Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients.

PURPOSE: To determine whether the elimination of extended release (ER) opioids in the multimodal medication regimen of total knee replacement (TKR) patients resulted in improved patient outcomes. DESIGN: Retrospective cohort quality improvement. METHODS: This project utilizes a retrospective chart review to evaluate an institution's current postoperative pain protocol. The outcomes of interest include mean hospital length of stay, discharge disposition, mean pain score, antiemetic use, mean opioid dose used, and number of opioid discharge prescriptions. RESULTS, CONCLUSIONS, AND CLINICAL IMPLICATIONS: Sixty patients were reviewed with a mean age at 70 years for both the pre-protocol (n = 36) and post-protocol groups (n = 34). There was a reduction in antiemetic use, t(59) = 2.2, p = .03 and length of stay, t(58) = 1.0, p = .33, and more discharges to home than rehab, x2 = 60, p < .001. All patients received 30 tablets of only one opioid prescription upon discharge with no refill, either oxycodone-IR (82%, n = 49), hydromorphone (5%, n = 3), or tramadol (12%, n = 7). The project, aimed to reduce opioid overprescription and overconsumption, has the potential to improve prescribing practices, promoting patient safety and healthcare quality by supporting the current guidelines that recommend against using ER opioids for the study population.

Protocol for the Development of the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline Using GRADE Methods.

ABSTRACT: The National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance are commencing a new (fourth) edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline . The fourth edition of the International Pressure Injury (PI) Guideline will be developed using GRADE methods to ensure a rigorous process consistent with evolving international standards. Clinical questions will address prevention and treatment of PIs, identification of individuals at risk of PIs, assessment of skin and tissues, and PI assessment. Implementation considerations supporting application of the guidance in clinical practice will be developed. The guideline development process will be overseen by a guideline governance group and methodologist; the guideline development team will include health professionals, educators, researchers, individuals with or at risk of PIs, and informal carers.This article presents the project structure and processes to be used to undertake a systematic literature search, appraise risk of bias of the evidence, and aggregate research findings. The methods detail how certainty of evidence will be evaluated; presentation of relative benefits, risks, feasibility, acceptability, and resource requirements; and how recommendations will be made and graded. The methods outline transparent processes of development that combine scientific research with best clinical practice. Strong involvement from health professionals, educators, individuals with PIs, and informal carers will enhance the guideline's relevance and facilitate uptake. This update builds on previous editions to ensure consistency and comparability, with methodology changes improving the guideline's quality and clarity.

Best-practices for preventing skin injury beneath personal protective equipment during the COVID-19 pandemic: A position paper from the National Pressure Injury Advisory Panel.

COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.

Racial Disparities and Pressure Injuries Among Hospitalized Patients.

OBJECTIVE: To describe the demographic factors, hospitalization-related factors, comorbid states, and social determinants of health among racial groups in a sample of patients with a primary or secondary diagnosis of pressure injury (PI) admitted to New Jersey hospitals during the year 2018. METHODS: Researchers conducted a retrospective analysis of the Health Care Utilization Project's 2018 New Jersey State Inpatient Database. Patients with a primary or secondary diagnosis of PI (sacrum, buttocks, or heels; N = 17,781) were included in the analytic sample. Analysis compared patients who identified as Black (n = 3,515) with all other racial groups combined (n = 14,266). RESULTS: A higher proportion of Black patients were admitted for a PI (P < .001) and had higher proportions of stage 4 PIs (P < .001) but a lower proportion of stage 1 PIs (P < .001). Higher proportions of Black patients were younger, resided in lower income communities, and identified Medicaid as their primary payor source. CONCLUSIONS: Results highlight the racial disparities that exist among patients with PIs in this diverse state and may represent a much larger problem. Clinical research examining the impact of skin tone rather than by racial group is needed. The impact of racial disparities on social determinants of health with regard to PIs remains largely unknown, but its importance cannot be underestimated.

The Role of Patient Engagement in Surgical Site Infection Reduction: A Process Improvement Project.

