Pressure Injury Stage Research Articles

Effects of hospital-community-family nursing model among stroke patient combined with pressure injury

Objective To explore the effects of hospital-community-family nursing model on curative effect and quality of life (QOL) of stroke patient combined with the pressure injury. Methods From January to October 2016, we selected 60 stroke outpatients with pressure injury who needed long-term lying discharged from the Department of Neurology, Rehabilitation Department and other of the Fifth Affiliated Hospital of Guangzhou Medical University as subjects. All of the patients were divided into observation group and control group based on the stages of pressure injury, 30 cases in each group. Patients of control group received routine nursing, while patients of observation group were treated with hospital-community-family nursing model. Three months later, we evaluated the quality of life of patients between two groups with the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and determined the cure rate and stages of pressure injury. Results After intervention, the dimension scores of QOL of patients in observation group were higher than those in control group with statistical differences (P<0.05) ; the cure rates of pressure injury of patients in observation group was better than those in control group with statistical differences (P<0.05) . Conclusions The application of hospital-community-family nursing model in stroke patient combined with pressure injury can effectively increase the cure rate of pressure injury, improve clinical symptoms and QOL of patients. Key words: Stroke; Quality of life; Pressure injury; Hospital-community-family nursing

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

The direct cost of pressure injuries in an Australian residential aged care setting.

Pressure injuries have a negative effect on well-being and the cost of treatment places a significant burden on the health care system. Research has, however, tended to extrapolate or estimate the cost of pressure injuries resulting in uncertainty regarding the true cost of this condition. The aim of this prospective observational study was to quantify the cost of pressure injury treatment in the Australian residential aged care setting. An electronic health care record audit and observation of usual pressure injury treatment was undertaken with a sample of 20 participants who had 23 pressure injuries. The actual treatment cost, an evidence-based practice model cost, and a projected treatment cost were calculated. The overall cost of pressure injury treatment was AU$98,489.22. The average daily cost by pressure injury stage was AU$26.42 for a Stage 1 pressure injury, AU$37.17 for a Stage 2 pressure injury, AU$30.01 for a Stage 3 pressure injury, and AU$10.22 for an Unstageable pressure injury. The projected cost of treatment was AU$104,510.41. At 42 days this cost extended to AU$116,552.79. This study has quantified the cost of pressure injury treatment in a residential aged care setting. The study may inform future efforts to accurately calculate the cost of PIs and the effectiveness of strategies to reduce the economic burden of this condition.

Instruments for the care of pressure injury in pediatrics and hebiatrics: an integrative review of the literature.

ABSTRACTObjective:to identify existing instruments in the scientific literature about the care of pressure injuries in pediatric and hebiatric patients. Method:an integrative review that selected 32 articles from the PubMed/Medline, LILACS, Scopus and CINAHL databases using the descriptors pressure ulcer, decubitus ulcer, pediatrics, adolescent and protocols and their equivalent terms in Portuguese and Spanish. Inclusion criteria: research articles in full, in Portuguese, English or Spanish without any temporal cut-off. The descriptive analysis was adopted to categorize the instruments found into the three domains of care: evaluative, preventive and curative. Results:25 instruments for the care of pressure injuries in pediatric and hebiatric patients were found, with an emphasis on the Braden Q Scale being the most commonly used to assess pressure injury risk, and the protocols containing pressure injury staging guidelines developed by the National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP). Conclusion:the scientific literature has valid and reliable instruments that can be used in nursing care practice aimed at the evaluative, preventive and curative care of pressure injuries in pediatric and hebiatric patients.

