Interactive Evidence-Based Pressure Injury Education Program for Hospice Nursing: A Quality Improvement Approach.

PURPOSE: The purpose of this quality improvement (QI) project was to develop and implement an interactive, evidence-based pressure injury (PI) education program and evaluate the impact on frontline hospice nursing staff knowledge and practice. PARTICIPANTS AND SETTING: The QI setting was a 12-bed inpatient hospice unit in a tertiary care Veterans Affairs (VA) Medical Center in Cleveland, Ohio. Nineteen licensed and unlicensed hospice nursing staff participated in this pre-/postworkshop project. APPROACH: Chart audit determined baseline PI incidence and prevalence on the inpatient hospice unit. Interviews with key leaders informed the need to develop and implement innovative PI education opportunities. A literature review determined existing standards regarding the benefits of PI education for nursing staff but did not reveal measurable targets in hospice settings. We developed a PI education intervention based on Kolcaba's Theory of Comfort framework and a Plan-Do-Study-Act (PDSA) performance improvement model. Education was delivered in 7 workshops, lasting 2 hours each. Knowledge, practice, and comfort for inpatient hospice nursing staff were evaluated at baseline and 8 weeks following the final refresher visit. Workshop satisfaction was collected once using standard program evaluation forms after final workshop delivery. OUTCOMES: We observed a significant improvement in staff PI knowledge (P = .001) and practice (P = .001) after initial workshop attendance and repeat engagement (P = .001). There was a large magnitude of effect for overall knowledge change (d = 1.04); similarly PI care planning and practice showed a large magnitude of effect and significant improvement (P = .001, d = 2.64). Staff comfort with job duties was stable with low effect size (mean 4.52, d = 0.04), and satisfaction with the workshop education was high (100% agreement with trainer effectiveness). IMPLICATIONS FOR PRACTICE: We found that frontline hospice nursing staff knowledge and practice improved after attendance at our evidence-based PI education program. Results of this QI project have stimulated ongoing discussion on how to sustain this program in our hospice setting.

A novel topical oxygen treatment for chronic and difficult-to-heal wounds: case studies.

BACKGROUND: Pressure ulcers are one of the most prevalent causes of morbidity in patients with spinal cord injury (SCI). For those requiring hospital-based management, conventional wound management may necessitate a prolonged institutional stay. This may subsequently increase the likelihood of comorbidities and increase the social, psychological, and financial burdens associated with wound management. Therefore, novel adjunct treatments that potentiate improved healing rates should be seriously considered. STUDY DESIGN: Case reports. OBJECTIVE: To observe the efficacy of the EpiFLO device as an adjunct treatment modality in chronic wound management. SETTING: An SCI unit at a Veterans Affairs Medical Center. METHODS: Three men with SCI, who each presented with a stage IV pressure ulcer in the pelvic region, were treated with the EpiFLO device as an adjunct therapy. In Case 1, the patient was monitored for 9 weeks, whereas in Cases 2 and 3, the patients were monitored for 5 weeks. Healing was determined on a weekly basis by wound dimensions and volume, which were compared before and after the intervention. RESULTS: Comparison of pre- and posttreatment outcome measurements showed significant improvement with EpiFLO in each case. CONCLUSION: EpiFLO seems to have had a positive effect on the healing rate of chronic pressure ulcers in individuals with SCI.

Independent home use of a brain-computer interface by people with amyotrophic lateral sclerosis.

OBJECTIVE: To assess the reliability and usefulness of an EEG-based brain-computer interface (BCI) for patients with advanced amyotrophic lateral sclerosis (ALS) who used it independently at home for up to 18 months. METHODS: Of 42 patients consented, 39 (93%) met the study criteria, and 37 (88%) were assessed for use of the Wadsworth BCI. Nine (21%) could not use the BCI. Of the other 28, 27 (men, age 28-79 years) (64%) had the BCI placed in their homes, and they and their caregivers were trained to use it. Use data were collected by Internet. Periodic visits evaluated BCI benefit and burden and quality of life. RESULTS: Over subsequent months, 12 (29% of the original 42) left the study because of death or rapid disease progression and 6 (14%) left because of decreased interest. Fourteen (33%) completed training and used the BCI independently, mainly for communication. Technical problems were rare. Patient and caregiver ratings indicated that BCI benefit exceeded burden. Quality of life remained stable. Of those not lost to the disease, half completed the study; all but 1 patient kept the BCI for further use. CONCLUSION: The Wadsworth BCI home system can function reliably and usefully when operated by patients in their homes. BCIs that support communication are at present most suitable for people who are severely disabled but are otherwise in stable health. Improvements in BCI convenience and performance, including some now underway, should increase the number of people who find them useful and the extent to which they are used.

Reliability of electronic versus manual wound measurement techniques.

OBJECTIVE: To compare the accuracy and reliability of 3 wound measurement techniques, including linear and 2 electronic techniques--Visitrak and the VeV MD system. DESIGN: Repeated measures involving forty 2-dimensional "wounds" with a range of clinically relevant sizes were created using regular paper. Blinded observers measured the surface areas of wounds in 2 sessions, using 3 techniques. SETTING: Research department of a tertiary referral center. PARTICIPANTS: Four blinded observers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mixed linear models were fitted to determine interobserver and intraobserver variability. The average root mean square error (RMSE) for each measurement technique was determined to investigate the accuracy. RESULTS: Intraobserver variation was not significant in most measurement techniques. Interobserver variation was significant for all techniques. Linear measurements showed the highest RMSE, whereas VeV and Visitrak were comparable. CONCLUSIONS: Reliability of repeated wound measurements for all techniques can be achieved only with the same observer. Linear measurement has the least accuracy in evaluating wound size, VeV is slightly better than Visitrak for large wounds, and Visitrak is slightly better than VeV for small wounds. Our study shows that the use of electronic devices is superior to manual techniques to achieve valid measurements of wound area.