BACKGROUND: Surgical site infections (SSIs) are the second most common healthcare-associated infection, with prevention being a high-priority goal for all healthcare organizations. Although routine surveillance and standardized prevention protocols have long been used, patient engagement is an additional intervention that should be considered and may be beneficial in SSI prevention. OBJECTIVE: To determine if the development of a standardized patient education discharge plan for management of a surgical site and/or surgical drain would contribute to a reduction in SSI rates in inpatients undergoing colorectal, plastic, or general surgery. METHODS: A preintervention/postintervention design was used. Before intervention, patients and surgeons were surveyed regarding various discharge practices related to surgical incision/drain care. The intervention consisted of implementing a standardized discharge plan including standardized education and patient discharge kits. After implementation, patients were surveyed regarding discharge practices. Patient survey responses and SSI rates were compared between the preintervention and postintervention time frames. RESULTS: Rates of SSIs decreased across all three surgical specialties during the project period: colorectal SSIs decreased from 3.2% to 2.7%, plastics from 1.2% to 0.5%, and general from 0.86% to 0.33%. Improvements were also realized in patient survey responses to various aspects of surgical incision/drain care. CONCLUSIONS: Patient engagement may be an important strategy to integrate with SSI evidence-based care bundles. Active engagement of surgical patients perioperatively has the potential to improve the patient experience, which ultimately can result in improved healthcare outcomes for this population.

Necessary Products for the Prevention and Treatment of Pressure Injuries: Lessons Learned That Translate Beyond the COVID-19 Pandemic.

OBJECTIVE: To identify the challenges encountered in obtaining the required support surfaces and products to meet pressure injury (PrI) prevention and treatment needs during COVID-19. METHODS: The authors used SurveyMonkey to gather data on healthcare perceptions and the challenges experienced regarding specific product categories deemed necessary for PrI prevention and treatment in US acute care settings during the pandemic. They created three anonymous surveys for the target populations of supply chain personnel and healthcare workers. The surveys addressed healthcare workers' perceptions, product requests, and the ability to fulfill product requests and meet facility protocols without substitution in the categories of support surfaces and skin and wound care supplies. RESULTS: Respondents answered one of the three surveys for a total sample of 174 respondents. Despite specific instructions, nurses responded to the surveys designed for supply chain personnel. Their responses and comments were interesting and capture their perspectives and insights. Three themes emerged from the responses and general comments: (1) expectations differed between supply chain staff and nurses for what was required for PrI prevention and treatment; (2) inappropriate substitution with or without proper staff education occurred; and (3) preparedness. CONCLUSIONS: It is important to identify experiences and challenges in the acquisition and availability of appropriate equipment and products for PrI prevention and treatment. To foster ideal PrI prevention and treatment outcomes, a proactive approach is required to face daily issues or the next crisis.

Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel.

BACKGROUND: Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent. OBJECTIVE: To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones. METHODS: The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education. CONCLUSIONS: This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.

Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy.

PURPOSE: The purpose of this study was to identify predictors of 30- and 60-day hospital readmission in patients undergoing ileostomy or colostomy creation. DESIGN: A retrospective, cohort study. SAMPLE AND SETTING: The study sample comprised 258 patients who underwent ileostomy or colostomy creation from 2018 to 2021 in a suburban teaching hospital in the northeastern United States. The mean age of participants was 62.8 (SD 15.8) years; half were female and half were male. Slightly more than half 50.3% (n = 130) and 49.2% (n =127) underwent ileostomy surgery. METHODS: Data were abstracted from the electronic medical record and included the following variable categories: demographic factors, ostomy- and surgical-related factors, and ostomy- and surgical-related complications. Study outcome measures were readmission within 30 and 60 days from the index hospital admission discharge date. Predictors of hospital readmission were analyzed using bivariate testing, followed by multivariate analysis. RESULTS: Within 30 days of the index hospitalization, 49 patients were readmitted (19%), and 17 patients were readmitted (6.6%) within 60 days. For readmissions within 30 days, anatomical location of the stoma in the ileum and transverse colon as compared to descending/sigmoid colon stomas emerged as significant predictors (odds ratio [OR] 2.2; P = .036; confidence interval [CI] 1.05-4.85; OR 4.5; P = .036; CI 1.17-18.53, respectively). Within 60 days, length of the index hospitalization from 15 to 21 days as compared to shorter lengths of hospitalization emerged as the only significant predictor at this timeframe (OR 6.62; P = .018, CI 1.37-31.84). CONCLUSIONS: These factors provide a basis for identifying patients at higher risk for hospital readmission following ileostomy or colostomy surgery. For patients at higher risk for readmission following ostomy surgery, heightened surveillance and management in the immediate postoperative period may be necessary to avert potential complications.

