Effect of the guideline implementation “Risk assessment and prevention of pressure ulcers” of the Registered Nurses‘Association of Ontario (RNAO)
e202109126
Keywords:
Pressure ulcer, Clinical practice guideline, Evidence-based practice, Prevalence, Nursing assessment, Translational medical researchAbstract
Background: The Best Practice Spotlight Organizations® Program is being developed in Spain to reduce the variability of clinical practice by implementing clinical practice guidelines from the Registered Nurses’ Association of Ontario. This study described the results of the implementation of the guide “Risk assessment and prevention of
pressure ulcers”.
Methods: We carried out a retrospective observational study (2015-2018) at the Hospital Universitario Virgen de las Nieves on 4,464 patients from 22 hospitalization units, analyzing type of unit, risk assessment, preventive measures, origin and category of ulcers. Descriptive analysis and contingency tables were performed with the Chi-square statistic p<0.05.
Results: The patients at risk were 62.2% in medical units, 53.4% in surgical units and 90% in intensive care. The application of preventive measures was 67.9%, 60.2% and 92.1% (respectively) for each unit. In medical units, 13.1% of pressure ulcers were identified, of which 68.1% were present at the time of admission. While in surgical units and intensive care they developed during hospitalization (60.8% and 88.9% respectively) (p<0.001). The presence of ulcers seemed to show a decreasing trend in the years analyzed (19.6% to 11.2%).
Conclusions: There are favorable environments for implantation (medical units and intensive care) that reflect a higher level of risk assessment, use of pressure management surfaces and a decrease in prevalence. The recommendations have not been implemented homogeneously, with differences depending on the type of unit.
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References
Lang ES, Wyer PC y Haynes RB. Knowledge translation: closing the evidence-to-practice gap. Annals of emergency medicine. 2007; 49:355–63. https://doi.org/10.1016/j.annemergmed.2006.08.022
Jordan Z, Lockwood C, Munn Z et al. Redeveloping the JBI Model of Evidence Based Healthcare. Int J Evid Base Healthc.2018; 16:227–41. https://doi.org/10.1097/XEB.0000000000000139
Grol R, Wensing M, Eccles M et al. Improving Patient Care: The implementation of Change in Clinical Practice. 2ª ed. Elsevier; 2013.392 p. ISBN: 978-1-118-52597-5.
Morris ZS, Wooding S y Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine. 2011; 104:510–20. https://doi.org/10.1258/jrsm.2011.110180
Lockwood C, Porritt K, McArthur A et al. An introduction to evidence implementation. In: Porritt K, McArthur A, Lockwood C, Munn Z (Editores). JBI Handbook for Evidence Implementation. JBI. 2019. [consultado el 14/12/2020]. Disponible en: https://implementationhandbook.joannabriggs.org
Straus S, Tetroe J, Graham ID et al. Monitoring and evaluating knowledge. En: Straus S, Tetroe J, Graham ID, editores. Knowledge translation in health care. Oxford, UK: Wiley-Blackwell; 2009:151-159.
Graham ID, Logan J, Harrison MB et al. Lost in knowledge translation: time for a map?. The Journal of continuing education in the health professions. 2006; 26:13–24. https://doi.org/10.1002/chp.47
Grimshaw JM, Eccles MP, Lavis JN et al. Knowledge translation of research findings. Implement sci.2012;7:50. https://doi.org/10.1186/1748-5908-7-50
Registered Nurses Association of Ontario (RNAO). Toolkit: Implementation of best practice guidelines. 2ª ed. 2012.[Consultado 2/11/2020]. Disponible en: http://rnao.ca/sites/rnao-ca/files/RNAO_ToolKit_2012_rev4_FA.pdf].
González-María E, Moreno-Casbas MT, Albornos-Muñoz L et al. Grupo de Trabajo del Programa de implantación de buenas prácticas en Centros Comprometidos con la Excelencia en Cuidados®. Implantación de Guías de Buenas Prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®. Enferm Clin. 2020;30:136-144.
Grupo de trabajo sobre GPC. Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud. Actualización del Manual Metodológico. Madrid: Plan Nacional para el SNS del MSC. Instituto Aragonés de Ciencias de la Salud-I+CS; 2016 [Consultado 30/11/2020]. Disponible en: http://portal.guiasalud.es/emanuales/elaboracion_2/
Registered Nurses’ Association of Ontario. Valoración del riesgo y prevención de las úlceras por presión. 2011. [Consultado 15/11/20]. Disponible en: http://rnao.ca/sites/rnao-ca/files/D0025_UlcerasPresion_spp_01052015.pdf
Pancorbo-Hidalgo PL, García-Fernández FP, Torra JE et al. Epidemiología de las úlceras por presión en España en 2013: 4.º Estudio Nacional de Prevalencia. Gerokomos. 2014 [Consultado 12/11/2020]; 25:162-170.
Soldevilla J, Torra JE, Posnett J et al. The burden of pressure ulcers in Spain. Wounds. 2007; 7:201-206.
