The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

Lin, Frances; Wu, Zijing; Song, Bing; Coyer, Fiona; Chaboyer, Wendy

doi:10.1016/j.ijnurstu.2019.103483

Cited by 68 publications

(91 citation statements)

References 47 publications

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“…A minimum PI preventative intervention set has been developed based on international consensus, which has the potential to decrease PI incidence within intensive care. While other multicomponent bundles have been found to be effective in decreasing PI in intensive care, 24 the intervention set developed in this study specifically targets different levels of PI risk and may prove to be more effective. Furthermore, the intervention set was developed through international collaboration between experienced, senior intensive care nurses, and thus potentially may be more appropriate for far‐reaching global implementation.…”

Section: Resultsmentioning

confidence: 99%

“…Even if the intervention set as a whole is not implemented into a particular setting, this research clearly demonstrates that preventative interventions should be implemented relative to assessed level of risk and this approach should guide practice. Given that many studies which have tested PI preventative bundles have been quality improvement projects, 24 higher level research is required into the use of PI preventative bundles, and more specifically, the minimum PI preventative intervention set determined in this study. for his assistance with study conception and methodology development.…”

Section: Discussionmentioning

confidence: 99%

“…An exploratory descriptive study of prescribed and implemented PI preventative interventions in one hospital setting identified that a minimum intervention set applied to each level of PI risk would be an effective means of structuring PI preventative intervention implementation 23 . Bundled approaches have also been demonstrated to be effective in the intensive care setting 24 …”

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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Patient (age, male sex, comorbidity) and treatment (mechanical ventilation) risk factors for PI observed in the DecubICUs study contribute to a clinical paradox [5]. While multicomponent prevention bundles including frequent risk assessment, repositioning, and use of pressure redistribution surfaces are believed to reduce the incidence of PIs [6], the non-modifiable nature of contributing risk factors may mean some PIs are unavoidable [7]. PI risk is logically high in the early ICU encounter when patients may be hemodynamically unstable and treated with multiple medical devices and therapies.…”

mentioning

confidence: 99%

“…The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: a systematic review [6] 78-399 Multicomponent programs were associated with decreased pressure injury incidence. Common components include repositioning, staff/patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition assessment, documentation, and mobilization…”

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confidence: 99%

Leaving a mark: pressure injury research in the intensive care unit

Dale

Tran²,

Herridge

2021

Intensive Care Med

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Dressings and topical agents for preventing pressure ulcers

Patton,

Moore,

Boland

et al. 2024

Cochrane Database of Systematic Reviews

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Background Pressure ulcers occur when people cannot reposition themselves to relieve pressure over bony prominences. They are difficult to heal, costly, and reduce quality of life. Dressings and topical agents (lotions, creams, and oils) for pressure ulcer prevention are widely used. However, their effectiveness is unclear. This is the third update of this review. Objectives To evaluate the effects of dressings and topical agents on pressure ulcer prevention, in people of any age without existing pressure ulcers, but at risk of developing one, in any healthcare setting. Search methods We used the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, two other databases, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify the studies that are included in the review. The latest search date was November 2022. We imposed no restrictions on language, publication date, or setting. Selection criteria We included randomised controlled trials that enroled people at risk of developing a pressure ulcer. Data collection and analysis We used standard Cochrane methodological procedures. Main results In this update, we added 33 new studies, resulting in a total of 51 trials (13,303 participants). Of these, 31 studies involved dressings, 16 topical agents, and four included both dressings and topical agents. All trials reported the primary outcome of pressure ulcer incidence. Dressings Pressure ulcer incidence We made a total of 13 comparisons with 9027 participants. We present seven prioritised comparisons in the summary of findings (SoF) tables, as follows: silicone foam dressing versus no dressing (18 trials, 5903 participants; risk ratio (RR) 0.50, 95% confidence interval (CI) 0.33 to 0.77); foam dressing versus film dressing (3 trials, 569 participants; RR 0.72, 95% CI 0.20 to 2.67); hydrocellular foam dressing versus hydrocolloid dressing (1 trial, 80 participants; RR not estimable); silicone foam dressing type 1 versus silicone foam dressing type 2 (2 trials, 376 participants; RR 0.80, 95% CI 0.56 to 1.15); foam dressing versus fatty acid (2 trials, 300 participants; RR 1.67, 95% CI 0.49 to 5.72); polyurethane film versus hydrocolloid dressing (1 trial, 160 participants; RR 0.58, 95% CI 0.24 to 1.41); and hydrocolloid dressing versus no dressing (2 trials, 230 participants; RR 0.60, 95% CI 0.46 to 0.78). All low or very low‐certainty evidence. The evidence is very uncertain about the effect of dressings on pressure ulcer development. Pressure ulcer stage Three comparisons reported pressure ulcer (PU) stage. Silicone foam dressing versus no dressing: PU stage 1 (8 trials, 1823 participants; RR 0.32, 95% CI 0.13 to 0.79); PU stage 2 (10 trials, 2873 participants; RR 0.47, 95% CI 0.30 to 0.73); PU...

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The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

Abstract: The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review.

Cited by 68 publications

References 47 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

Leaving a mark: pressure injury research in the intensive care unit

Dressings and topical agents for preventing pressure ulcers

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