Malnutrition and Pressure Injury Risk in Vulnerable Populations: Application of the 2019 International Clinical Practice Guideline.

ABSTRACT: Nutrition plays a vital role in promoting skin integrity and supporting tissue repair in the presence of chronic wounds such as pressure injuries (PIs). Individuals who are malnourished are at greater risk of polymorbid conditions, adverse clinical outcomes, longer hospital lengths of stay, PI development, and mortality, and incur increased healthcare costs compared with patients who are adequately nourished. In addition, some patient populations tend to be more vulnerable to PI formation, such as neonates, patients with obesity, older adults, and individuals who are critically ill. Accordingly, this article aims to review the latest nutrition care recommendations for the prevention and treatment of PIs, including those recommendations tailored to special populations. A secondary objective is to translate nutrition recommendations into actionable steps for the healthcare professional to implement as part of a patient plan of care.Implementing an evidence-based plan of care built around individualized nutrition interventions is an essential step supporting skin integrity for these populations. The 2019 Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (CPG) affirms that meeting nutrient requirements is essential for growth, development, maintenance, and repair of body tissues. Many macronutrients and micronutrients work synergistically to heal PIs. Registered dietitian nutritionists play an important role in helping patients identify the most nutrient dense foods, protein supplements, and oral nutrition supplements to meet their unique requirements.

Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey.

PURPOSE: The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey. DESIGN: Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING: The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years. METHODS: Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units. RESULTS: Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups. CONCLUSION: Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.

Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey.

PURPOSE: The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN: Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING: The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS: Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS: The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS: Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.

Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey.

PURPOSE: The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey. DESIGN: Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING: The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample. METHODS: Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units. RESULTS: Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00). CONCLUSION: Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.

Association Between Food Insecurity and Diet Quality Among Early Care and Education Providers in the Pennsylvania Head Start Program.

INTRODUCTION: Food insecurity affects dietary behaviors and diet quality in adults. This relationship is not widely studied among early care and education (ECE) providers, a unique population with important influences on children's dietary habits. Our study's objective was to explore how food insecurity affected diet quality and dietary behaviors among ECE providers. METHODS: We used baseline data from a cluster-randomized controlled trial (January 2019-December 2020) on 216 ECE providers under the Pennsylvania Head Start Association. We used radar plots to graph scores for the Healthy Eating Index 2015 and the Alternative Healthy Eating Index (AHEI) 2010 and fitted a multivariate regression model for diet quality measures, adjusting for covariates. RESULTS: Among the 216 participants, 31.5% were food insecure. ECE providers who were food insecure had a lower AHEI-2010 mean score (mean difference for food insecure vs food secure = -4.8; 95% CI, -7.8 to -1.7; P = .002). After adjusting for covariates, associations remained significant (mean difference = -3.9; 95% CI, -7.5 to -0.4; P = .03). Food insecure ECE providers were less likely to use nutrition labels (22.8% vs 39.1%; P = .046) and more likely to report cost as a perceived barrier to eating fruits and vegetables. CONCLUSION: We found a significant inverse association between food insecurity and the AHEI-2010 diet quality score among ECE providers after adjusting for covariates. More studies are needed to examine the effects of food insecurity on dietary behaviors of ECE providers and their response to nutrition education programs targeting their health.

Pressure Injuries in Critical Care Patients: A Conceptual Schema.

GENERAL PURPOSE: To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and the mitigating measures that influence pressure injury (PI) development in the critical care population. 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 will: 1. Choose a static intrinsic factor that increases the risk for the development of PI. 2. List several dynamic intrinsic risk factors for developing a PI. 3. Identify dynamic extrinsic risk factors that may predispose a patient to developing a PI. 4. Explain the pathophysiology of PI development.

