Pressure Injuries: Protocol Implementation Intervention

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Physical injuries to any region of the body bring the patient a great deal of pain and agony. Such catastrophes frequently necessitate significant lifestyle modifications in order for the affected person to recuperate quickly and avoid further harm. However, these alterations, notably extended bed rest, can lead to the formation of pressure ulcers, which are harmful to the health and well-being of patients. This project will look at a pressure injury protocol implementation intervention that begins in the emergency department.

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The first study’s findings suggest that early pressure injury surveillance and risk assessment at the moment of presentation to the ED is necessary so that prevention and treatment may begin as soon as feasible. Although managing pressure injuries in the ambulance and ED is more complicated, pressure-relieving equipment should be explored for individuals who are most at risk.

The second research discovered that various nurses have distinct responsibilities to play in PMPIs. The five CMO configurations highlighted the importance of health care organizations supporting those working to improve PMPI practices from within by creating a ward environment that promotes practice-based teaching, open communication, and seamless escalation of PI prevention and management at all levels.

The items examined to provide information to answer and complement the PICOT inquiry. The proposed research will see if a strategy started in the emergency room successfully lowers the occurrence of nosocomial pressure ulcers in patients compared to those who get standard treatment. The intervention will comprise a full-body skin examination, patient posture, and support surfaces for patients at high risk of discomfort. The intended outcome is a considerable decrease in the number of patients admitted to the emergency room with pressure-related injuries.

References

Fulbrook, P., Miles, S., & Coyer, F. (2019). Prevalence of pressure injury in adults presenting to the emergency department by ambulance. Australian Critical Care, 32(6), 509-514. Web.

Teo, C. S., Claire, C. A., Lopez, V., & Shorey, S. (2018). Pressure injury prevention and management practices among nurses: A realist case study. International Wound Journal, 16(1), 153–163. Web.

Appendix

Study 1 Study 2
Citation: (i.e., author(s), date of publication, & title)