Gorecki C, Nixon J, Madill A et al. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability. 2012;21:3-12. doi: 10.1016/j.jtv.2011.11.001
Sinn CL, Tran J, Pauley T et al. Predicting adverse outcomes after discharge from complex continuing care hospital settings to the community. Prof Case Manag. 2016;21:127-E4. doi: 10.1097/NCM.0000000000000148
Jiang Q, Li X, Qu X et al. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China. Int J Clin Exp Pathol. 2014;7:2587-2594.
García-Molina P, Balaguer-López E, García-Fernández FP et al. Pressure ulcers’ incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units. Int Wound J. 2018;15:571-9. doi: 10.1111/iwj.12900
Pancorbo-Hidalgo PL, García-Fernández FP, Pérez-López C et al. Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en población adulta en hospitales españoles: resultados del 5º Estudio Nacional de 2017. Gerokomos. 2019 [Consultado 12/11/2020]; 30:76-86. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2019000200076&lng=es
Tayyib N, Coyer F. Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: a systematic review. Worldviews Evid Based Nurs. 2016;13:432-44. doi: 10.1111/wvn.12177
Bredesen IM, Bjøro K, Gunningberg L et al. The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study. Int J Nurs Stud. 2015;52:149-56. doi: 10.1016/j.ijnurstu.2014.07.005
Sving E, Högman M, Mamhidir AG et al. Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting. Int Wound J. 2016;13:645-54. doi: 10.1111/iwj.12337
Van Gaal BG, Schoonhoven L, Mintjes-de Groot JA et al. Concurrent incidence of adverse events in hospitals and nursing homes. J Nurs Scholarsh. 2014;46:187-98. doi: 10.1111/jnu.12063
Fulbrook P, Anderson A. Pressure injury risk assessment in intensive care: comparison of inter-rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales. J Adv Nurs. 2016; 72:680-92. doi: 10.1111/jan.12825
Leal-Felipe MLÁ, Arroyo-López MDC, Robayna-Delgado MDC et al. Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study. Aust Crit Care. 2018;31:355-61. doi: 10.1016/j.aucc.2017.11.003
National Pressure Ulcer Advisory Panel. NPUAP Pressure Injury Stages. 2016. Disponible en: http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/
Lorente-Granados MG, Quiñoz-Gallardo MD, Teixiné-Martín A et al. Implantación de la Guía de buenas prácticas en prevención de lesiones por presión: desarrollo, resultados y sostenibilidad. Enferm Clin. 2020; 30:198-211. https://doi.org/10.1016/j.enfcli.2020.04.001
Moya-Suárez AB, Canca-Sánchez JC, Enríquez de Luna-Rodríguez M et al. Factors associated with variability in the prevention of pressure ulcers. J Tissue Viability. 2018; 27:211-16. doi: 10.1016/j.jtv.2018.10.006
Gunningberg L, Stotts NA, Idvall E. Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as the foundation for future quality improvement. Int Wound J. 2011; 8:465-73. doi: 10.1111/j.1742-481X.2011.00818.x
Chaboyer W, Bucknall T, Gillespie B et al. Adherence to evidence-based pressure injury prevention guidelines in routine clinical practice: a longitudinal study. Int Wound J. 2017;14:1290-8. doi: 10.1111/iwj.12798
Latimer S, Chaboyer W, Gillespie B. Pressure injury prevention strategies in acute medical inpatients: an observational study. Contemp Nurse. 2016;52:326-40. doi: 10.1080/10376178.2016.1190657
Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2019 Jan 31; 1:CD006471. doi: 10.1002/14651858.CD006471.pub4. PMID: 30702158; PMCID: PMC6354222
Mallah Z, Nassar N, Kurdahi Badr L. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Appl Nurs Res. 2015; 28:106-13. doi: 10.1016/j.apnr.2014.07.001
Gadd MM, Morris SM. Use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting: the role of total score and individual subscale scores in triggering preventive interventions. J Wound Ostomy Continence Nurs. 2014;41:535-8. doi: 10.1097/WON.0000000000000066
Stephen-Haynes J. Implementing the NICE pressure ulcer guideline. Br J Community Nurs. 2006; 11:S16-S18. doi: 10.12968/bjcn.2006.11.Sup4.21768
Smith SK, Ashby SE, Thomas L et al. Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings. Int Wound J. 2018; 15:95-105. doi: 10.1111/iwj.12840
Barker AL, Kamar J, Tyndall TJ et al. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study. Int Wound J. 2013; 10:313-20. doi: 10.1111/j.1742-481X.2012.00979
Soban LM, Hempel S, Munjas BA et al. Preventing pressure ulcers in hospitals: A systematic review of nurse-focused quality improvement interventions. Jt Comm J Qual Patient Saf. 2011; 37:245-52. doi: 10.1016/s1553-7250(11)37032-8
Beeckman D, Clays E, Van Hecke A et al. A multi-faceted tailored strategy to implement an electronic clinical decisions support system for pressure ulcer prevention in nursing homes: a two-armed randomiz controlled trial. Int J Nurse Stud. 2013; 50: 475–486.
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Copyright (c) 2021 Mª Dolores Quiñoz Gallardo, Sergio Barrientos Trigo, Ana María Porcel Gálvez
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