Pressure Injury Prevention Research Articles

ATUAÇÃO DA ENFERMAGEM NA PREVENÇÃO E TRATAMENTO DE LESÕES POR PRESSÃO

The aim of this study is to understand the role of nursing in the prevention and treatment of pressure injuries. It is known that pressure injuries are not a specific category of injury, but can refer to damage that occurs due to problems related to blood pressure, such as hypertension. Thus, the following problem stands out: What is the role of the nursing team in the treatment of pressure injuries? Based on this question, it can be seen that nursing care for patients is essential to ensure their survival and prevent complications. Nursing care protocols can vary depending on the severity and extent of the treatment, as well as the individual needs of each patient. This is an exploratory and descriptive integrative review study. Data was collected by searching for original scientific articles in the Virtual Health Library, PubMed, Scopus and Scientific Electronic Library Online databases. Content analysis and thematic categorization were used to evaluate and present the data. It should be noted that there is a shortage of international and national studies; many are descriptive and few make effective contributions. Therefore, it is necessary to include reflections on health care in the face of physical-emotional weaknesses, contextualized in their disparities and social injustices.

Development of a care package to prevent medical device-related pressure injuries using the Delphi Method: A maintenance care package development study.

The purpose is to develop a care package for the prevention of medical device-related pressure injuries using the Delphi Method. The study is a methodological. The care package was developed using the Delphi Method, a consensus-based technique. Two expert groups were selected to develop the care package to prevent medical device-related pressure injuries. The invitation letter and the questionnaire consisting of two questions were sent to the relevant experts via email and completed in three rounds after receiving responses. The scores from the experts were uploaded to the SPSS 25.0 software package. The range (R) was calculated as R = Q3-Q1. The differences (R) between the quartiles were examined. Items with R < 1.2 were accepted as having reached a consensus. As a result of the evaluation, it was organized as 83 items. As a result of the analysis of the scores of the second round of the Delphi Method, the range values of each item were examined. In the third round of the Delphi Method, it was found that consensus was reached in the third round on items 18, 29, and 56, on which consensus could not be reached in the second round, and the care package was accepted with 83 items. An 83-item care package was created to prevent medical device-related pressure injuries in children.

Implementing a Hospital-Acquired Pressure Injury Prevention Bundle in Critical Care.

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the third in a series on applying IS, describes how a nurse-led team at a multisite health system used IS concepts, methods, and tools to implement a hospital-acquired pressure injury (HAPI) prevention bundle on six critical care units, with the aim of decreasing HAPI incidence.

Shape‐Programmable Lamellar Aerogel Enabling 3D Wireless Point‐of‐Care Electronics for Assistance in Pressure Injury Prevention

AbstractBedridden patients are at high‐pressure injuries risk, and timely turning or moving a bedridden patient is crucial to release localized pressure and reduce pressure injury risk. Pressure‐sensing electronics can collect real‐time pressure signals reflecting the movement of a patient and help carers evaluate pressure injury risk early and intervene timely. However, most pressure‐sensing electronics cannot be seamlessly mounted on the curved surface of the skin, resulting in signal instability and inaccuracy. Besides, detecting small pressures over a wide range is challenging. Herein, a lamellar shape‐memory conductive (LSMC) aerogel is developed to assemble 3D wireless point‐of‐care electronics for assisting pressure injury prevention. The lamellar structure makes the LSMC aerogel highly compressible, endowing the assembled electronics with high sensitivity and low detection limit. Moreover, the excellent shape‐memory effect allows the fabrication of 3D electronics on certain curved surfaces for adaptive wearing and provides sensitive and stable signals. Furthermore, a point‐of‐care monitoring system that integrates the LSMC aerogel‐based 3D electronics with wireless technology is developed. The system records real‐time pressure signals at certain locations (e.g., foot), which facilitates carers to analyze an individual's bedridden time and body movements, assess pressure injury risk, and intervene timely; this greatly benefits pressure injury prevention.

Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach.

