate PIPM practices.