CICATRIZAÇÃO DE LESÕES POR PRESSÃO EM PACIENTES ACOMPANHADOS POR UM SERVIÇO DE ATENÇÃO DOMICILIAR

RESUMO Objetivo: avaliar a cicatrização de lesões por pressão em pacientes na atenção domiciliar. Método: estudo longitudinal observacional com amostra intencional de 38 pacientes conduzido em um serviço de atenção domiciliar. Foram coletados dados sociodemográficos, clínicos e as características das lesões no período de abril a outubro de 2015. A cicatrização foi avaliada pelo instrumento Pressure Ulcer Scale for Healing, por planimetria e pela profundidade das lesões por pressão. A coleta de dados ocorreu durante as visitas domiciliares realizadas na admissão do paciente no serviço e após quatro e seis semanas. Dados em prontuário também foram coletados. A comparação das variáveis referentes à cicatrização foi realizada pelo Teste de Friedman e a probabilidade de cicatrização, pelo método Kaplan-Meier. Resultados: dos pacientes, 50% eram mulheres e 60,5%, idosos. A mediana de lesões por paciente foi 2. Predominaram os estágios 2 (48,3%) e 3 (35,6%), e 47,1% das feridas cicatrizaram. O escore do Pressure Ulcer Scale for Healing, a planimetria e a profundidade variaram significativamente no período do estudo (p&lt;0,05). A probabilidade de cicatrização aumentou com o passar do tempo, sendo a mediana de cicatrização 44 dias. Conclusão: houve evolução favorável na cicatrização de acordo com os métodos de mensuração utilizados.

Developing a Mobile App for Prevention and Treatment of Pressure Injuries.

This descriptive study describes the planning and development of a mobile application (app) for prevention and treatment of pressure injuries for use by providers in a university research center. The app delineates risk factors for pressure injury development, provides an evaluation of the wound, recommends wound cleansing procedures, performs pressure injury staging, and recommends treatment interventions. A mobile app was developed using a contextualized instructional design, which involves a constructivist proposal and planning, developing, and applying specific didactic situations, thus incorporating mechanisms that favor contextualization. A literature search was conducted to identify relevant studies for the construction of the mobile app. The development process involved the selection of app tools, definition of the navigation structure, and planning of the environment configuration. The environment for downloading the app software on the Internet and installing it on the mobile device was created. The literature search yielded 18 articles, 2 books, and 1 master's degree thesis. A mobile app was created with an easy-to-use graphic interface. The app stores the patient's demographic characteristics and provides an evaluation of his/her wound, a list of risk factors for pressure injury development, wound cleansing procedures, and treatment interventions. The developed app may be useful in clinical practice, helping to prevent pressure injuries and promote select nursing interventions for the treatment of patients with pressure injury.

An analysis of patients in palliative care with pressure injuries.

The aim of this study was to evaluate the factors that are effective for the treatment, recovery of pressure injury (PI) and costs in palliative care (PC) patients. From a retrospective review of patient records, the PI localization, the presence of infection, PI stage on admission, discharge and treatment costs were recorded. Patients were grouped according to diagnoses, and PI localizations (sacrum, trochanter, ischium, and heel). The comparison was made of changes in wound stage in the groups. PI was present in all 154 patients during hospitalization and in 94 (61%) on discharge. Full recovery was determined in 52/129 (40.3%) patients with PI in the sacrum, in 23/46 (50%) in the trochanter, in 22/40 (55.0%) in the heel, and in 10/12 (83.3%) in the ischium. Worsening PI stage was observed in 5 (3.9%) in the sacrum, in 1 in the trochanter and in 4 in the heel. Improvement in PI stage was seen in 96 (74.4%) in the sacrum, in 35 (3.9%) in the trochanter, in 27 (50.5%) in the heel, and in 10 (83.3%) in the ischium. Regardless of wound localization, the improvement was observed in 168 (74%) of 227 PI and worsening in 10 (4.4%). The group with no change in the PI stage had prolonged hospital stay and higher costs. The Karnovsky Performance Score and Glasgow Coma Score of fully recovered patients were determined to be higher, and no statistically significant difference was seen in respect of age. PC patients are prone to PI due to many chronic diseases. The localization of PI and infection are effective factors in the healing of ulcers. The treatment costs for PC patients is higher if they have a pressure ulcer. More comprehensive studies will be useful to clarify the economic and social dimensions of this issue.

The characteristics of pressure injury photographs from the electronic health record in clinical settings.