The first step in successful pressure injury (PI) prevention is to determine appropriate risk factors. In patients who are critically ill, PI risk is multietiologic, including the pathophysiologic impacts associated with a critical illness, concomitant preexisting comorbid conditions, and treatment-related factors that are essential in the ongoing management of a critical illness. To outline a conceptual schema describing the relationships among the empirically supported risk factors, the etiologic factors, and the mitigating measures that influence PI development in the critical care population. Risk factors for PI included in the conceptual schema were identified after a comprehensive review of the literature. Risk factors were categorized as static intrinsic factors, dynamic intrinsic factors, or dynamic extrinsic factors. The schema illustrates the complex relationships between risk factor duration and intensity and the underlying etiology of PI development. The relationships among cumulative risk factors, etiologic factors, and mitigating measures for PI prevention are also outlined in the schema within the context of potentially unavoidable PI development. Examining PI development in patients who are critically ill through the lens of a conceptual schema may guide future research endeavors focusing on the etiologic bases for PI development. It may also provide a framework to explore alternatives to current formal PI risk assessment in this unique subset of hospitalized patients.

Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database.

PURPOSE: The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. DESIGN: Observational, cross-sectional cohort study. SUBJECTS AND SETTING: An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). METHODS: Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. RESULTS: Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. CONCLUSIONS: Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.

Acute Skin Failure in the Critical Care Patient.

OBJECTIVE: The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population. METHODS: Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model. RESULTS: Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively. CONCLUSIONS: The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.

Wound Care 101.

The clinical nurse may be the first caregiver to assess changes in a patient's skin and initiate wound care. This article provides practical guidelines that any nurse can implement.

Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis.

BACKGROUND: Pressure injury (PI) development in the critical care population is multifactorial. Despite the application of evidence-based prevention strategies, PIs do occur and may be unavoidable in some patients. OBJECTIVES: To describe the risk factors associated with PI development in a sample of medical-surgical intensive care unit patients and determine whether these risk factors were congruent with the risk factors proposed in the work of the National Pressure Ulcer Advisory Panel on unavoidable PIs. METHODS: A retrospective, descriptive design was used to determine the PI risk factors present in a sample of 57 critically ill patients admitted to the medical-surgical intensive care unit for more than 24 hours and who acquired a PI during their admission. RESULTS: The most frequently identified risk factors were immobility (n = 57 [100%]), septic shock (n = 31 [54%]), vasopressor use (n = 37 [65%]), head-of-bed elevation greater than 30° (n = 53 [93%]), sedation (n = 50 [87.7%]), and mechanical ventilation for more than 72 hours (n = 46 [81%]). The most common PI location was the sacrum (n = 32 [56%]), and the most common stage reported was deep-tissue PI (n = 39 [68%]). The mean number of days to PI development was reported at 7.5 (SD, 7.2) days. CONCLUSIONS: Results of this descriptive study were congruent with the literature surrounding the clinical situations that predispose patients to unavoidable PIs. While the implementation of aggressive PI prevention strategies is essential to reducing PI rates, it is important to recognize that in certain populations, such as the critically ill, exposure to certain risk factors may potentially escalate PI risk beyond the scope of prevention and result in an unavoidable PI. Recognizing these risk factors is significant in the journey to differentiate PIs that result from a lack of preventive care from those that may be prevention immune.

Factors associated with falls in hospitalized adult patients.

INTRODUCTION: Despite efforts in hospitals to identify patients at risk for falls and to prevent these incidents, falls among hospitalized patients are not a rare event and continue to be a major health care concern, occurring in approximately 700,000-1,000,000 hospitalized patients per year. PURPOSE: The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. METHODS: A retrospective correlational design was used to examine 160 patients admitted to a medical-surgical unit over the year 2012. Analytical weighting was applied to the study sample to conduct bivariate and multivariate analysis. FINDINGS: In multivariate analysis, the variables age, narcotic/sedative use, and overnight shift, significantly predicted the likelihood of a fall during the hospitalization. Cardiovascular disease, neuromusculoskeletal disease, evening shift, the implementation of fall prevention strategies and higher RN to unlicensed assistive personnel staffing ratios decreased the likelihood of a fall during the hospitalization. In addition, patients at high risk for falls using the Hendrich I fall scale were nearly 17% more likely to fall during the hospitalization. CONCLUSIONS: Many factors influence the occurrence of a fall in hospitalized patients. Fall risk assessment and the implementation of fall prevention strategies are both effective strategies in the clinical area to identify and decrease the probability of a fall. The presence of the RN is significant in fall prevention in medical-surgical patients.