Effective Strategies in Pressure Ulcer Prevention

Sources of literature
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Course
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Date
Gillespie, B. M., Chaboyer, W.P., Mclness, E., Kent, B., Whitty, J.A.,, & Thalib, L. (2014). Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev, 4:1-35. DOI: 10.1002/14651858.CD009958.
Focused on the effects of repositioning in preventing pressure ulcers, and how different repositioning schedules affected the incidences of pressure ulcer as well as the resource and cost implications for choosing different repositioning schedules.
The authors note that hospital acquired pressure ulcers is one of the top five adverse effects that affects hospitalized patients and increases a financial burden to hospitals. However, analysis on two trials comparing tilting at 30 and 90 degrees gave inclusive results and was at risk of Type II error, while a third randomized trial on impact of frequency in repositioning was imprecise.
Nonetheless, the less frequent repositioning schedule resulted to a cost saving, and allowed nurses to attend to other activities.
However, the article did not adequately address the role of repositioning in PU, addressing the need for more robust data on repositioning.
Peterson, M. J., Gravenstein, N., Schwab, W. K., van Oostrom, J. H., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer risk-Monitoring interface pressures of at-risk patients. Journal Of Rehabilitation Research & Development, 50(4), 477-488. doi:10.1682/JRRD.2012.03.0040
Looks into the impact of repositioning on pressure ulcers given that the techniques are at times not effective even in nondisabled persons.
The article does not provide information on the gravity of the problem, but all the participants chosen had areas where there was a high risk of pressure ulcers, with the authors relying on patient demographics and Braden score data for statistical analysis.
The authors also highlight on the need to focus on tissue-relieving effectiveness as health practitioners are at times unaware about the most effective strategies to relieve pressure.
Consequently, the authors highlight that there is a need for improvement in the repositioning technique while also focusing on at risk tissue.
Moore, Z., Cowman, S., & Conroy, R. (2011). A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. Journal Of Clinical Nursing, 20(17/18), 2633-2644. doi:10.1111/j.1365-2702.2011.03736.x
Timing repositioning affects the way occurrence of pressure ulcers just like mobility status.
The study used SPSS to obtain the chi squared test and multiple regression analysis of the risk factors.
They highlight that there is no consensus on the best way through which to carry out repositioning. This study delved into the impact of three hourly 30 degrees tilt versus the six hour 90 degree lateral rotation.
The study is relevant in addressing the problem of repositioning and presser ulcers. The 30 degrees 3 hourly repositioning choice was found to be more effective than the control group underlying the importance of choosing the most effective repositioning technique at appropriate timing.
Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., & Baumgarten, M. (2011). Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair & Regeneration, 19(1), 10-18. doi:10.1111/j.1524-475X.2010.00644.x
Repositioning is a commonly utilized technique to reduce pressure ulcers, but at times the cost implication calls into question whether the method is effective.
The GEE model was used to analyze repositioning data at the time of visiting the hospital, after admission and facilitated completion of other covariate data.
The authors focused on the impact of frequency in repositioning for 12 turns or more for an average of every 2 hours. The results of the study showed that there were no significant differences when there was a higher frequency of turning.
The implication for this is that nurses should assess the most appropriate frequency of carrying out repositioning as this has a direct impact on the hospital’s labor cost and time allocated to repositioning.
Lahmann, N., Kottner, J., Dassen, T., & Tannen, A. (2012). Higher pressure ulcer risk on intensive care? - Comparison between general wards and intensive care units. Journal Of Clinical Nursing, 21(3/4), 354-361. doi:10.1111/j.1365-2702.2010.03550.x
Delved into the divergences between pressure ulcer rate incidences between general wards, and intensive care units while controlling for risk factors.
In carrying out the study, the researchers relied on information collected form trained nurse working in different German hospitals and facilities and relied on SRISAG logistic regression model (surface, immobility, shear forces age, gender).
The risk factors for different facilities are different, and patients in intensive care wards were at a higher risk of pressure ulcers than in general wards.
Hence, when controlling for various factors, there is a need to improve quality of care in hospital settings with emphasis on repositioning and other techniques to reduce incidences of pressure ulcers.
Sullivan, N., & Schoelles, K. M. (2013). Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy. Annals Of Internal Medicine, 158410-416.
There are approximately 60,000 deaths annually in the US related to pressure ulcer complications.
Hence, the authors conduct a systematic review on the strategies that are effective in reducing PU, and they focus more on strength of evidence in findings of study data.
The article merely highlights on the need to utilize various core strategies to reduce risk of PU.
However it captures relevant information on issues likely to be encountered in prevention pressure ulcers.
Chou, R., Dana, T., Bougatsos, C., Blazina, I., Starmer, A. J., Reitel, K., & Buckley, D. I. (2013). Pressure Ulcer Risk Assessment and Prevention. Annals Of Internal Medicine, 159(1), 28-38.
The researchers conducted a systematic review of prevention pressure ulcer focusing on English- language articles.
They searched various databases delving into risk assessment and outcomes from interventions, with the review comparing the strength of evidence.
The articles did not adequately cover repositioning and its effect on prevalence of pressure ulcers, but there was strong evidence that advanced static surfaces were associated will lower pressure ulcers.
The authors did not report on the prevalence of PU in the population, but the article supports the need to focus on support surfaces to prevent pressure ulcers.
Källman, U., Bergstrand, S., Ek, A., Engström, M., Lindberg, L., & Lindgren, M. (2013). Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients. Journal Of Advanced Nursing, 69(1), 133-144. doi:10.1111/j.1365-2648.2012.06000.x
Highlight that lying positions affect tissue blood flow where 30° lateral position has a considerable decrease in blood flow than the supine positions.
Change in blood flow was calculated using Excel, the risk assessment pressure ulcer scale helped to identify patients at high risk of PU, and the other analyses were based on PASW Statistics, 18.0, 2009.
The authors state that PU affects 4.5% to 18% of hospitalized patients in Europe, and 6.3% to 20% in America.
Hence, the article is relevant in pointing out that the lying position is a crucial aspect of repositioning and to an extent patient care.
Park, S., Boyle, D. K., Bergquist-Beringer, S., Staggs, V. S., & Dunton, N. E. (2014). Concurrent and Lagged Effects of Registered Nurse Turnover and Staffing on Unit-Acquired Pressure Ulcers. Health Services Research, 49(4), 1205-1225. doi:10.1...