Are pressure injuries related to skin failure in critically ill patients?

Nowicki, Jake; Mullany, Daniel; Spooner, Amy J.; Nowicki, Tracy; Mckay, Peta M.; Corley, Amanda; Fulbrook, Paul

doi:10.1016/j.aucc.2017.07.004

Cited by 46 publications

(42 citation statements)

References 27 publications

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“…In Australia, a comparative study of one state's public hospitals over 3 years found that people admitted to intensive care had significantly more hospital‐acquired PI than those admitted to other areas (11.5% vs 3%), and were 3.8 times more likely to develop a PI 9 . These significant differences were evident in another Australian study in one tertiary hospital, with intensive care hospital‐acquired PI incidence 10‐fold greater than that of other settings 11 . Similarly, a German comparative study in 256 participating hospitals over 8 years found that intensive care‐acquired PI prevalence was 14.9%, compared to 3.9% in general wards 10 …”

Section: Introductionmentioning

confidence: 96%

“…While PI prevalence across hospital settings is significant, 4 critically ill people admitted to intensive care are particularly vulnerable to PI 9‐11 . A systematic review of PI in intensive care reported that, internationally between 2002 and 2017, PI prevalence was as high as 23.8%, with the 95% confidence interval of cumulative incidence as high as 29.5% 12 .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the ability of a critically ill person to react to tissue pressure may also be diminished by treatment with sedatives, analgesia, and muscle relaxants 16,17 . It is contended that some PI associated with intensive care may thus be unavoidable 2,11,18 . Nonetheless, prevention measures are key to patient safety 1,19…”

Section: Introductionmentioning

confidence: 99%

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International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

Lovegrove

Fulbrook

Miles

2020

International Wound Journal

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The aim of this modified Delphi study was to determine a minimum pressure injury preventative intervention set for implementation relative to critically ill patients' risk level. Preventative interventions were identified via systematic review, risk levels categorised by an intensive‐care‐specific risk‐assessment‐scale (COMHON Index), and panel members (n = 67) identified through an international critical care nursing body. Round 1: panel members were asked to rate implementation of 12 interventions according to risk level (low, moderate, high). Round 2: interventions were rated for use at the risk level which received greatest round 1 support. Round 3: interventions not yet achieving consensus were again rated, and discarded where consensus was not reached. Consensus indicated all patients should receive: risk assessment within 2‐hours of admission; 8‐hourly risk reassessment; and use of disposable incontinence pads. Additionally, moderate‐ and high‐risk patients should receive: a reactive mattress support surface and a heel off‐loading device. High‐risk patients should also receive: nutritional supplements if eating orally; preventative dressings (sacral, heel, trochanteric); an active mattress support surface; and a pressure‐redistributing cushion for sitting. Repositioning is required at least 4‐hourly for low‐risk, and 2‐hourly for moderate‐ and high‐risk patients. Rigorous application of the intervention set has the potential to decrease pressure injuries in intensive care.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

Lovegrove

Fulbrook

Miles

2020

International Wound Journal

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“…For example, funding penalties for stages 3 and 4, and more recently, unstageable injuries, may apply in Queensland, Australia 8. While there is broad consensus that some PI are unavoidable, most are considered preventable 9,10…”

Section: Introductionmentioning

confidence: 99%

Australian Nurses' Knowledge of Pressure Injury Prevention and Management

Fulbrook

Lawrence

Miles

2019

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The aim of this study was to assess nurses' knowledge of pressure injuries in order to gather benchmark data, identify knowledge gaps, and based on results, implement educational strategies to improve practice. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: The study setting was a large Australian tertiary general hospital employing approximately 2500 nurses in both full-time and part-time roles. A proportional sample (25%) stratified by experience, preparation, and facility-generated categories (nursing grade) was generated. The sample included nursing students and nursing assistants. Three hundred six participants completing the survey. INSTRUMENT: The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZPUKT) version 2, comprising 72 statements, with 3 subscales (prevention/risk, staging, and wound description) was used to measure pressure injury knowledge. Item responses are “True,” “False,” and “Don't know.” For the purpose of analyses, correct responses were scored 1, and incorrect or “don't know” responses were scored 0. Generally accepted ranges of scoring for the original PZPUKT specify less than 70% as unsatisfactory, 70% to 79.9% as satisfactory, 80% to 89.9% as good, and 90% and greater as very good knowledge of pressure injury prevention. METHODS: The survey was advertised throughout the hospital by strategically placed posters, computer screen savers within the hospital, and e-mails. Respondents completed paper-based questionnaires and data were manually entered online. Data were collected between September 2015 and October 2016. Descriptive and nonparametric inferential statistical tests (Mann-Whitney U , Kruskal-Wallis H ) were used to analyze within sample differences in scores. RESULTS: The overall mean knowledge score was 65%; approximately two-thirds of the sample (68%) scored 60% and greater, reflecting an unsatisfactory knowledge level of pressure injury prevention according to the original PZPUKT scores. The lowest mean scores were found in the “wound description” subscale. Participants who sought pressure injury information via the Internet or had read pressure injury guidelines scored significantly higher than those who did not ( P = .001 and P < .001, respectively). Seventeen items were answered incorrectly by over half of participants, identifying important knowledge deficits, particularly within the wound description subscale. CONCLUSIONS: When compared with results from studies using the PZPUKT, we contend that a cutoff score of 60% and greater (instead of ≥70%) should be used to indicate an overall satisfactory score. Our results identified deficits in pressure injury knowledge related to seating support and seated individuals and wound dressings as areas where nurses would benef...

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“…Intensive care patients are at high risk of developing pressure injuries (PIs) because of their illness severity, vasopressor use, poor tissue perfusion, comorbidities immobility, mechanical ventilation, infrequent repositioning, and use of medical devices that come in contact with the skin and apply sustained tissue deformations . Common areas for PIs to develop include the sacrum, heels, mouth, ears, and nose .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

Barakat‐Johnson

Lai

Gefen

et al. 2018

International Wound Journal

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This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post‐test design with a historical control group was used in a 54‐bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty‐four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger‐scale study.

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Are pressure injuries related to skin failure in critically ill patients?

Cited by 46 publications

References 27 publications

International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

International consensus on pressure injury preventative interventions by risk level for critically ill patients: A modified Delphi study

Australian Nurses' Knowledge of Pressure Injury Prevention and Management

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

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