To analyse and understand the characteristics of pressure injury images stored in the electronic health record. To improve the quality of pressure injury documentation, photographing pressure injuries and storing the images in the electronic health record are standard practices in many hospitals. As new technologies develop, the utilisation of computer-assisted image processing makes automatic measurement of pressure injury size and tissue segmentation through pressure injury images possible. The translation of new technological developments to pressure injury photography conducted in clinical environments faces obstacles such as the complexity of conditions in which photographs are taken. A cross-sectional descriptive study. A set of 360 pressure injury images were obtained from a hospital in western Pennsylvania. These images were taken in clinical settings during daily wound care service. The authors reviewed the pressure injury images to analyse the relative position of the pressure injury in the images, the shooting angle of the digital camera and the clinical objects in the background. Only 5.9% of the pressure injury images were confined to only the wound region. In 80.1% of the images, the pressure injury is located in the central part of the image. In 54.0% of the images, the lens of the digital camera was not pointed perpendicularly to the plane of the pressure injury. Bedside wound assessment of pressure injuries and assessment from photographs of pressure injuries display reasonable agreement with pressure injury staging. To extract wound information (e.g., size and tissue type) from pressure injury images through novel image processing technologies, the characteristics of pressure injury images in clinical settings should be better understood during the development of tools for pressure injury image processing. Our results can help image processing experts understand wound photography characteristics to shorten the gap between laboratory and clinical environments when translating new image processing technologies.

Estado nutricional de idosos e prevalência de lesão por pressão na assistência domiciliar

O objetivo do estudo foi avaliar o estado nutricional e determinar a prevalência de lesão por pressão (LPP) emidosos assistidos por um serviço de atendimento domiciliar. Trata-se de um estudo transversal descritivo, realizadopor meio de visita domiciliar junto à equipe multidisciplinar dos Núcleos Regionais de Atenção Domiciliar Norte eSul do Distrito Federal. Foram usadas ferramentas de avaliação nutricional como Índice de Massa Corporal (IMC)e Mini Avaliação Nutricional (MAN). Para classifi car o estágio das LPP foram considerados os critérios do NationalPressure Ulcer Advisory Panel. Amostra formada por 51 idosos, na qual prevaleceu o sexo feminino (76,5%). A médiado IMC no grupo dos idosos sem LPP foi de 24,4kg/m2 e nos portadores de lesões, 21,9kg/m2. A maioria dos idososcom lesões (54,5%) apresentou-se desnutrida, segundo a MAN. A prevalência de LPP foi de 21,6%. A classifi caçãodas lesões foi a seguinte: duas (12%) grau I, cinco (29%) grau II, sete (41%) grau III e três (18%) grau IV. Conclui-seque, segundo a MAN, mais da metade dos idosos com lesão por pressão apresentou desnutrição. A prevalência deLPP entre os idosos foi elevada.Palavras-chave: Idoso; Lesão por Pressão; Prevalência; Avaliação Nutricional; Assistência Domiciliar.

Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients.

The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients. Retrospective review of electronic medical records. The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013. Analysis is based on data from 6377 patients. Retrospective chart review was used to determine Braden Scale total and subscale scores, age, and incidence of pressure injury development. We used survival analysis to determine the hazards of developing a pressure injury associated with each subscale of the Braden Scale, with the lowest-risk category as a reference. In addition, we used time-dependent Cox regression with natural cubic splines to model the interaction between age and Braden Scale scores and subscale scores in pressure injury risk. Of the 6377 ICU patients, 214 (4%) developed a pressure injury (stages 2-4, deep tissue injury, or unstageable) and 516 (8%) developed a hospital-acquired pressure injury of any stage. With the exception of the friction and shear subscales, regardless of age, individuals with scores in the intermediate-risk levels had the highest likelihood of developing pressure injury. The relationship between age, Braden Scale subscale scores, and pressure injury development varied among subscales. Maximal preventive efforts should be extended to include individuals with intermediate Braden Scale subscale scores, and age should be considered along with the subscale scores as a factor in care planning.

Pressure Injuries in Medically Complex Children: A Review.

Pressure injuries are a challenging problem in the care of medically complex children. Available evidence is limited, and there are theoretical reasons to use caution before extrapolating adult data, including key differences in body composition, common locations of pressure injury, and association with medical devices. The focus of this article will be to review the definition of a pressure injury and what is known about pathophysiology, prevention, recognition, staging, and treatment of pressure injuries in children with medical complexity.

