Pressure injury risk assessment for palliative care patients in the acute hospital setting: A scoping review

Abstract

Background: Hospitalised palliative care patients are at risk of pressure injury. The development of pressure injuries causes physical and psychological distress for patients. Therefore, the prevention of hospital-acquired pressure injury is a nursing priority. The first step in prevention is conducting a risk assessment, which should be population-specific. In Australia, five palliative care phases guide care planning for appropriate clinical management of palliative care patients. In phases 1-3, the palliative patient cohort is based on acute care, where patients require medical treatment and/or symptom management, whereas Phase 4 refers to end-of-life care. Objectives: To review and analyse contemporary literature to determine what is known about pressure injury risk assessment for acute palliative care patients and identify which pressure injury risk assessment tools are most appropriate for this cohort. Methods:This scoping review was conducted according to Joanna Briggs Institute methodology. The search strategy was developed based on the Population-Concept-Context mnemonic. Studies of any design, articles and guidelines relating to pressure injury risk assessment in acute palliative care patients were included. Publications from 2002 to 2023 from Google Advanced Search, three grey literature and five nursing/health databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Scopus, Web of Science, EMBASE) were searched. The protocol was prospectively registered with Open Science Framework. Results: From 2,576 search results, 15 articles met the inclusion criteria. None reported the use of a pressure injury risk assessment tool designed specifically for acute palliative care patients. However, 20 pressure injury risk assessment tools/methods were identified. Furthermore, the definition of palliative care patients was inconsistent, and no articles clearly defined the differences between acute palliative care patients and those at end-of-life. Conclusions: The results of this review indicate a need to develop a new PI risk assessment tool for acute palliative care patients that considers their specific risk factors. Further research is needed to address the knowledge gap relating to pressure injury risk assessment and prevention for hospitalised acute palliative care patients.