Level of Evidence

Fulbrook, P., Miles, S., & Coyer, F. (2019). Prevalence of pressure injury in adults presenting to the emergency department by ambulance. Australian Critical Care, 32(6), 509-514.
Level: II
Teo, C. S., Claire, C. A., Lopez, V., & Shorey, S. (2018). Pressure injury prevention and management practices among nurses: A realist case study. International Wound Journal, 16(1), 153–163.
Level: I
Purpose of the Study
  • to investigate the prevalence of pressure injury in adults on arrival by ambulance to the ED.
  • To determine the prevalence of PI in adult patients presenting to the ED by ambulance.
  • To explore and explain how nurses prevent and manage PIs in one public hospital in Singapore.
  • To identify factors that influence PI prevention and management and the mechanisms through which nurses prevent and manage PIs.
Theory or Conceptual Framework
  • Current PI prevention guidelines recommend undertaking skin inspection within eight hours of hospital admission.
  • If all PIs are not identified at the hospital’s point of entry, a delay in implementing prevention and treatment strategies may occur.
  • PI found later may inadvertently be categorized as hospital-acquired, incurring a possible financial penalty in some jurisdictions.
  • Four main concepts form the basis of realistic evaluation.
  • CCMOs refer to transferable lessons derived from the analysis of the relationships between CMOs, which will only be derived upon data analysis.
  • Achieving patient safety through reducing PIs is perceived to be the intended effect of the mechanisms.
Design/ Method
  • An observational, cross-sectional descriptive study design was used.
  • Participants were recruited from the EDs of two Australian tertiary hospitals.
  • Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within one h of presentation.
  • Used a qualitative, descriptive, and explanatory case study research methodology to allow for an in-depth understanding of a phenomenon within its real-life context.
  • This design was adopted to facilitate analysis within and across the different levels of nurses to attain a holistic understanding of PMPI practices.
Sample/ Setting
  • A randomized sample of patients presenting to the ED via ambulance was surveyed to determine the presence of PI.
  • Inclusion criteria were all adult patients presenting to the ED via ambulance who could have a full-body skin inspection within one h of triage.
  • The inclusion criteria were full-time nurses aged 21 and older, directly involved in PMPIs with at least one year of working experience, and currently working in an inpatient, general ward setting.
  • The exclusion criteria were clinicians not responsible for PI prevention and management working in specialist outpatient clinics, emergency departments, and operating theatres.
Major Variables Studied and
Their Definitions
  • PI
  • IQR
  • ED
  • POST
  • NEAT
  • ED LOS
  • ATS
  • ENs
  • SNs
  • CIs
  • WNs
  • NCs
Measurement of Major Variables
  • IQR – 59-75
  • PI – 5.2%
  • NEAT – 9.1
  • ENs – 5%
  • SNs – 5%
  • CIs – 5%
  • WNs – 4%
  • NCs – 5%
Data
Analysis
  • Data were entered into SPSS™ (version 23) for analysis.
  • PI prevalence is expressed as a percentage using the formula (numerator/denominator) × 100%, where numerator = the number of consenting patients with one or more PI (all stages) and denominator = the total number of consenting patients inspected.
  • Central tendency is described using median and IQR values, with nonparametric tests used to examine sample differences and associations regarding PI occurrence, PI risk category, ambulance transfer time, on-stretcher time, and ED LOS, with significance set at p <.05.
  • Ten individual interviews and three focus FGDs were conducted.
  • Thematic analysis was adopted by first transcribing the tape-recorded interviews verbatim and, second, by reading and rereading the transcripts to gain a deeper level of familiarisation.
Study Findings
  • The prevalence of PI of patients presenting to hospital by ambulance to be 5.2%, with the majority of those identified with PI subsequently admitted to the hospital.
  • Patients at higher risk of PI have longer on-stretcher times and ED LOS, which are likely to increase their susceptibility to PI.
  • Different levels of nurses require different types of knowledge
  • Future education for PMPIs should focus more on providing hands-on opportunities, allowing nurses to gain knowledge through application rather than conventional pedagogical methods.
  • Health care organizations should be more attuned to the needs of the nurses concerning manpower and resource allocation.
Strength of the Evidence (i.e., level of evidence + quality study strengths and weaknesses)
  • Strengths:
    • Clear goals
    • Data analysis is informative
  • Weakness:
    • Lack of information about theory framework
  • Strengths:
    • The theoretical framework is shown.
    • The study has accurate paragraphs.
  • Weaknesses:
    • The setting is not precise.
    • The data analysis should have been more informative

Legend

Study 1

ED Emergency Department
PI Pressure injuries
SPSS SPSS Statistics is a software package used for interactive, or batched, statistical analysis
IQR Interquartile range
LOS length of stay
POST Patient off stretcher time
NEAT National Emergency Access Target
ED LOS Emergency department length of stay
ATS Australasian Triage Scale

Study 2

PI Pressure injuries
CCMO Conjectured context-mechanism-outcomes configurations
CMO Context, mechanism, outcomes
PMPI Standard profiling interface
FGD Focus group discussions
ENs Enrolled nurses
SNs Staff nurses
CIs Clinical instructors
WNs Wound nurses
NCs Nurse clinicians

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NursingBird. (2022, August 6). Pressure Injuries: Protocol Implementation Intervention. Retrieved from https://nursingbird.com/pressure-injuries-protocol-implementation-intervention/

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NursingBird. (2022, August 6). Pressure Injuries: Protocol Implementation Intervention. https://nursingbird.com/pressure-injuries-protocol-implementation-intervention/

Work Cited

"Pressure Injuries: Protocol Implementation Intervention." NursingBird, 6 Aug. 2022, nursingbird.com/pressure-injuries-protocol-implementation-intervention/.

References

NursingBird. (2022) 'Pressure Injuries: Protocol Implementation Intervention'. 6 August.

References

NursingBird. 2022. "Pressure Injuries: Protocol Implementation Intervention." August 6, 2022. https://nursingbird.com/pressure-injuries-protocol-implementation-intervention/.

1. NursingBird. "Pressure Injuries: Protocol Implementation Intervention." August 6, 2022. https://nursingbird.com/pressure-injuries-protocol-implementation-intervention/.


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NursingBird. "Pressure Injuries: Protocol Implementation Intervention." August 6, 2022. https://nursingbird.com/pressure-injuries-protocol-implementation-intervention/.