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British Journal of Nursing (Mark Allen... Aug 2016Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in... (Review)
Review
Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in order to accurately assess the pressure ulcer risk of vulnerable patients, and to subsequently reduce patient harm. The majority of pressure ulcers are avoidable, however, a variety of intrinsic and extrinsic factors can contribute towards the development of deep tissue injury. Understanding the body's internal responses to external pressure will enable nurses to recognise that a visual assessment alone may not necessarily identify patients at risk of deep tissue damage. This article reviews the evidence for the internal causative mechanisms of deep tissue injury, while linking to clinical practice and pressure ulcer prevention.
Topics: Humans; Nursing Care; Practice Guidelines as Topic; Pressure Ulcer; Risk Assessment; Skin; Time Factors
PubMed: 27523755
DOI: 10.12968/bjon.2016.25.15.840 -
AORN Journal Jul 2023Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and...
Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.
Topics: Child; Humans; Pressure Ulcer; Perioperative Period; Practice Guidelines as Topic
PubMed: 37368530
DOI: 10.1002/aorn.13948 -
Inquiry : a Journal of Medical Care... 2021We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four... (Review)
Review
We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm's effectiveness, we compared the incidence of medical device-related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device-related pressure injuries in this population.
Topics: Algorithms; Humans; Incidence; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 34672226
DOI: 10.1177/00469580211050219 -
The Pan African Medical Journal 2018
Topics: Aged, 80 and over; Humans; Male; Oral Ulcer; Pressure Ulcer; Tongue Diseases
PubMed: 30167058
DOI: 10.11604/pamj.2018.30.31.15007 -
Clinics in Dermatology 2018Aging results in both anatomic and physiologic changes in the skin's structure and vascular system. These vascular changes result in a wide array of dermatologic... (Review)
Review
Aging results in both anatomic and physiologic changes in the skin's structure and vascular system. These vascular changes result in a wide array of dermatologic findings, ranging from the benign to the highly morbid. Herein, we review the impact of both intrinsic and common extrinsic factors of aging on cutaneous vasculature and highlight the manifestations of microvascular, venous, arterial, lymphatic, and neuropathic alterations in the geriatric population.
Topics: Aging; Chronic Disease; Humans; Leg Ulcer; Pressure Ulcer; Skin; Skin Diseases, Vascular; Skin Ulcer; Venous Insufficiency
PubMed: 29566928
DOI: 10.1016/j.clindermatol.2017.10.015 -
Advances in Skin & Wound Care Apr 2022The authors identify and synthesize the published primary literature on unavoidable skin breakdown and end-of-life wounds known as terminal ulcers. (Review)
Review
OBJECTIVE
The authors identify and synthesize the published primary literature on unavoidable skin breakdown and end-of-life wounds known as terminal ulcers.
DATA SOURCES
Sources were identified through a systematic search of the Cochrane Library, Medline, ProQuest, EMBASE, CINAHL complete, and PubMed databases.
STUDY SELECTION
The date limiters were set between 1984 and 2020 to locate primary qualitative, quantitative, and/or mixed-methods studies on terminal ulcers.
DATA EXTRACTION
Investigators examined 180 sources and ultimately included four quantitative studies in this review. All were conducted in the US and published between 1989 and 2019. Retrospective chart audits of deceased patients' medical files were undertaken in three of the studies, and prospective observations were used in the fourth.
DATA SYNTHESIS
Descriptive and inductive content analyses were conducted. Three categories emerged: (1) distinguishing the ulcer development patterns, (2) identifying the ulcer characteristics, and (3) delivering specialized and individualized end-of-life care.
CONCLUSIONS
Limited primary evidence has been published on terminal ulcers. Pressure injuries and terminal ulcers have similar appearances, but their development differs significantly. The lack of a specific terminal ulcer assessment tool and staging system increases the risk of these unavoidable end-of-life wounds being incorrectly assessed and managed as pressure injuries. Further research on terminal ulcers is needed to inform clinical practice and ensure specialized care is delivered to patients who develop these wounds.
Topics: Adult; Death; Humans; Pressure Ulcer; Prospective Studies; Retrospective Studies; Ulcer
PubMed: 34693923
DOI: 10.1097/01.ASW.0000798032.98853.95 -
Deutsche Medizinische Wochenschrift... Jul 2016
Meta-Analysis Review
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages, Hydrocolloid; Confounding Factors, Epidemiologic; Humans; Pressure Ulcer; Prevalence; Registries; Risk Factors; Treatment Outcome
PubMed: 27404927
DOI: 10.1055/s-0042-108143 -
Nursing Standard (Royal College of... May 2015National and international guidelines recommend the use of clinical assessments and interventions to prevent pressure-related skin damage. This includes the...
National and international guidelines recommend the use of clinical assessments and interventions to prevent pressure-related skin damage. This includes the categorisation of pressure ulcers as avoidable or unavoidable, which is challenging in clinical practice, mainly because of poor documentation and record-keeping for care delivered. Documentation and record-keeping are influenced by the individual's employing organisation, maintenance procedures for documentation and record-keeping, and local auditing processes. A transfer sticker to enable patient assessment and promote pressure ulcer documentation was designed and implemented. The transfer sticker captures the date, time and location of a pressure ulcer preventive risk assessment and the plan of care to be implemented. The increased clarity of record of care achieved by using the transfer sticker has enabled the number of avoidable hospital-acquired pressure ulcers resulting from poor documentation on admission or ward transfers to be reduced. The transfer sticker helps staff identify patients at risk and allows interventions to be implemented in a timely manner.
Topics: Documentation; Humans; Nursing Assessment; Pressure Ulcer; Risk Assessment; United Kingdom
PubMed: 25942987
DOI: 10.7748/ns.29.36.56.e9674 -
International Journal of Palliative... May 2015It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article... (Review)
Review
It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).
Topics: Evidence-Based Practice; Humans; Nutritional Status; Pain Measurement; Practice Guidelines as Topic; Pressure Ulcer; Risk Assessment; Skin; Terminal Care
PubMed: 26107544
DOI: 10.12968/ijpn.2015.21.5.225 -
The Cochrane Database of Systematic... Sep 2015Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony... (Review)
Review
BACKGROUND
Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers.
OBJECTIVES
To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting.
SEARCH METHODS
In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria.
MAIN RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure ulcers. Well-designed trials addressing important clinical, quality of life and economic outcomes are justified, based on the incidence of the problem and the high costs associated with pressure ulcer management.
Topics: Humans; Patient Care Team; Pressure Ulcer
PubMed: 26373268
DOI: 10.1002/14651858.CD011011.pub2