A Multisite Quality Improvement Project to Standardize the Assessment of Pressure Ulcer Healing in Veterans with Spinal Cord Injuries/Disorders

Thomason, Susan S.; Powell‐Cope, Gail; Peterson, Matthew J.; Guihan, Marylou; Wallen, E. S.; Olney, Christine M.; Bates‐Jensen, Barbara M.

doi:10.1097/01.asw.0000482283.85306.8f

Cited by 15 publications

(13 citation statements)

References 14 publications

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“…Several reported download statistics for online tools or requests for the toolkit [11, 15, 29–31, 67, 88, 90], but most studies reported no denominator and reported the total number of downloads at the time of the publication with no further detail. Three studies that reported a point of reference stated that 2000 toolkit copies were downloaded in 7 months [11], that 725 copies had been downloaded in 1 year [15], or that the toolkit had been accessed by 8163 practitioners over 255 days [67].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies that reported a point of reference stated that 2000 toolkit copies were downloaded in 7 months [11], that 725 copies had been downloaded in 1 year [15], or that the toolkit had been accessed by 8163 practitioners over 255 days [67]. Some studies tracked which or how many individual tools included in the toolkit had been adopted by the end users [21, 24, 25, 29, 34, 35, 40, 46, 51, 56, 61, 64, 69, 75, 76, 78, 81, 88]. The evidence table shows variable uptake with no studies reporting full uptake of the toolkit.…”

Section: Resultsmentioning

confidence: 99%

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Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

et al. 2019

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Background The objective was to conduct a systematic review of toolkit evaluations intended to spread interventions to improve healthcare quality. We aimed to determine the components, uptake, and effectiveness of publicly available toolkits. Methods We searched PubMed, CINAHL, and the Web of Science from 2005 to May 2018 for evaluations of publicly available toolkits, used a forward search of known toolkits, screened references, and contacted topic experts. Two independent reviewers screened publications for inclusion. One reviewer abstracted data and appraised the studies, checked by a second reviewer; reviewers resolved disagreements through discussion. Findings, summarized in comprehensive evidence tables and narrative synthesis addressed the uptake and utility, procedural and organizational outcomes, provider outcomes, and patient outcomes. Results In total, 77 studies evaluating 72 toolkits met inclusion criteria. Toolkits addressed a variety of quality improvement approaches and focused on clinical topics such as weight management, fall prevention, vaccination, hospital-acquired infections, pain management, and patient safety. Most toolkits included introductory and implementation material (e.g., research summaries) and healthcare provider tools (e.g., care plans), and two-thirds included material for patients (e.g., information leaflets). Pre-post studies were most common (55%); 10% were single hospital evaluations and the number of participating staff ranged from 17 to 704. Uptake data were limited and toolkit uptake was highly variable. Studies generally indicated high satisfaction with toolkits, but the perceived usefulness of individual tools varied. Across studies, 57% reported on adherence to clinical procedures and toolkit effects were positive. Provider data were reported in 40% of studies but were primarily self-reported changes. Only 29% reported patient data and, overall, results from robust study designs are missing from the evidence base. Conclusions The review documents publicly available toolkits and their components. Available uptake data are limited but indicate variability. High satisfaction with toolkits can be achieved but the usefulness of individual tools may vary. The existing evidence base on the effectiveness of toolkits remains limited. While emerging evidence indicates positive effects on clinical processes, more research on toolkit value and what affects it is needed, including linking toolkits to objective provider behavior measures and patient outcomes. Trial Registration PROSPERO registration number: PROSPERO 2014: CRD42014013930 . Electronic supplementary material The online version of this article (10.1186/s13012-019-0929-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

et al. 2019

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“…Although the U.S. Department of Veterans Affairs (VA) SCI Services held a Train‐the‐Trainer Collaborative in 2011 to facilitate implementation of SCI‐PUMT in VA Centers, only half the Centers were using the tool to evaluate PrU treatment a year later. Among 206 PrU identified by medical record review, only 25% had the expected number of weekly SCI‐PUMT scores documented and severe PrU were twice as likely as less severe PrU to have had SCI‐PUMT scores documented . Facilitators to adoption of the SCI‐PUMT included strong interdisciplinary wound care teams, staff support and leadership, structured wound round processes, and use of an SCI‐PUMT template or database.…”

