Pressure Ulcer Prevention Interventions Research Articles

Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review

BackgroundThe high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PurposeTherefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. MethodsThis systematic review of the literature used, PRISMA to guide the search. FindingsThe review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DiscussionThere were gaps in the interventions that have been proven successful in other global settings. ConclusionIn SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.

Intervention for Pressure Injuries Prevention in Bed Rest Patients

Pressure injuries, also known as pressure injuries or hospital-acquired pressure injuries, was damage to the integrity of the skin or soft tissue in a local area that tends to compress the bony prominences with the surface area due to a combination of prolonged pressure such as friction, shear and moisture. The main groups at risk for pressure injuries were patients with spinal cord injuries, hospitalized patients, especially those undergoing orthopedic surgery and patients admitted to the intensive care unit (ICU). The purpose was to determine the types of tools, materials, techniques and nursing interventions for the prevention of pressure injuries in bed rest patients. The research used a literature review using 3 databases, namely Science direct, Pudmed, Google Scholer with studies design included Quasi Experimental and Romdomized Controlled Trials. The study obtained 7 articles describing pressure ulcer prevention interventions such as providing bed rest, giving oral supplements, providing massage therapy and lubricating agents, providing moisturizers in the wound area and providing appropriate mattresses for bed rest patients.

Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development.

This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi-experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P< .0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P= .05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n=1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at-risk groups to further validate what was found in this study.

Pressure ulcer prevalence and prevention interventions - A ten-year nationwide survey in Sweden.

The aim of this study was to describe pressure ulcer prevalence and prevention interventions in hospital care in Sweden based on nationwide surveys conducted over a 10-year period. All Swedish hospitals were invited to participate in annual pressure ulcer prevalence surveys during the period 2011-2020. The data collection protocols included gender, age, skin assessment, risk assessment, and preventive interventions. In total, more than 130,000 patients were included in the ten prevalence surveys. The prevalence of pressure ulcers in Swedish hospital patients decreased significantly from 17.0 %to 11.4% between 2011 and 2020 and hospital-acquired pressure ulcers decreased from 8.1% to 6.4% between 2018 and 2020. There was no significant decline in medicaldevice-related pressure ulcers during the same period. The proportion of patients who were risk and skin assessed increased, as did the use of pressure-reducing mattresses, sliding sheets, heel protection, and nrepositioning plans. This study shows that the implementation of a national patient safety program has had an impact on the nationwide prevalence of pressure ulcers in hospital care and the occurrence of prevention strategies. However, one in ten patients in Swedish hospitals still suffers from pressure ulcers. Further improvements can be made.

Hemşirelere Algoritma Rehberliğinde Yerinde Simülasyon ile Verilen Eğitimin Basınç Yarasını Önlemeye Etkisi: Müdahale Çalışması

Objective: The aim of this study was to determine the effect of training given to nurses with algorithm-guided in-situ simulation on preventing pressure ulcers. Material and Methods: This was an intervention study. The study was conducted at a university hospital's orthopedia and traumatology clinic with 21 beds. The study sample consisted of 10 post-licensure nurses and 79 pre-simulation and 84 postsimulation patients over 18 years of age, who had stayed in the clinic for at least 24 h. In the collection of data, 3 forms (the demographic data form, the information assessment form, the skill assessment form) were administered to the post-licensure nurses and 3 forms (the demographic data, the Braden scale, the follow-up form) were administered to the patients. The study consisted of 3 stages. In the first stage (01.04.2018-30.06.2018), the nurses recorded the demographic characteristics, nursing interventions for pressure ulcer prevention, pressure ulcer risks, and pressure ulcer incidence data of the patients. In the second stage, nurses participated in a scenario-based standardized patient simulation at the clinic where they worked. In the third stage (01.07.2018-30.09.2018), the nurses recorded the demographic characteristics, nursing interventions for pressure ulcer prevention, pressure ulcer risks, and pressure ulcer incidence data of the patients. The nursing interventions during this period were guided by the algorithm. Incidences of pressure ulcers for 3 months before and 3 months after the simulation were compared at the end of the study. Results: Nurses' knowledge, performance, and care interventions significantly improved during the 3 months simulation (p<0.05). Incidences of Stage 1 pressure ulcers per 1,000 patient days were 8.51 and 4.73 during the 3 months before and the 3 months after simulation, respectively (p=0.136). Conclusion: In-situ simulation is a method to reduce the incidence of pressure ulcers.

Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis.

IntroductionRepositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes.ObjectiveTo analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis.Concept DescriptionRepositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences.DiscussionRepositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications.ConclusionRepositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.

