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British Journal of Community Nursing Mar 2020Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article...
Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article discusses how one NHS trust reduced the incidence of heel pressure ulcers within adult inpatient settings. In 2016/17, the trust identified 14 avoidable category 3 and above pressure ulcers/injuries in inpatient settings, of which 10 had developed on the heels. Through root cause analysis, the organisation identified themes, which prompted action, and a quality improvement project 'Deal with heels' was planned and implemented. Changes were introduced through a collaborative and structured approach; the key stakeholders included the tissue viability team, procurement, medical devices, patient safety, managers, matrons, ward sisters and tissue viability link advisors, who worked together to reduce heel ulcer prevalence through education and standardised practice. As a result of improved organisational awareness and some changes, the number of heel pressure ulcers/injuries reduced to two over a 3-year period, which also helped reduce the total number of avoidable pressure ulcers/injuries.
Topics: Heel; Hospitalization; Humans; Patient Care Team; Pressure Ulcer; Quality Improvement; United Kingdom
PubMed: 32160061
DOI: 10.12968/bjcn.2020.25.Sup3.S6 -
Journal of Tissue Viability Feb 2024Pressure ulcers are a significant health problem that affects a large population, especially the elderly and individuals with physical limitations. These injuries cause... (Review)
Review
Pressure ulcers are a significant health problem that affects a large population, especially the elderly and individuals with physical limitations. These injuries cause pain, are difficult to heal, and can be expensive to manage, leading to a negative impact on the quality of life of those affected. This scientific paper provides an overview of medical devices such as support surfaces, dressings, and topical agents for preventing and managing pressure ulcers. This review focuses on the importance of understanding the viscoelastic mechanical properties, water vapor transmission rate, and biocompatibility testing of medical devices, which can help define performance criteria needed to prevent and manage pressure ulcers effectively. The paper highlights the potential use of alginate, polyurethane, silicone, polyvinyl alcohol, and collagen as pressure relief and wound care solutions. Synthesizing this research can help medical device manufacturers make better decisions and improve the quality of care for patients with pressure ulcers.
Topics: Humans; Aged; Pressure Ulcer; Quality of Life; Bandages; Skin Care
PubMed: 38142200
DOI: 10.1016/j.jtv.2023.12.001 -
Journal of Rehabilitation Research and... 2015Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support... (Review)
Review
Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.
Topics: Humans; Pressure Ulcer; Self Care; Self-Help Devices; Spinal Cord Injuries
PubMed: 26237111
DOI: 10.1682/JRRD.2014.02.0064 -
Journal of Advanced Nursing Oct 2014To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.
AIM
To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.
BACKGROUND
A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.
DESIGN
Consensus study.
METHOD
A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.
FINDINGS
The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.
CONCLUSION
The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework.
Topics: Humans; Los Angeles; Pressure Ulcer; Risk Assessment
PubMed: 24845398
DOI: 10.1111/jan.12444 -
Journal of Wound Care Oct 2017
Topics: Health Services Needs and Demand; Humans; Models, Organizational; Physician Assistants; Practice Patterns, Physicians'; Pressure Ulcer; United States
PubMed: 28976833
DOI: 10.12968/jowc.2017.26.Sup10.S3 -
American Family Physician Nov 2015Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because...
Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because pressure ulcers are often missed in inpatient, outpatient, and long-term care settings. High-risk patients should use advanced static support surfaces to prevent pressure ulcers and air-fluidized beds to treat pressure ulcers. Physicians should document the size and clinical features of ulcers. Cleansing should be done with saline or tap water, while avoiding caustic agents, such as hydrogen peroxide. Dressings should promote a moist, but not wet, wound healing environment. The presence of infection is determined through clinical judgment; if uncertain, a tissue biopsy should be performed. New or worsening pain may indicate infection of a pressure ulcer. When treating patients with pressure ulcers, it is important to keep in mind the patient's psychological, behavioral, and cognitive status. The patient's social, financial, and caregiver resources, as well as goals and long-term prognosis, should also be considered in the treatment plan.
Topics: Education, Medical, Continuing; Humans; Practice Guidelines as Topic; Pressure Ulcer; Risk Factors; United States; Wound Healing
PubMed: 26554282
DOI: No ID Found -
Journal of Wound Care Mar 2022To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting...
OBJECTIVE
To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery.
METHOD
A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge.
RESULTS
Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA.
CONCLUSION
Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.
Topics: Adult; Cohort Studies; Epidermis; Humans; Male; Middle Aged; Pressure Ulcer; Skin; Skin Care
PubMed: 35199594
DOI: 10.12968/jowc.2022.31.3.254 -
Journal of Wound Care Mar 2023To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence... (Review)
Review
OBJECTIVE
To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients.
METHOD
A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included.
RESULTS
In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment.
CONCLUSION
PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
Topics: Humans; COVID-19; Pressure Ulcer; Critical Care; Delivery of Health Care; Prevalence
PubMed: 36930283
DOI: 10.12968/jowc.2023.32.Sup3.S9 -
International Wound Journal Feb 2017The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four...
The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Hospitals; Humans; Indonesia; Intensive Care Units; Male; Middle Aged; Pressure Ulcer; Prevalence
PubMed: 27021798
DOI: 10.1111/iwj.12580 -
Computational Intelligence and... 2022Pressure ulcers are a type of injury that causes tissue ischemia, a deficiency of nutrition and oxygen to the tissues, and, eventually, tissue necrosis when an area of...
Pressure ulcers are a type of injury that causes tissue ischemia, a deficiency of nutrition and oxygen to the tissues, and, eventually, tissue necrosis when an area of skin is placed under constant pressure for an extended length of time. With the acceleration of the aging process, the problem of providing care for pressure ulcers for the bedridden elderly becomes increasingly urgent. This study conducts a field survey based on the research status of 221 disabled elderly in 16 communities on 7 typical streets in Beijing, focusing on the problem of pressure ulcer complications caused by bedridden. An automatic inflatable airbag mattress is designed according to anthropometric dimensions of bedridden elderly, pressure ulcer-prone areas, and the decompression standard, so that the airbag mattress can reduce the pressure in its initial shape. To achieve accurate control of the pressure in the pressure-prone areas of an airbag, air pressure control system is proposed which can control airbags individually and link multiple airbags, evaluating the safety of pressure ulcer points based on the data from sensors and making corresponding air pressure changes to reduce the possibility of generating pressure ulcers. The proposed pressure ulcer preventing system will be an efficient healthcare tool for families who had elderly bedridden patients, patients with chronic degenerative disease side effects, and terminal and postsurgical patients, as well as femur fractures, in their homes.
Topics: Aged; Beds; Beijing; Humans; Pressure Ulcer
PubMed: 35942465
DOI: 10.1155/2022/4895038