International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

Abstract

The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive‐care‐specific risk‐assessment‐scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2‐hours of admission; 8‐hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate‐ and high‐risk patients should receive: a reactive mattress support surface and a heel off‐loading device. High‐risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure‐redistributing cushion for sitting. Repositioning is required at least 4‐hourly for low‐risk, and 2‐hourly for moderate‐ and high‐risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.

Authors' response to comment on “International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study”

“…We also agree with the international guideline 7 statement, "Do not rely on a total risk assessment tool score alone as a basis for risk based prevention" (p. 60). Accordingly, in our paper, 1 Our approach has been to develop evidence, based on international expert consensus, using a formal and rigorous research method, as described in our paper (p. 1114). 1 In the intensive care setting, our results demonstrated expert consensus that as risk level increases, so too should the number and intensity of preventative interventions.…”

“…Accordingly, in our paper, 1 Our approach has been to develop evidence, based on international expert consensus, using a formal and rigorous research method, as described in our paper (p. 1114). 1 In the intensive care setting, our results demonstrated expert consensus that as risk level increases, so too should the number and intensity of preventative interventions. This is also consistent with our previous findings, which indicated that as risk level increases, nurses prescribe (plan) more preventative interventions.…”

Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study

“…11 Five to fifteen experts are considered adequate to achieve content validity. 12,13 Delphi processes have previously been used to inform critical care practice including management of COVID-19, 14 preventing pressure injury 15 and identifying core outcome measures after respiratory failure. 16 The aim of this study was to gather expert consensus to identify important risk factors for NOAF during critical illness.…”

Comment on “International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study”

“…Dear Editors, With great interest, we read the recent paper by Lovegrove et al who developed pressure injury (PI) preventive interventions based on risk categories of the Consciousness, Mobility, Heamodynamics, Oxygenation, Nutrition (COMHON) Index. 1 PI prevention in clinical practice is a complex and challenging task, and initiatives aimed at guiding and improving setting-specific PI prevention are highly welcome. Because the authors use the latest International Guideline for prevention and treatment of PIs 2,3 as background for their work, some assumptions and statements should be put into context: First, citing the International Guideline, 3 the authors state: "PI prevention begins with risk assessment, which should be undertaken using a structured risk assessment scale combined with clinical judgement."…”

“…Because the authors use the latest International Guideline for prevention and treatment of PIs 2,3 as background for their work, some assumptions and statements should be put into context: First, citing the International Guideline, 3 the authors state: "PI prevention begins with risk assessment, which should be undertaken using a structured risk assessment scale combined with clinical judgement." 1 We would like to clarify that such a statement does not exist in the International Guideline. 3 We feel very concerned about this wrong and misleading citation, which Lovegrove et al 1 used to justify their risk assessment approach.…”