Effect of Educational Program on Pressure Ulcer Prevention Intervention among Nurses of Intensive Care Units at a Public Hospital, Pakistan

objective: The purpose of this study is to evaluate the effect of an educational program on pressure ulcer prevention intervention among nurses in intensive care units at a public hospital in Pakistan. design: It is a Quasi experimental study. Participants: 144 staff nurses with different educational backgrounds working more than 6 month in an intensive care units were participants. methods: They were evaluated pre-test. Workshops, lectures and hands on practice related to pressure ulcer prevention intervention were conducted. After these interventions post-tests were taken results: There was a major difference between the mean knowledge score about the pressure ulcer preventive measures among nurses before (5.73±1.488) and after (12.01±.908) education sessions. P value is 0.000 which was less than .001 shows a significant difference in mean knowledge score before and after the education. conclusion: Knowledge base practices improved the quality of life and care. In the current study, post-test knowledge of nurses after a seminar, lecture and literature which given by the researcher, show improvement and most of the nurses get high marks in post-test session.

Patient expectations of pressure ulcer prevention in the NHS, healthcare demands and national policy: a critical commentary.

Preventive care was recently identified as a Government priority, which is likely to affect pressure ulcer (PU) preventive care in the NHS. Contemporary economic analyses of PU prevention interventions are undermined by factors including methodological challenges and poor inter-rater reliability of PU risk assessment tools. Healthcare demands on the NHS created by PU prevention remain unclear, although the burden is high, with litigation costs rising continuously. The poorly understood economics of PU prevention may create variation in practice. Patient expectations of PU prevention may be influenced by mainstream media, national awareness campaigns and the varied information and advice offered by professionals. Patient expectations and low levels of functional health literacy may create confusion and unrealistic expectations. This article critically examines the impact of recent changes in Government priorities related to PU prevention, considering the effects of healthcare demand, economics and patient expectations.

Sex-specific differences in prevention and treatment of institutional-acquired pressure ulcers in hospitals and nursing homes

IntroductionGender and/or sex have a major impact on staying healthy, becoming ill, or care dependent. Differences between men and women have been described for socioeconomic positions, health behaviors, courses and severities of diseases and mortality rates. Consequently, sex and/or gender need to be adequately taken into account while developing and implementing evidence-based healthcare. Evidence regarding differences between men and women in pressure ulcer care is limited. Our research aim was to measure possible differences between male and female hospital patients and nursing home residents in prevention and treatment of institutional-acquired pressure ulcers. MethodsA secondary data analysis was conducted including data sets collected in nursing homes and hospitals in Germany annually from 2001 to 2016. Relevant variables were compared according to biological sex (men/woman). ResultsThe study included 38,655 nursing home residents (mean age 85.4 years women, 77.3 years men) and 58,760 hospital patients (mean age 66.7 years women, 63.4 years men). More women were underweight and at pressure ulcer risk in both settings. The proportion of institutional-acquired pressure ulcers was higher for men in hospitals. Slightly more men had a PU category 2 to 4 (OR 0.87, 95% CI 0.76 to 0.99) in nursing homes or developed an institutional-acquired pressure ulcers category 2 to 4 in both settings (OR 0.85, 95% CI 0.76 to 0.95). Special mattresses were more often used by women at PU risk. More men with an institutional-acquired pressure ulcer in hospitals received counseling of relatives (OR 0.53, 95% CI 0.39 to 0.72). ConclusionAlthough slightly more men had institutional-acquired pressure ulcers than women, overall differences regarding pressure ulcer occurrence were minor. Gender and/or sex can rather not be considered as an independent risk factor for pressure ulcer development and differences regarding pressure ulcer prevention interventions seem to be minor.

Nurses' knowledge and practice of pressure ulcer prevention and treatment: An observational study

Aims and objectivesTo assess nurses' knowledge on pressure ulcer (PU) prevention and treatment in Jordan, and the frequency of and factors influencing nurses’ implementation of PU prevention and treatment interventions. BackgroundHighly educated and experienced nurses can provide effective PU care; however, previous studies highlighted poor knowledge and implementation of PU care. DesignA correlational study examining nurses’ knowledge of PU prevention and frequency of PU preventive actions in Jordanian hospitals. MethodsParticipants were 377 nurses and 318 patients from 11 hospitals. Data were collected to quantify the frequency of nurses’ implementation of pressure ulcer prevention and treatment interventions for patients suffering from PUs and/or at risk of PU development using a self-reported cross-sectional survey and prospective 8-h observation. ResultsFor observed PU prevention while type of hospital and number of beds in units were significant it is not known without further work if this is replicable. For observed PU treatment, linear regression analysis revealed significant negative beta values for more than 50 beds in clinical unit (β = −2.49). ConclusionThe study addressed new factors, facilitating the provision of prevention and treatment strategies to PU development, including type of clinical institution and number of beds in clinical unit. Relevance to clinical practiceThere is a need to develop training programmes to improve insufficient nurses’ knowledge and, thus, clinical practices on PU prevention and treatment. These programmes would assist both junior and senior nurses and other key stakeholders (e.g. hospital managers, policy-makers, and educators) to improve the performance of PU services, thus, minimising patient suffering.

Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review

BackgroundChronic wounds including pressure ulcers represent a significant burden to patients and healthcare providers. Increasingly patients are required to self-manage their care but patient adherence to prevention strategies is a significant clinical challenge. It is important to increase understanding of the factors affecting patients’ ability and willingness to follow pressure ulcer prevention interventions. ObjectivesTo investigate from a patient perspective the factors affecting adherence to pressure ulcer prevention strategies. DesignIntegrative literature review. Data sourcesA systematic search of electronic databases (Athens, Pub Med, Web of Science, Science Direct, AMED, CINAHL, Cochrane Library, PsychInfo, Google Scholar, Delphis) was initially conducted in May 2017 (repeated August 2018). Review methodsThe methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) principles. The Noticing, Collecting, Thinking (NCT) model of qualitative data analysis was used to identify key themes. ResultsA total of twelve studies met the inclusion criteria and were included in the review. The majority of studies were qualitative and three key themes were identified: (i) individual/daily lifestyle considerations, (ii) patient involvement in the decision-making process, and (iii) pain and/or discomfort. ConclusionThere is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies.

Outcomes for Pressure Ulcer Trials (OUTPUTs): protocol for the development of a core domain set for trials evaluating the clinical efficacy or effectiveness of pressure ulcer prevention interventions

BackgroundCore outcome sets (COS) are being developed in many clinical areas to increase the quality and comparability of clinical trial results as well as to ensure their relevance for patients. A COS represents an agreed standardized set of outcomes that describes the minimum that should be consistently reported in all clinical trials of a defined area. It comprises a core domain set (defining what core outcomes should be measured) and a core measurement set (defining measurement/assessment instruments for each core domain). For pressure ulcer prevention trials a COS is lacking. The great heterogeneity of reported outcomes in this field indicates the need for a COS.Methods/designThe first part of this project aims to develop a core domain set by following established methods, which incorporates four steps: (1) definition of the scope, (2) conducting a scoping review, (3) organizing facilitated workshops with service users, (4) performing Delphi surveys and establishing consensus in a face-to-face meeting with different stakeholders.DiscussionAfter achieving consensus on the core domain set, further work will be undertaken to determine a corresponding core measurement set. This will lead to better pressure ulcer prevention research in the future. There are a number of methodological challenges in the field of COS development. To meet these challenges and to ensure a high-quality COS, the OUTPUTS project affiliates to current standards and works in close collaboration with international experts and with existing international service user groups.Trial registrationThe OUTPUTs project is registered in the COMET database: (http://www.comet-initiative.org/studies/details/283). Registered on 2015.

Scalability of an IT Intervention to Prevent Pressure Ulcers in Nursing Homes

BackgroundPressure ulcers pose an important quality-of-care challenge in nursing homes, with serious consequences for residents' health. We assessed the scalability of the On-Time Pressure Ulcer Prevention (On-Time) intervention strategy, developed by the Agency for Healthcare Research & Quality, in nursing homes nationwide. InterventionOn-Time uses electronic health record reports to identify changes in resident pressure ulcer risk and facilitate multidisciplinary input into clinical decision making. ObjectiveTo assess the scalability and impact of On-Time on pressure ulcer incidence in nursing homes. DesignWe used quasi-experimental methods, employing a difference-in-differences design, to compare the pre-post trends in pressure ulcer incidence in the treatment and comparison homes. Setting and participantsThe study population included long-stay residents at high risk for developing pressure ulcers in 47 nursing homes and matched comparison homes in 17 states. MeasuresStage 2 to 4 pressure ulcer incidence among long-stay residents who met the criteria for high risk, identified using an algorithm adapted from the Minimum Data Set 3.0 Percent of High-Risk Residents with Pressure Ulcers (Long Stay) measure. ResultsThe overall decline in pressure ulcer rates for treatment relative to matched comparison homes was statistically insignificant (P > .05). A subgroup of heterogeneous homes experienced a statistically significant decline of 3.24 percentage points (61.0% relative decrease) in pressure ulcer rates relative to matched comparison homes, but no uniting characteristic common across homes readily explained their success. Conclusions/ImplicationsScalability of future health information technology–based quality improvement interventions in nursing home settings requires nuanced implementation support, particularly around electronic health record report accessibility and accuracy.

Efficacy of pressure ulcer prevention interventions in adult intensive care units: a protocol for a systematic review and network meta-analysis

IntroductionPressure ulcers (PUs) are associated with substantial health burden. Patients in intensive care units (ICUs) are at high risk for developing PU. In the absence of large randomised controlled trials...

