Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study

Abstract

ObjectiveTo determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients.MethodsThis was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle".ResultsFifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor.ConclusionA quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.

Understanding the Hawthorne effect in wound research—A scoping review

“…The authors explained that additional attention from the health care team might have altered the true effect of the interventional dressings. A similar explanation for reduced incidence of dependent variables was reported in 10 other studies …”

“…A similar explanation for reduced incidence of dependent variables was reported in 10 other studies. [33][34][35][36][37][38][39][40][41][42] The impact of HE might be heightened in studies involving subjective assessments such as wound pain. This was the case in a small three-arm RCT by Karimi et al 34 involving 57 participants.…”

“…HE in the reviewed articles was present as a passing mention and related to three purposes: justifying an aspect of the research design, 23,24,[26][27][28][29][30]53 defending unexpected findings, [32][33][34][35][36][38][39][40]44,46,54,55 and acknowledging a deficit of conducting an open-label study. 37,42,47,56,57 Regardless of the purpose, the term HE was referred to briefly and lacked definition in most of the reviewed articles.…”

Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review

“…The most common study design was RCTs ( n = 6). Regarding the PU preventive interventions, most of the featured studies focused on support surfaces, health professional's education, multiple intervention programmes, repositioning and early mobilisation, preventive skincare, prophylactic dressings, remind systems on patient care plan, and risk‐assessment tools . According to the care setting where the studies were carried out, most of them ( n = 17) were developed in intensive care units (ICU) followed by medicine ( n = 6), geriatrics ( n = 2), surgical ( n = 2), orthopaedics ( n = 2), oncology ( n = 1), rehabilitative ( n = 1), community hospital ( n = 1), and other specific units ( n = 4).…”

O Ambiente De Cuidado Em Uti Neonatal: A Percepção Dos Pais E Da Equipe De Saúde

“…Assim o envolvimento da equipe na assistência a esta família, facilita a interação entre os profissionais que por ali passam e executam suas tarefas diárias, facilitando a recuperação do RN pelo envolvimento dos pais dentro do processo de hospitalização (LOUDET et al, 2017).…”