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national HAPI rate of 3.5% of observed patients. In rapid response, a multidisciplinary team was formed to address and improve the HAPI rate via a quality improvement project. To achieve the goal of decreased pressure injuries or ulcers, a team of nurses, patient care technicians, nutritionists, infectious disease specialists, radiologists, surgeons, vascular technicians, supply chain administrators, case management and social workers, hyperbaric medicine specialists, and wound care experts was created. The team completed a gap analysis and discovered inconsistencies in documentation and care practices that led to HAPI rates above the national average. The team then standardized a policy, standardized documentation of wounds, and provided staff education. Measures were implemented to proactively prevent pressure injuries. There was a 4.2 percentage point decrease in HAPIs from the beginning of the project (5.76%) to the last survey (1.59%). However, this difference was not statistically significant (P = .07). Overall, there were 6 fewer patients (8 vs 2 patients) with hospital-onset observed injury. Additionally, the length of stay decreased by 46%. Documentation of skin assessments within 24 hours of admission improved to 100%. We implemented a quality improvement program across 10 service lines, monitoring pressure injuries, HAPI incidence, and length of stay in 480 patients over 2 years. Although the reduction in HAPI was not statistically significant (P = .07), our program positively impacted the hospital's response to pressure injuries and warrants further replication.

Best Evidence Summary for the Prevention of Pressure Injuries in Orthopaedic Patients.

To systematically search, evaluate and synthesise the most robust evidence regarding pressure injury prevention in orthopaedic patients admitted to general wards. The present study provides an evidence-based summary of the most robust findings, adhering to the evidence guidelines established by the Center for Evidence-Based Nursing of Fudan University. According to the "6S" model, a systematic search was conducted for literature on pressure injury prevention among orthopaedic patients in general wards. The types of literature included guidelines, clinical decisions, expert Consensus, evidence summaries, etc. The search period covered the time from the beginning of the database up to December 2023. The following databases and resources were systematically searched: Up To Date, JBI, NICE, WOCN, NZWCS, etc. RESULTS: Fifteen literature sources were included, comprising one clinical decision, eight guidelines, one systematic review, and one expert Consensus. In these sources, a comprehensive collection of 34 pieces of best evidence was formed across six key topics: risk assessment, position management, skin care, device used for device-related pressure injury, nutritional assessment, and support, as well as health education and training. Among the evidence gathered, a strong recommendation was made for 18 pieces, while the remaining 16 received a weak recommendation. This study provides a comprehensive synthesis of the most robust evidence on pressure injury prevention in orthopaedic patients, encompassing 34 pieces of evidence that can serve as valuable references for clinical practice. Before implementing this evidence, it is crucial to evaluate the specific contextual factors within different countries and medical institutions, as well as the facilitators and barriers influencing its application by healthcare professionals and patient's preferences. Furthermore, targeted evidence selection should be conducted through careful screening and subsequent adjustments in implementation, thereby offering a more scientifically grounded basis for clinical nursing practice. Future research endeavours should prioritise investigating strategies for effective evidence utilisation. The prevention of pressure injuries poses a significant challenge for orthopaedic patients. This study presents a synthesis of 34 pieces of best evidence to provide guidance on preventive measures for pressure injuries in orthopaedic patients. Adhering to and implementing these 34 pieces of evidence can effectively aid in preventing pressure injuries in clinical practice. This evidence encompasses risk assessment, position management, skin care, device usage for device-related pressure injuries, nutritional support and evaluation, and health education and training, establishing a comprehensive and systematic implementation process. Assessing the risk of pressure injuries during interventions serves as an essential prerequisite for developing effective strategies to prevent such injuries among orthopaedic patients. Ultimately, this study will offer valuable guidance to healthcare professionals worldwide regarding preventing pressure injuries in orthopaedic patients. Upon admission to the hospital, it is essential to conduct a risk assessment and implement evidence-based, individualised prevention measures for pressure ulcers in patients to prevent their occurrence. This study will provide valuable insights into preventing pressure injuries in orthopaedic patients admitted to orthopaedic wards for healthcare workers worldwide. The PRIMA manifest is utilised during the text preparation process. ES20245365.

The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle

Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.

