ObjectiveTo determine the effectiveness of a quality management program in reducing
the incidence and severity of pressure ulcers in critical care patients.MethodsThis was a quasi-experimental, before-and-after study that was conducted in a
medical-surgical intensive care unit. Consecutive patients who had received
mechanical ventilation for ≥ 96 hours were included. A "Process
Improvement" team designed a multifaceted interventional process that
consisted of an educational session, a pressure ulcer checklist, a
smartphone application for lesion monitoring and decision-making, and a
"family prevention bundle".ResultsFifty-five patients were included in Pre-I group, and 69 were included in the
Post-I group, and the incidence of pressure ulcers in these groups was 41
(75%) and 37 (54%), respectively. The median time for pressure ulcers to
develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the
Post-I group after admission for each period. The incidence of
advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%)
in the Post-I group, and finally, the presence of pressure ulcers at
discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all
comparisons). Family participation totaled 9% in the Pre-I group and
increased to 57% in the Post-I group (p < 0.05). A logistic regression
model was used to analyze the predictors of advanced-grade pressure ulcers.
The duration of mechanical ventilation and the presence of organ failure
were positively associated with the development of pressure ulcers, while
the multifaceted intervention program acted as a protective factor.ConclusionA quality program based on both a smartphone application and family
participation can reduce the incidence and severity of pressure ulcers in
patients on prolonged acute mechanical ventilation.
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