Impact of Pressure Injury Prevention Protocol in Home Care Services on the Prevalence of Pressure Injuries in the Dubai Community

Abstract

<b><i>Background:</i></b> Pressure injuries (PIs) in the community have emerged as a health care burden in the past few years, leading to high rates of morbidity and mortality among the elderly population. There is evidence that simple risk assessment tools and protocols have reduced the prevalence of PIs considerably by shifting the focus to timely prevention and adequate management. The prevalence of PIs is high in home care setting and utilizes a major share of the organizational resources for its treatment and prevention. <b><i>Aim:</i></b> This study aims to assess the impact of the newly developed PI prevention protocol for home care patients in Dubai. The objectives are to evaluate effective implementation of the proposed protocol and its impact on the prevalence of PIs in the community to identify the gaps for improvement in the future. <b><i>Methods:</i></b> This retrospective observational was conducted in 13 primary health care centers in Dubai, UAE. Data were collected from 249 patients’ records at an average age of 75.5 ± 14.5 years old with compromised mobility (bedbound/chairbound) from January to July 2019. The PI prevalence was assessed before and after 6 months of implementing the PI prevention protocol and comparison was done using a standardized skin assessment scale (Braden Scale). Internationally validated tools from the Agency for Healthcare Research and Quality and National Institute for Health and Care Excellence were used to ensure the reliable use of the Braden Scale and PI protocol compliance. The prevalence was calculated from the existing key performance indicators in the home care office and considering the significant improvement at <i>p</i> value of <0.05. <b><i>Results:</i></b> The findings in the first quarter revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) to approximately 2.0%. Overall PIs prevalence declined significantly after implementing the protocol (<i>p</i> < 0.0001) among both genders. Also, a significant improvement was detected in the use of Braden Scale and multidisciplinary care plan (<i>p</i> < 0.0001). <b><i>Conclusion:</i></b> This study indicates that standardization of care delivery reduces the increased risk and incidence of PIs with a potentially positive outcome on PI prevalence.

Skin health of community-living older people: a scoping review

“…The most often investigated skin condition was melanoma and/or non-melanoma skin cancer ( n = 34) [ 22 , 23 , 26 , 48 – 56 , 60 , 61 , 63 , 64 , 66 , 69 , 71 , 73 , 75 – 80 , 82 – 84 , 86 , 89 , 93 , 94 , 97 , 101 ], three studies did not specify ‘skin cancer’ [ 32 – 34 ]. Different types of ‘eczema’ (including atopic dermatitis) were included in eight studies [ 30 , 31 , 33 , 34 , 46 , 65 , 88 , 91 ], pressure injuries [ 45 , 68 , 81 , 85 , 90 , 99 ] and psoriasis [ 29 , 33 , 34 , 57 , 58 , 100 ] each in six studies, and xerosis/ichthyosis in five studies [ 24 , 25 , 27 , 45 , 47 , 95 ]. Other studies focused on vitiligo [ 33 , 34 , 47 , 62 ] and parasites [ 33 , 34 , 47 , 92 ], bullous pemphigoid [ 59 , 87 , 98 ], intertrigo [ 67 , 74 ...…”

“…Table S7 (Supplementary material 5) describes details of the 14 articles answering review question 3. Four studies applied interventional designs [ 38 , 68 , 99 , 114 ]. Most articles ( n = 7) focused on interventions regarding ‘skin cancer’ (melanoma, melanoma and non-melanoma skin cancer, not specified), four on the prevention (sun protection, awareness/education campaigns) [ 35 , 36 , 64 , 115 ], two on screening [ 48 , 60 ] and one referred to both [ 77 ].…”

“…Most articles ( n = 7) focused on interventions regarding ‘skin cancer’ (melanoma, melanoma and non-melanoma skin cancer, not specified), four on the prevention (sun protection, awareness/education campaigns) [ 35 , 36 , 64 , 115 ], two on screening [ 48 , 60 ] and one referred to both [ 77 ]. Two articles looked into the prevention of pressure injuries, one investigating different pads in incontinent persons [ 99 ], and one introduced a pressure injury prevention protocol, including screening and risk assessment [ 68 ]. Further, two articles focused on herpes zoster, one tested a skin prick test for predicting the development of herpes zoster [ 114 ] and one the effectiveness of the vaccine in the UK [ 116 ].…”

“…Most evidence in relation to the effects of screening, risk assessment and diagnosis, prevention and treatment of skin conditions had a descriptive design and analysed incidence and/or prevalence estimates in relation to prevention of and screening for ‘skin cancer’ (Table S7, Supplementary material 5). Two studies [ 68 , 99 ] focusing on pressure injury prevention reported a reduction in pressure injury prevalence and/or incidence. One study describing a teledermatology project reported that 49.8% of patients were repatriated to their primary care physician and the most common prescriptions were ‘emollients’, ‘topical antifungal’, ‘sunscreen’ and ‘topical corticosteroids’ [ 38 ].…”

Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer

“…A study conducted in Dubai revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) of pressure ulcers, approximately 2.0% after implementing the protocol. [ 20 ] Timely and effective skincare using oil or creams reduces the occurrences of pressure ulcers.…”