Under pressure

Omery, Anna; Mussell, Deanna; Rondinelli, June; Ecker, Margaret; Baker, John; Shanks, Helana T.; Kleinhelter, Pam

doi:10.1097/01.numa.0000444876.62569.51

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…The expected standard of care included use of appropriate bed and chair surfaces such as mattress overlays, regular turning, repositioning, offloading pressure, and common clinical pathways for the management of nutrition and incontinence. Further description of this standard of care is in previous publications (Crawford, Corbett, & Zuniga, 2014; Omery et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

“…Higher scores indicate increasing mortality burden: The univariate 30-day mortality risk is 1.7% for scores < 40, 5.2% for scores of 40–64, and 9.0% for scores ≥ 65 (Escobar et al, 2013, 2015, 2016). For comparison, the Charlson Comorbidity Index, previously used in HAPI research for scoring the potential impact of multiple comorbidities (Gardiner, Reed, Bonner, Haggerty, & Hale, 2016; Omery et al, 2014), was also examined. In addition, presence of diabetes and stroke at admission were included.…”

Section: Methodsmentioning

confidence: 99%

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Hospital-Acquired Pressure Injury

et al. 2018

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Background Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. Objective The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. Methods Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. Results Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. Discussion Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Hospital-Acquired Pressure Injury

et al. 2018

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“…Included in the final review, following screening and eligibility, were 180 records (Figure 1). 1–58,60–63,67–187 The use of the term “skin failure” has increased over time, reaching 12 publications in 2009 and steadily increasing to a peak of 19 records in 2019 (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Understanding Skin Failure: A Scoping Review

Dalgleish

Campbell

Finlayson

et al. 2021

Adv Skin Wound Care

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OBJECTIVE To map the use of the term “skin failure” in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included “skin failure,” “acute skin failure,” “chronic skin failure,” and “end stage skin.” All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term “skin failure” was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term “skin failure” has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.

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Ethical Considerations for Healthcare Organizations

Rao¹

2020

Semin Speech Lang

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Ethical misbehavior in the delivery of healthcare creates harm not only to individual therapists and administrators who might choose to overstep ethical boundaries but also, more broadly, causes harm to patients, to healthcare organizations, to professional organizations, and ultimately to society. Both corporate codes of conduct and professional codes of ethics are important, because they set standards of conduct and penalize noncompliant or unethical conduct. The purposes of this article are (1) to differentiate corporate compliance from ethics in a healthcare organization; (2) to explain the application of ethics principles to organizational and professional behaviors; (3) to discuss three important ethical issues (cultural competence, conflict of interest, and employer demands); and (4) to emphasize that, whether applying a corporate code of conduct or a professional code of ethics (or both), the integrity of each individual is essential to ethical behavior. To illustrate these concepts, ASHA's Code of Ethics is discussed in detail (including the ethics complaint adjudication process), and hypothetical case studies are presented under the macro headings of Cultural Competence, Conflict of Interest, and Employer Demands.

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Under pressure

Abstract: Read this article to determine if nursing interventions help prevent hospital-acquired pressure ulcer (HAPU) development.

Cited by 3 publications

References 17 publications

Hospital-Acquired Pressure Injury

Hospital-Acquired Pressure Injury

Understanding Skin Failure: A Scoping Review

Ethical Considerations for Healthcare Organizations

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