Detecting Patient Position Using Bed-Reaction Forces for Pressure Injury Prevention and Management

A key best practice to prevent and treat pressure injuries (PIs) is to ensure at-risk individuals are repositioned regularly. Our team designed a non-contact position detection system that predicts an individual’s position in bed using data from load cells under the bed legs. The system was originally designed to predict the individual’s position as left-side lying, right-side lying, or supine. Our previous work suggested that a higher precision for detecting position (classifying more than three positions) may be needed to determine whether key bony prominences on the pelvis at high risk of PIs have been off-loaded. The objective of this study was to determine the impact of categorizing participant position with higher precision using the system prediction F1 score. Data from 18 participants was collected from four load cells placed under the bed legs and a pelvis-mounted inertial measurement unit while the participants assumed 21 positions. The data was used to train classifiers to predict the participants’ transverse pelvic angle using three different position bin sizes (45°, ~30°, and 15°). A leave-one-participant-out cross validation approach was used to evaluate classifier performance for each bin size. Results indicated that our prediction F1 score dropped as the position category precision was increased.

The pressure injury prevalence and practice improvements (PIPPI) study: A multiple methods evaluation of pressure injury prevention practices in an acute-care hospital.

Pressure injuries are a significant problem for immobile patients in acute care and can have a profound impact on patients' health and well-being, putting pressure on healthcare systems and strain on the healthcare economy. Nurses play a pivotal role in preventing pressure injuries. A study using multiple methods was conducted to explore pressure injury prevention practices in four inpatient units within a tertiary-level Australian Hospital. Quantitative and qualitative methods were used to gather data across a 9-month period. Observations, audits, surveys and interviews were used to collect data across five time points. Statistical analysis of the quantitative data was undertaken, and thematic analysis was used to analyse qualitative data. Data were integrated using a realist evaluation framework. Ethical approval for the study was granted. The quantitative results demonstrated significant reductions in pressure injury prevalence from 11.5% at commencement to 4.8% at completion of the study. Hospital-acquired pressure injuries also reduced from 4.6% to 1.9%. These results were achieved even though nursing knowledge and attitudes did not increase during the study period. Three qualitative themes were identified: Making Nursing Care Visible, Understanding the 'Why' and Engagement is Key. This study demonstrates that pressure injuries can be prevented with improvements in nursing care processes. Nurses' knowledge and attitudes towards pressure injury prevention did not change throughout this study and further research is required on how nurses' knowledge and attitudes contribute towards pressure injury prevention practices.

A randomised controlled phase II trial to examine the feasibility of using hyper-oxygenated fatty acids (HOFA) to prevent facial pressure injuries from medical devices among adults admitted to intensive care-A research protocol.

One in three patients admitted to intensive care will sustain a pressure injury (PI) from a medical device. These injuries are painful and when on the face, head or neck they can result in permanent disfigurement. Preliminary evidence of the efficacy of hyper-oxygenated fatty acids (HOFAs) to prevent facial pressure injuries from medical devices is promising; however, the feasibility of incorporating HOFAs into current standard care to prevent PI from a medical device of the face, head and neck has not been extensively explored. It is intended that the findings from this phase II feasibility study will inform the design of a larger phase III trial, by addressing two primary aims: (1) to assess the feasibility of incorporating HOFAs into standard care to prevent device-related pressure ulcers of the skin associated with the face, head and neck assess the feasibility and (2) efficacy preliminary effectiveness of HOFA. This feasibility study is an investigator-initiated mixed method study incorporating a multi-centre randomised controlled trial of using HOFAs as an adjunct to standard pressure injury prevention and care, compared with standard care alone to prevent facial, head or neck from medical devices among adults admitted to intensive care. The primary outcome of interest is the incidence of facial, head or neck pressure injuries during the first 14 days in intensive care. Secondary outcomes include PI staging, medical device exposure and intensive care and hospital outcomes. The primary analysis will be undertaken using Cox's Proportional Hazards model, and due to the exploratory nature of this phase II trial, efficacy will be based on a one-sided p-value for superiority set at 0.10. Type I and Type II error rates are set at 20%; therefore, a total sample size of 196 study participants is planned. To explore the feasibility of incorporating HOFA into usual care and to design a larger phase III trial, we will aim to interview between 10 and 20 nurses across participating intensive care unit sites. Pressure injuries of the face, head or neck from medical devices, among adults admitted to intensive care, are considered preventable. This phase II study will investigate the feasibility and efficacy of HOFAs as an adjunct to standard care. Importantly, we aim to inform the development of a larger phase III trial.