Interventions for pressure ulcers: a summary of evidence for prevention and treatment.

Narrative review. Pressure ulcers are a common complication in people with reduced sensation and limited mobility, occurring frequently in those who have sustained spinal cord injury. This narrative review summarises the evidence relating to interventions for the prevention and treatment of pressure ulcers, in particular from Cochrane systematic reviews. It also aims to highlight the degree to which people with spinal cord injury have been included as participants in randomised controlled trials included in Cochrane reviews of such interventions. Global. The Cochrane library (up to July 2017) was searched for systematic reviews of any type of intervention for the prevention or treatment of pressure ulcers. A search of PubMed (up to July 2017) was undertaken to identify other systematic reviews and additional published trial reports of interventions for pressure ulcer prevention and treatment. The searches revealed 38 published systematic reviews (27 Cochrane and 11 others) and 6 additional published trial reports. An array of interventions is available for clinical use, but few have been evaluated adequately in people with SCI. The effects of most interventions for preventing and treating pressure ulcers in people with spinal cord injury are highly uncertain. Existing evaluations of pressure ulcer interventions include very few participants with spinal cord injury. Subsequently, there is still a need for high-quality randomised trials of such interventions in this patient population.

Effects of shaped soft silicone foam dressing on prevention of pressure ulcer in spine surgery

Objective To investigate the effects of soft silicone foam dressing on the prevention of intraoperative pressure ulcer in patients undergoing spine surgery. Methods A total of 232 patients were divided into control group and experimental group (116 cases each group) by coin slot method. The control group was treated with conventional pressure ulcer prevention and treatment. The experimental group was treated with conventional intervention measures. Soft silicone foam dressing paste use, the end of surgery to observe the two groups of patients under the chin skin condition. Results In the control group, there were 10 cases at stage I in the lower part of the skin, and 5 cases (4 cases of skin blisters and 1 case of partial cortical absence) at stage Ⅱ. 2 cases in the experimental group were at stage I; no cases were at stage Ⅱ, the two groups were no stage Ⅲ and above pressure ulcer occurred in the experimental group under the chin pressure ulcer was significantly lower than the control group, The difference was statistically significant (χ2=10.727, P<0.05). Conclusion Conventional pressure ulcer prevention and control interventions combined with shaped soft silicone foam dressing for skin protection of special parts of chin under prone position surgery is beneficial to prevention of intraoperative pressure ulcers. Key words: Pressure ulcer; Prevention; Prone position; Shaped soft silicone foam dressing

Does participating in a clinical trial affect subsequent nursing management? Post-trial care for participants recruited to the INTACT pressure ulcer prevention trial: A follow-up study

BackgroundParticipation in a clinical trial is believed to benefit patients but little is known about the post-trial effects on routine hospital-based care. ObjectivesTo describe (1) hospital-based, pressure ulcer care-processes after patients were discharged from a pressure ulcer prevention, cluster randomised controlled trial; and (2) to investigate if the trial intervention had any impact on subsequent hospital-based care. MethodsWe conducted a retrospective analysis of 133 trial participants who developed a pressure ulcer during the clinical trial. We compared outcomes and care processes between participants who received the pressure ulcer prevention intervention and those in the usual care, control group. We also compared care processes according to the pressure ulcer stage. ResultsA repositioning schedule was reported for 19 (14.3%) patients; 33 (24.8%) had a dressing applied to the pressure ulcer; 17 (12.8) patients were assessed by a wound care team; and 20 (15.0%) were seen by an occupational therapist. Patients in the trial’s intervention group were more likely to have the presence of a pressure ulcer documented in their chart (odds ratio (OR) 8.18, 95% confidence intervals (CI) 3.64–18.36); to be referred to an occupational therapist OR 0.92 (95% CI 0.07; 0.54); to receive a pressure relieving device OR 0.31 (95% CI 0.14; 0.69); or a pressure relieving mattress OR 0.44 (95% CI 0.20; 0.96). Participants with Stage 2 or unstageable ulcers were more likely than others to have dressings applied to their wounds (p=<0.001) and to be referred to an occupational therapist for protective devices (p=0.022). ConclusionParticipants in the intervention group of a clinical trial were more likely to receive additional post trial care and improved documentation compared with those in the control group but documentation of pressure ulcer status and care is poor.

Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

Enhancing Documentation of Pressure Ulcer Prevention Interventions

Enhancing Documentation of Pressure Ulcer Prevention Interventions

Comparative Effectiveness of Quality Improvement Interventions for Pressure Ulcer Prevention in Academic Medical Centers in the United States

Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (p<.05). Five QI interventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.