Section: Background and Introductionmentioning

confidence: 99%

“…Facilitators to adoption of the SCI‐PUMT included strong interdisciplinary wound care teams, staff support and leadership, structured wound round processes, and use of an SCI‐PUMT template or database. Barriers included staff resistance, lack of a centralized location for SCI‐PUMT data, and the increased workload in the face of time constraints . High‐adoption sites reported that the SCI‐PUMT helped them to formalize the wound care process and improved consistency in wound assessment and treatment, thereby enhancing communication and continuity of care.…”

Section: Background and Introductionmentioning

confidence: 99%

Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage

Gould

Bohn

Bryant

et al. 2019

Wound Repair Regeneration

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Pressure ulcers (PrUs) affect approximately 2.5 million patients and account for 60,000 deaths annually. They are associated with an additional annual cost of $43,000 per related hospital stay and a total cost to the US health care system as high as $25 billion. Despite the implementation of national and international PrU prevention guidelines and toolkits, rates of facility-acquired PrU s and PrUs in people with spinal cord injury are still high. A new paradigm is needed that distinguishes between prevention and treatment research methods and includes not only the causative factors of pressure and tissue deformation but also patient-specific anatomical differences and the concomitant biological cellular processes, including reperfusion injury, toxic metabolites, ischemia, cell distortion, impaired lymphatic drainage, and impaired interstitial fluid flow that compound existing tissue damage.

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“…The strengths of the BWAT are the use of the tool as a foundation for development of other instruments, use in clinical research trials, with a wide variety of chronic wounds, and with various populations across multiple settings. The BWAT has provided a basis for other wound assessment tools including the DESIGN‐R in Japan, the photographic wound assessment tool, the spinal cord injury pressure ulcer monitoring tool, and the diabetic foot ulcer assessment scale (DFUAS) . In each of these cases, the BWAT has been used as the reference method to validate the new instrument.…”

mentioning

confidence: 99%

Reliability of the Bates‐Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study

Bates‐Jensen

McCreath

Harputlu

et al. 2019

Wound Repair Regeneration

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The Bates‐Jensen Wound Assessment Tool (BWAT) is used to assess wound healing in clinical practice. The purpose of this study was to evaluate BWAT use among nursing home residents with pressure injury. Findings and reliability estimates from the BWAT related to pressure injury characteristics (stage, anatomic location) and natural history (resolved, persisted) among 142 ethnically and racially diverse residents are reported. In this prospective 16‐week study, 305 pressure injuries among 142 participants (34% prevalence) are described by stage, anatomic location, and BWAT scores. Visual and subepidermal moisture assessments were obtained from sacrum, buttock, ischial, and heel ulcers weekly. Participants were 14% Asian, 28% Black, 18% Hispanic, 40% White with a mean age of 78 ± 14 years, and were 62% female; 80% functionally dependent (bed mobility extensive/total assistance) and at risk (Braden Scale score 14 ± 2.7). The reliability coefficient for BWAT score (all participants, all anatomic locations) was high (r = 0.90; p < 0.0001; n = 1,161 observations). Weighted Kappas for characteristics ranging from 0.46 (skin color surrounding wound) to 0.79 (undermining) were consistent for all participants. BWAT scores showed strongest agreement coefficients for stage 4 pressure injury (r = 0.69), pressure injuries among Asian and White ethnicity/racial groups (r = 0.89, and r = 0.91, respectively), and sacrum anatomic location (r = 0.92) indicating scores are better correlated to fair skin tones. Lower agreement coefficients were demonstrated for stage 2 pressure injury (r = 0.38) and pressure injuries among African American and Hispanic ethnicity/racial groups (r = 0.88 and 0.87, respectively). BWAT scores were significantly different by pressure injury stage (F = 496.7, df = 6, p < 0.001) and anatomic location (F = 33.76, df = 8, p < 0.001). BWAT score correlated with pressure injury natural history (ulcer resolved 18.4 ± 7.4, ulcer persisted 24.9 ± 10.0; F = 70.11, df = 2, p < 0.001), but not with comorbidities. The BWAT provides reliable, objective data for assessing pressure injury healing progress.

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A Multisite Quality Improvement Project to Standardize the Assessment of Pressure Ulcer Healing in Veterans with Spinal Cord Injuries/Disorders

Cited by 15 publications

References 14 publications

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

Spread tools: a systematic review of components, uptake, and effectiveness of quality improvement toolkits

Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage

Reliability of the Bates‐Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study

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