Prevention of Medical Device-Related Pressure Injury in The Operating Room: Nurses’ Knowledge and Training Imperatives

Prevention of Medical Device-Related Pressure Injury in The Operating Room: Nurses’ Knowledge and Training Imperatives

Effect of Pressure Loading on Heel Skin Temperature and Moisture in Healthy Volunteers: Preliminary Results.

Recent studies emphasize the significance of skin microclimate in the prevention of pressure injuries (PI). The objective was to evaluate the effect of pressure loading on skin temperature and moisture in the heels of healthy adults. This is a before-and-after study performed at Brazil, in October 2022. Skin temperature (°C) was measured by an infrared digital thermometer, and skin moisture (%) using electrical bioimpedance. Ten individuals/twenty heels were evaluated. The average temperature of the right and left heel was the same at baseline (27.2 °C). It was recognized that after 30 min of pressure loading on the heels, there was a decrease in temperature, and after 15 min of pressure offloading, the temperature decreased again. It was found that at t0, the moisture of the right heel (12.6%) was lower than the left heel (15.6%). The median moisture in the right heel increased from t0 to t1 and decreased in t2, while in the left heel, there was a small variation of the median from t0 to t1, as well as to t2. The pressure loading leads to a decrease in temperature and changes the skin moisture of the heels of healthy individuals.

The effects of shoulder morphology on the distribution of shoulder pressure during load carriage.

To enhance the prevention of shoulder pressure injuries in various load-bearing populations, the effects of shoulder morphology on pressure distribution were investigated. In this study, 69 participants underwent three-dimensional scanning, and based on shoulder morphological characteristic indicators, they were classified into four shoulder types. From these, 28 participants were selected to have the pressure within shoulder regions measured using a pressure-sensing vest while carrying a backpack load equivalent to 15% of their body weight. The results indicated that variations in shoulder morphology significantly impact pressure distribution. The greater bumpiness of the shoulder surface contributed to pressure concentration at specific points, resulting in uneven pressure distribution. The enhanced fullness of the shoulder surface promoted even pressure dispersal across the area. This study provided a theoretical basis for developing more effective shoulder injury prevention and management strategies tailored to load-bearing populations with different shoulder types.

Impact of the degree of synergy between patient and nurse perceptions on the clinical outcome of pressure injury prevention: a mixed-methods systematic review protocol

IntroductionPressure injuries are a common and significant concern in clinical practice, often serving as a vital quality indicator. While (clinical) practice guidelines have been established to offer recommendations for mitigating...

A systematic review investigating the effectiveness of interventions in preventing stage 1 and 2 pressure injury of hospitalized elderly patients

Pressure injuries are now the third most costly disease after cancer and cardiovascular disease. Around 60,000 deaths occur annually from the complications of pressure injuries. Pressure injuries are preventable but frequently result in adverse events or severe complications such as infection when developed. This study aims to determine which interventions prevent hospitalized-acquired pressure injuries and are more effective in hospitalized elderly patients. The design used in this study is a systematic review. As presented, it summarizes the studies that were analyzed in the effective interventions in the prevention of pressure injuries in hospitalized elderly patients. Multiple interventions include healthcare professionals’ teamwork measures, education of the healthcare staff, use of risk-assessment tools, offloaded heels or bony prominences, repositioning, and assessment of the nutritional status and the skin. Increasing staff knowledge and patient and family involvement improved health outcomes. There was a significant reduction in the incidence of hospitalized-acquired pressure injuries in elderly patients.

The Impact of Assessment of Nurses' Experiences in Thoracic Surgery in Onco-Hematological Patients.

