Pressure Ulcer Prevention System

Pressure ulcers, also known as bedsores, are a widespread but often understated problem. A pressure ulcer is an injury that develops with constant pressure on an area of skin for a long time. They range from bruises to open wounds to even exposed bone. These injuries especially impact bedridden and elderly hospital inpatients, since these people must depend on nursing staff for mobility. Pressure ulcers can seem to be a solved problem. Solutions that completely eliminate pressure ulcers do exist. These solutions, however, are too expensive for widespread use, at thousands of dollars per bed. Other solutions, such as relying on nursing staff to move all patients is not reliable, and nurses develop chronic back pain from the strain of moving so many patients so often. The Pressure Ulcer Prevention System is designed specifically to be an affordable solution for these injuries in a hospital or assisted living setting. The system collects data from a gyroscopic sensor and multiple pressure sensors mounted on the patient, and sends an alert to the nurses’ station if a patient is at risk of developing a pressure ulcer, and needs attending. The system does not replace nurse care, nor does it change the most common solution of manually moving patients, but it instead helps nursing staff be more efficient

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

Interdisciplinary Research That Demonstrates the Role of Nurses in Improving the Quality of Care

Describes RWJF's Interdisciplinary Nursing Quality Research initiative, which conducted forty studies into practices, processes, and work environments to determine nurses' impact on patient care quality. Profiles nurse-led quality improvement projects

What Can We Learn From the Existing Evidence of the Business Case for Investments in Nursing Care: Importance of Content, Context, and Policy Environment

Decisions of health care institutions to invest in nursing care are often guided by mixed and conflicting evidence of effects of the investments on organizational function and sustainability. This paper uses new evidence generated through Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded research and published in peer-reviewed journals, to illustrate where the business case for nursing investments stands and to discuss factors that may limit the existing evidence and its transferability into clinical practice. We conclude that there are 3 limiting factors: (1) the existing business case for nursing investments is likely understated due to the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability; (2) studies rarely devote sufficient attention to describing the content and the organization-specific contextual factors, thus limiting generalizability; and (3) fragmentation of the current health care delivery and payment systems often leads to the financial benefits of investments in nursing care accruing outside of the organization incurring the costs, thus making potentially quality-improving and cost-saving interventions financially unattractive from the organization\u27s perspective. The payment reform, with its emphasis on high-quality affordable patient-centered care, is likely to strengthen the business case for investments in nursing care. Methodologically rigorous approaches that focus on broader societal implications of investments in nursing care, combined with a thorough understanding of potential barriers and facilitators of nursing change, should be an integral part of future research and policy efforts

Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT

Background: Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting: The trial was set in 42 secondary and community inpatient facilities in the UK. Participants: Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures: Time to event. Results: From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations: A lower than anticipated event rate. Conclusions: In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work: Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration: Current Controlled Trials ISRCTN01151335. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information

The Effect of Standardized Photodocumentation on Coding of Pressure Injuries

Background and Purpose: Pressure injuries (PI) are prevalent and costly for hospitals. Hospitals implement different practices to accurately document PIs ranging from pen and paper to photodocumentation in electronic medical records (EMRs). In some instances, PIs that have been documented are not coded for billing and reporting. The purpose of this study is to determine if different documentation practices affect the number of coded PIs. Methods: Counts of coded PIs were collected from 2011- 2017 from two hospitals: a 500-bed acute care hospital (ACH) and a 42-bed acute rehabilitation hospital (ARH). A series of PI documentation practices were implemented over the course of the six years data were collected. The aim of the changes were to improve the accuracy of wound assessment, facilitate transparent and accurate reporting, and improve care. The four documentation practice time periods included 1) baseline, 2) PI photodocumentation with paper and all paper charting, 3) PI photodocumentation on paper and EMR for all other charting, and finally 4) all charting and documentation in the EMR. Results: In the 500-bed facility, a statistically significant difference was found in the mean number of PIs coded among the four documentation periods (F(3) = 45.460; p \u3c 0.001), with the highest number of PI’s reported during PI photodocumentation with paper and all paper charting. In the ARH there was a statistically significant difference in the average number of PIs among the four different documentation periods (Period 1-ARH Mean = 56, Period 2-ARH Mean = 31, SD = 11.3, Period 3-ARH Mean = 36.1, SD = 14.4, Period 4-ARH Mean = 58.7, SD = 11.3; F(3) = 5.994; p = 0.006). In post hoc analysis a significant difference between Period 2-ARH and Period 4-ARH (p = 0.036), as well as between Period 3-ARH and Period 4-ARH (p = 0.005) was observed. Discussion: Changes in documentation practice coincided with significant changes in the number of PIs being coded in the ACH and ARH. Improper or inaccurate documentation of PIs has the potential to result in inaccurate coding and therefore missed payment for services provided. More serious PIs that are not coded properly may cost the facility thousands of dollars in missed payments. Accurate assessment and subsequent coding of PIs ensures the facility is fairly compensated for services provided

