Nursing interventions for pressure injury prevention among critically ill patients: A systematic review

Abstract

Aim To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. Background Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital‐acquired pressure injuries continue to occur in these settings. Design A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) and Synthesis without meta‐analysis (SWiM) guidelines. Methods Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis. Results The review included 14 studies. Randomised controlled trials, quasi‐experimental, case series and cross‐sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device‐related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low. Conclusions Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence‐based care to prevent all types of pressure injuries, including medical device‐related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries. Relevance to clinical practice Nursing interventions should consist of evidence‐based ‘bundles’ and be adapted to patients’ needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

Systematic review: Nurses' safety attitudes and their impact on patient outcomes in acute‐care hospitals

“…For example, fall‐related injuries, medication errors and infections are the most commonly reported adverse events in acute‐care settings in Australia (Australian Institute of Health & Welfare, 2018). Similarly, pressure injuries are considered a preventable adverse event by national and international groups such as the Agency for Healthcare Research and Quality (Alshahrani et al, 2021; Chou et al., 2013), Australian Commission on Safety and Quality in Healthcare (Australian Commission on Safety & Quality in Health Care, 2019) and the US Joint Commission on Accreditation in Healthcare Organizations (The Joint Commission, 2016). Consequently, financial penalties are increasingly being imposed on healthcare providers to acknowledge the gravity and preventability of pressure injuries (Nguyen et al., 2015).…”

Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

“…PIs are associated with longer hospital stays, higher hospitalization costs (Nguyen et al, 2015), and prolonged physical or mental health conditions (Gorecki et al, 2012). They can impact the patients' quality of life (Jackson et al, 2017), ultimately increasing morbidity and mortality rates (Alshahrani et al, 2021). Factors associated with PI development in critical care patients include age, mobility/activity, poor perfusion (Alderden et al, 2017), bowel and bladder incontinence, and a moist skin due to fever and diaphoresis.…”

Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta‐analysis

“…This was suggested in other meta-analyses, which showed a similar effect of prophylactic sacral protective dressings on preventing pressure injury. [11][12][13][14][15] This requires further investigation and explanation because no clear rationale was found to explain these results. Well-designed studies are also needed to assess the factors including the combination of different ages, gender, and ethnicity, because our meta-analysis study could not answer whether these factors are associated with the results.…”

“…4 Numerous meta-analyses have examined the efficacy of prophylactically applied protective dressings. [11][12][13][14][15] A 2013 Cochrane review of prophylactic use of soft silicone foam dressings showed a decrease in pressure injury frequency in numerous studies, with inadequate indication because of the low quality of the comprised studies. 16 In an update to this meta-analysis, the indication was of very low and low graded for high risk of bias and high inaccuracy.…”

“…However, in the clinical setting, these dressings are often used prophylactically for subjects at high risk of pressure injury, especially critically ill subjects, 10 and are suggested for subject transport circumstances as a real notice to health care professionals about pressure injury inhibition 4 . Numerous meta‐analyses have examined the efficacy of prophylactically applied protective dressings 11‐15 . A 2013 Cochrane review of prophylactic use of soft silicone foam dressings showed a decrease in pressure injury frequency in numerous studies, with inadequate indication because of the low quality of the comprised studies 16 .…”