Understanding Skin Failure: A Scoping Review.

OBJECTIVE: To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES: The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION: Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION: Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS: Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS: Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.

Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review.

PURPOSE: Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. METHODS: This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. RESULTS: From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. CONCLUSION: Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.

Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review.

GENERAL PURPOSE: To present a systematic review of the literature conducted to define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in adult intensive care patients. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Outline the background information helpful for understanding the authors' systematic review of ASF in adult intensive care patients.2. Summarize the results of the authors' review of the risk factors, causes, and antecedent conditions of ASF in adult intensive care patients. ABSTRACT: To define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in the adult intensive care patient cohort.The Cochrane Library, Joanna Briggs Institute Evidence-Based Practice Database, PubMed, Medical Literature Analysis and Retrieval System, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar.Studies were selected if they were qualitative or quantitative research that reported ASF in adult human patients in an ICU setting. The preliminary search yielded 991 records and 22 full texts were assessed for eligibility. A total of three records were included. Studies were appraised using the Mixed Methods Appraisal Tool.Data from the included studies were extracted by one reviewer and summarized in data collection tables that were checked and verified by a second reviewer.Study authors identified five independent predictors of ASF: peripheral vascular disease, mechanical ventilation longer than 72 hours, respiratory failure, liver failure, and sepsis. However, the term ASF was applied to retrospective cohorts of patients who developed severe pressure injuries. This, combined with the absence of evidence surrounding the assessment, clinical criteria, and diagnosis of ASF, could impact these variables' predictability relative to the condition.These results highlight a substantial evidence gap regarding the etiology, diagnostic biomarkers, and predictors of ASF. Further research focused on these gaps may contribute to an accurate and agreed-upon definition for ASF, as well as improved skin integrity outcomes.

Daily 2% chlorhexidine gluconate bath wash in a tertiary adult intensive care and high dependency units to reduce risk of hospital acquired multi resistant organisms: a best practice implementation project.

BACKGROUND: There is growing evidence that the incidence of hospital acquired multi resistant organisms are increasing worldwide. Intensive care patients are particularly prone to hospital-acquired infections. In an effort to combat increasing nosocomial infections rates within the intensive care/high dependency unit setting, Canberra Hospital has implemented a daily 2% chlorhexidine gluconate bath wash in combination as part of a best practice policy to reduce hospital acquired multi resistant organism rates of colonization. This project focused on auditing the extent to which the protocol was implemented and on promoting its implementation. OBJECTIVES: The primary aim of this evidence implementation project was to promote best practice in the use of 2% chlorhexidine gluconate body cleansing in the Canberra Hospital intensive care unit and high dependency unit settings. A secondary aim was to improve intensive care/high dependency unit patient outcomes and resource utilization. METHODS: The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in 2% chlorhexidine gluconate wash health practice. A baseline audit was conducted followed by a three-prong education approach strategy targeted at clinicians and finalized using a follow-up audit. RESULTS: There was an improvement in best practice for all criteria monitored in the follow-up audit compared to the initial audit. The most significant improvement was education and allergy assessment with 90% and 46% improvements respectively. Wipe application compliance improved by 28% to 55%, suggesting a need for continual education. Minor decreases in compliance were also noted in allergy documentation and application technique by 2% and 7% respectively. CONCLUSIONS: The project was successful in increasing knowledge surrounding 2% chlorhexidine gluconate wash administration and has provided a future direction for sustaining evidence-based practice change. Further audits will need to be carried out in order to maintain the practice change and support sustained implementation of the best practice protocol.