Background: Nowadays, Thoracic Surgery is technologically advanced; therefore, it also focuses its attention on nursing care. The aim of the study is to evaluate the effect of the assessment of a dedicated team of nurses (DTN) in all onco-hematological patients undergoing VATS lobectomy for lung cancer on the outcome of the patient, preventing pressure injuries, reducing perioperative stress, duration of operations, complications, and hospital stay times. Methods: We performed a single-center observational retrospective study, including 31 DTN and 760 onco-hematological patients who underwent thoracic surgery between 30 October 2018 and 30 June 2023 at "Vanvitelli" University of Naples. Results: DTN ensures good nursing care before, during, and after surgery. Operative time was reduced by approximately 20 min, decreasing hospital infections in the DNT period and reducing intraoperative complications such as bleeding and hospital costs (p < 0.05). Conclusions: Thoracic surgery nurses require more specialized training to adapt to the development of sophisticated.

Latent Profile Analysis of Pressure Injury Knowledge Levels Among Nursing Staff in Tertiary General Hospitals.

Aims/Background The prevalence of pressure injuries (PIs) is a widely used clinical indicator of patient safety and quality of care. Nurses' understanding of pressure injury (PI) can significantly impact the treatment outcomes for patients. This study, based on latent profile analysis (LPA), reveals the characteristics associated with PI knowledge levels among clinical nurses in district and county tertiary medical institutions. We aim to help nursing managers formulate training plans accurately so that clinical nurses can provide high-level skin care services for patients. Method In June 2023, 1482 nurse staff from 4 tertiary general hospitals at the district and county level in Chengdu were chosen as research subjects using the convenience sampling method. Responses to the general information questionnaire, the Chinese Version of Pressure Ulcer Knowledge Assessment Tool (C-PUKAT), and the Chinese Version of Attitude towards Pressure ulcer Prevention (C-APuP) were used to compare the population's characteristics based on LPA. Results Three latent profiles of nurses' PI knowledge were identified: weak foundation type (46.3%), strengthening foundation type (42.7%), and special improvement type (11.0%). Subjects' departments, administrative positions, highest degrees and PI prevention attitude scores, as well as whether they have participated in the training, all differed significantly between latent profile groups (p < 0.05). Conclusion The PI knowledge level of nursing staff at the district and county tertiary general hospitals requires urgent improvement. Nursing managers should prioritize the management level and quality of PI training among clinical nursing staff. Precise training programs can be developed based on different categories of nursing staff to enhance their PI knowledge, thereby effectively improving the quality of healthcare for inpatients.

The Pressure Injury Prevention and Practice Improvements in Nursing - Intensive Care Unit (PIPPIN-ICU) Study.

The Pressure Injury Prevention and Practice Improvements in Nursing - Intensive Care Unit (PIPPIN-ICU) Study.

Pressure injury incidence measurement as a quality improvement strategy: national trends in Switzerland.

This study sought to determine the risk-adjusted (controlled for patient characteristics) trend in pressure injury (PI) incidence in Switzerland. A secondary data analysis was conducted. The data originated from the national PI quality measurement based on a multicentre cross-sectional design with repeated annual measurements. Descriptive statistics, a Cochran-Armitage trend test and logistic (multilevel) regression modelling were applied. The analysis sample comprised 123,715 patients from 230 hospitals over 10 survey years (2011-2019 and 2022). The incidence of descriptive PI varied in Switzerland between 3.7% and 5.6% over the survey years. No linear trend could be found when patient characteristics were not considered. A non-linear trend was detected when controlling for patient characteristics and the time effect (repeated measurement). This was also reflected in the plotted risk-adjusted incidence, which revealed a decrease followed by a levelling off. When only considering the incidence of PIs rated category 2 and higher, there was also a non-linear decreasing trend when controlling for patient characteristics and time effects. If the incidence per survey year were estimated on the basis of patient characteristics, an increase in the incidence would have been expected. Although patients' risk of developing a PI increased between 2011-2022, the incidence of PIs in Switzerland first decreased and then levelled off. The results indicated that care quality in Swiss hospitals has improved regarding PIs. Nevertheless, in view of demographic trends and increasing staff shortages, it is important to continue to monitor PI incidence and to invest in PI prevention.

A remote expert wound nurse consultation intervention for pressure injury prevention and management: intervention design and results of a feasibility study and pilot randomised controlled trial.

A remote expert wound nurse consultation intervention for pressure injury prevention and management: intervention design and results of a feasibility study and pilot randomised controlled trial.