Survey Results from Canada and Some Latin America Countries: 2016 National Pressure Ulcer Advisory Panel Changes in Terminology and Definitions.

Since the National Pressure Ulcer Advisory Panel (NPUAP) held its consensus conference in April 2016, various wound care specialists and professional organizations have been disseminating their response to the revised pressure injury staging definitions. The purpose of this survey was to get an objective perspective of the new NPUAP terminology and staging definitions changes from wound care colleagues outside the United States. In an attempt to obtain the opinions of wound care specialists outside the United States, a convenience sample from some countries in Latin America was invited to complete a survey during the Mexican Association for Integral Care and Wound Healing conference. In addition, students enrolled in the International Interprofessional Wound Care Course conducted in Toronto, Ontario, Canada, were also invited to participate in a revised NPUAP staging definition survey. Survey responses reveal strong support for the changes with consensus agreement greater than 80% on all survey items. These survey results can contribute to a universal agreement on terminology and definitions for pressure-related wounds, which may ultimately improve patient care.

Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System.

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development.

The effect of adjunctive noncontact low frequency ultrasound on deep tissue pressure injury.

The optimal treatment for deep tissue pressure injuries has not been determined. Deep tissue pressure injuries represent a more ominous early stage pressure injury that may evolve into full thickness ulceration despite implementing the standard of care for pressure injury. A longitudinal prospective historical case control study design was used to determine the effectiveness of noncontact low frequency ultrasound plus standard of care (treatment group) in comparison to standard of care (control group) in reducing deep tissue pressure injury severity, total surface area, and final pressure injury stage. The Honaker Suspected Deep Tissue Injury Severity Scale (range 3-18[more severe]) was used to determine deep tissue pressure injury severity at enrollment (Time 1) and discharge (Time 2). A total of 60 subjects (Treatment = 30; Control= 30) were enrolled in the study. In comparison to the control group mean deep tissue pressure injury total surface area change at Time 2 (0.3 cm2 ), the treatment group had a greater decrease (8.8 cm2 ) that was significant (t = 2.41, p = 0.014, r2 = 0.10). In regards to the Honaker Suspected Deep Tissue Injury Severity Scale scores, the treatment group had a significantly lower score (7.6) in comparison to the control group (11.9) at time 2, with a mean difference of 4.6 (t = 6.146, p = 0.0001, r2 = 0.39). When considering the final pressure ulcer stage at Time 2, the control group were mostly composed of unstageable pressure ulcer (57%) and deep tissue pressure injury severity (27%). In contrast, the treatment group final pressure ulcer stages were less severe and were mostly composed of stage 2 pressure injury (50%) and deep tissue pressure injury severity (23%) were the most common at time 2. The results of this study have shown that deep tissue pressure injury severity treated with noncontact low frequency ultrasound within 5 days of onset and in conjunction with standard of care may improve outcomes as compared to standard of care only.

Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale (ROMPIS): A novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa

BackgroundPatients who are intubated in the ICU are at risk of developing pressure injuries to the mouth and lips from endotracheal tubes. Clear documentation is important for pressure wound care; however, no validated instruments currently exist for the staging of pressure injuries to the oral mucosa. Instruments designed for the assessment of pressure injuries to other bodily regions are anatomically unsuited to the lips and mouth. ObjectivesThis study aimed to develop and then assess the reliability of a novel scale for the assessment of pressure injuries to the mouth and oral mucosa. MethodsThe Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) was developed in consultation with ICU nurses, clinical nurse educators, Intensivists, and experts in pressure wound management. ICU nurses and portfolio-holders in pressure wound care from Peninsula Health (Victoria, Australia) were invited to use the ROMPIS to stage 19 de-identified clinical photographs of oral pressure injuries via secure online survey. Inter-rater reliability (IRR) was calculated using Krippendorff's alpha (α). ResultsAmong ICU nurses (n=52), IRR of the ROMPIS was α=0.307; improving to α=0.463 when considering only responses where injuries were deemed to be stageable using the ROMPIS (i.e. excluding responses where respondents considered an injury to be unstageable).Among a cohort of experts in pressure wound care (n=8), IRR was α=0.306; or α=0.443 excluding responses indicating that wounds were unstageable. ConclusionsAn instrument for the assessment and monitoring of pressure injuries to the mouth and lips has practical implications for patient care. This preliminary study indicates that the ROMPIS instrument has potential to be used clinically for this purpose; however, the performance of this scale may be somewhat reliant on the confidence or experience of the ICU nurse utilising it. Further validation is required.

INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

BackgroundPressure injuries are a significant clinical and economic issue, affecting both patients and the health care system. Many pressure injuries in hospitals are facility acquired, and are largely preventable. Despite growing evidence and directives for pressure injury prevention, implementation of preventative strategies is suboptimal, and pressure injuries remain a serious problem in hospitals. ObjectivesThis study will test the effectiveness and cost-effectiveness of a patient-centred pressure injury prevention care bundle on the development of hospital acquired pressure injury in at-risk patients. DesignThis is a multi-site, parallel group cluster randomised trial. The hospital is the unit of randomisation. MethodsAdult medical and surgical patients admitted to the study wards of eight hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility), (b) expected to stay in hospital for ≥48h, (c) admitted to hospital in the past 36h; and (d) able to provide informed consent will be eligible to participate. Consenting patients will receive either the pressure injury prevention care bundle or standard care. The care bundle contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a healthy diet. Nurses will receive education about the intervention. Patients will exit the study upon development of a pressure injury, hospital discharge or 28 days, whichever comes first; transfer to another hospital or transfer to critical care and mechanically ventilated. The primary outcome is incidence of hospital acquired pressure injury. Secondary outcomes are pressure injury stage, patient participation in care and health care costs. A health economic sub-study and a process evaluation will be undertaken alongside the trial. Data will be analysed at the cluster (hospital) and patient level. Estimates of hospital acquired pressure injury incidence in each group, group differences and 95% confidence interval and p values will be reported. DiscussionTo our knowledge, this is the first trial of an intervention to incorporate a number of pressure injury prevention strategies into a care bundle focusing on patient participation and nurse–patient partnership. The results of this study will provide important information on the effectiveness and cost-effectiveness of this intervention in preventing pressure injuries in at-risk patients. If the results confirm the utility of the developed care bundle, it could have a significant impact on clinical practice worldwide. Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001343796.

Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study.

BackgroundPatients are at risk of developing pressure injuries in the peri-operative setting. Studies evaluating the impact of educational interventions on peri-operative nurses’ knowledge and reported practice are scarce. The purpose of this study was to evaluate the effect of a multifaceted intervention on peri-operative nurses’ (a) knowledge of pressure injury risks, risk assessment and prevention strategies for patients in the operating suite; and (b) reported practice relating to risk assessment practices and implementation of prevention strategies for patients in the operating suite.MethodsA before-after research design was used. A convenience sample of all registered and enrolled nurses employed in two hospitals’ operating suites was recruited. A multifaceted intervention was delivered which comprised a short presentation, educational materials and reminder posters. A 48-item survey tool was completed pre-and post-intervention to measure self-reported knowledge and practice.Results70 eligible peri-operative nurses completed both surveys. Post-intervention, statistically significant improvements were seen in knowledge of correct descriptions of pressure injury stages (p=0.001); appropriate reassessment for patients with a new pressure injury (p=0.05); appropriate actions for patients with an existing stage 1 (p=0.02) and stage 2 pressure injury (p=0.04). Statistical improvements were also seen in reported practice relating to an increase in the use of a risk assessment tool in conjunction with clinical judgement (p=0.0008); verbal handover of patients’ pressure injury risk status from the operating room nurse to the recovery room (p=0.023) and from the recovery room nurse to the postoperative ward nurse (p=0.045). The number of participants reporting use of non-recommended and recommended pressure-relieving strategies was unchanged.ConclusionA multi-faceted educational intervention can improve some aspects of perioperative nurses’ knowledge and reported practice such as risk assessment practices but not others such as use of recommended pressure-relieving devices. Further research is required to ascertain effective interventions which improve all areas of practice and knowledge, particularly in the use of appropriate pressure-relieving devices in order to prevent pressure injuries in surgical patients.