The Role of Nurses in Hospital Quality Improvement

Presents findings from interviews with hospital executives on the role nurses play in efforts to improve the quality of hospital care, factors affecting their involvement, and the challenges they face. Describes common quality improvement programs

Exploring Key Factors Required for Hybrid Systems: Analysis of a Focus Group

Background: There is a continued focus in healthcare that NHS Trusts must make cost savings while ensuring quality and productivity is not adversely affected. It is essential that health care professionals have access to pressure reduction/redistributing equipment that is evidence based and can promote skin integrity via adequate reduction of excessive pressures and/or shearing forces. This paper presents the results of a focus group exploring perceptions of a new hybrid mattress and its application to clinical practice. Hybrid systems are increasingly being used in clinical practice to assist in the prevention and management of pressure ulcers (PUs). Innova Care Concepts have launched a new hybrid system, The Solment Serene. Methods: A focus group design was used involving 5 Tissue Viability Key Opinion Leaders including an academic, infection control and tissue viability specialists. All data was recorded and transcribed verbatim, data generated was analyzed thematically. Confidentiality and anonymity was assured. Results: Four key themes were identified; (1) patient suitability, (2) Ease of Use and Effectiveness, (3) the importance of inter-professional working and (4) Loss of Equipment - Promotion of cost effectiveness Conclusions: The consensus was that there is a growing place for hybrid systems in preventing and managing pressure damage effectively. Health and social care should work inter-professionally to improve patient outcomes. The development of a flowchart based on scientific evidence was recommended to assist in the decision making of appropriate equipment

Evaluating the impact of nursing and midwifery sensitive clinical quality indicators on practice

This narrative literature review aimed to examine the literature that identified clinical quality indicators (CQIs) in nursing and midwifery and that also measured the impact of nursing and midwifery practice on CQI implementation and outcome. Specifically, the review objectives were to: (a) examine the evidence that reviewed how quality indicators are being used to influence care delivered by nursing and midwifery practitioners, and (b) from the evidence reviewed, identify the quality indicators that are most readily applied to nursing and midwifery practice in NHS Highland. Nurse and midwifery sensitive CQIs are quantitative measures which reflect professional care standards that monitor and evaluate particular aspects of care for which nurses and midwives have key responsibility. This narrative literature review considered the nurse and midwifery CQIs that have been implemented in NHS Scotland and identified themes from these indicators which reflect the nurse or midwives' distinct professional contribution to CQI outcomes. Additionally, factors have been identified that have been shown to support successful implementation of nurse and midwife sensitive CQIs into clinical practice

Description of Medical-Surgical Nurses Care of Patients at Risk for Pressure Ulcers

Aim: The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and perceptions of implementing PU prevention measures in nurses caring for patients in medical-surgical units. Method: The study was conducted in three (3) community hospitals within the same healthcare system using an Interpretive Description approach. Six (6) focus groups were conducted including thirty (30) participants. Findings: Participants described their knowledge of PU development and prevention as good and perceived continuing education as important in maintaining knowledge levels. Two (2) methods of identifying patients at risk for PU development were described: the Braden Scale and common patient diagnoses and conditions known to be associated with patients at risk for PU. Factors perceived to facilitate nurses\u27 implementation of PU prevention measures included personal motivation, use of evidence-based treatment protocols, availability of expert consultants, and leadership support. Barriers to nurses\u27 implementation of PU prevention measures perceived by study participants included the need to prioritize competing patient needs; lack of equipment and supplies; inadequate numbers and competency of staff; patient\u27s lack of or inability to cooperate; and family involvement. Finally, regulatory mandates limiting payment for hospital acquired PU were perceived by participants as a necessary measure and positive motivator in their implementation of PU prevention measures. Implications: Additional studies are needed to further describe differences between medical versus surgical patients and settings, the influence of patient families on nurses\u27 ability to provide care, and the influence of nurse leader and organizational culture on nurse motivation and performance. Organizations should implement evidence-based practice protocols, continue to provide ongoing education regarding PU prevention measures, and seriously consider adoption of the Wound Care Nurse role