Comparing Pressure Injury Incidence Based on Repositioning Intervals and Support Surfaces in Acute Care Settings: A Quasi-Experimental Pragmatic Study.

OBJECTIVE: To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. METHODS: This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. RESULTS: There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). CONCLUSIONS: The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.

Insight Into the Movement Behaviors of Nursing Home Residents Living With Obesity: A Report of Two Cases.

Obesity (body mass index [BMI] ≥30 kg/m2) can have a profound influence on the likelihood of developing a pressure injury (PrI); little is known about the movement behaviors (movement frequency, body position frequency, and position duration) of obese individuals. PURPOSE: This report examines 2 cases of obese nursing home residents and their movement behaviors in relation to their potential influence on overall PrI risk. METHODS: Resident movements were monitored 24 hours/day using a wearable sensor, and repositioning events were observed as part of a larger study examining repositioning intervals. Braden Pressure Ulcer Risk Assessment was conducted weekly. RESULTS: Both residents (BMI 39 kg/m2 and 50 kg/m2) had limitations in movement with prolonged periods spent in a single body position. Each resident addressed movement challenges unique to their desire to remain mobile and level of dependency on nursing staff. CONCLUSION: Presence of obesity is a factor affecting resident movement and creates environmental and psychosocial barriers to health. Nurses can play a key role in PrI prevention by addressing these barriers and encouraging positive, long-term behavior changes that mitigate risk. Future research should guide tailored PrI prevention protocols and national/ international guidelines for obese residents.

Comparing a patient positioning system to an overhead LIFT with pillows for impact on turning effectiveness.

BACKGROUND: Frequent patient handling activities present numerous challenges to healthcare workers. A variety of products are available to assist with in-bed positioning but few comparative studies have been completed to ascertain turning effectiveness. METHODS: The purpose of this study was to compare two turning devices (air-powered positioning system with wedges versus ceiling lift with pillows) for in-bed repositioning and turning effectiveness. The study took place at a large community hospital in the Midwestern USA and used a prospective, four-group crossover study design to compare devices. RESULTS: The two turning groups were not significantly different for any of the demographic variables. The use of an air-powered positioning system with wedges achieved a greater degree of turn and maintained that turn after an hour better than the lift device with pillows. There were no hospital acquired pressure injuries in either group. CONCLUSION: The devices used demonstrated significant differences in turn angle achieved and ability to maintain the turn at one hour. Future studies need to further delineate the ideal method for turning and compare devices to identify best practice and equipment. An effective turning method would integrate ease of use with the ability to achieve an optimal degree of turn in order to prevent hospital acquired pressure injuries while also decreasing caregiver injuries.

Occupational differences in workers' compensation indemnity claims among direct care workers in Minnesota nursing homes, 2005-2016.

BACKGROUND: Nursing assistants have one of the highest injury rates in the U.S., but few population-based studies assess differential injury risk by occupation in nursing homes. This statewide study assessed differences in musculoskeletal disorders (MSDs) and patient handling injuries among direct care workers in Minnesota nursing homes. METHODS: Indemnity claims from the Minnesota workers' compensation database were matched to time at risk from the Minnesota Nursing Home Report Card to estimate 2005 to 2016 injury and illness claim rates for certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Associations between occupation and claim characteristics were assessed using multivariable regression modeling. RESULTS: Indemnity claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers for CNAs, LPNs, and RNs, respectively. Patient handling injuries comprised 62% of claims. Compared to RNs, CNAs had higher odds of an indemnity claim resulting from an MSD (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.31-2.14) or patient handling injury (OR = 1.89; 95% CI, 1.47-2.45) as opposed to another type of injury or illness. CNAs had lower odds of receiving temporary and permanent partial disability benefits and higher odds of receiving a stipulation settlement. CONCLUSIONS: CNAs in Minnesota nursing homes are at heightened risk for lost time MSDs and patient handling injuries. Claims filed by CNAs are more frequently settled outside the regular workers' compensation benefit structure, an indication that the workers' compensation system is not providing adequate and timely benefits to these workers.

A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients.

OBJECTIVE: To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING: A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION: In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES: The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS: Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS: The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.

Factors associated with safe patient handling practice in acute care and its relationship with patient mobilization: A cross-sectional study.

BACKGROUND: Mobilizing hospital patients is associated with improved outcomes and shorter length of stay. Safe patient handling and mobility programs that include mechanical lift use facilitate mobilizing patients and reduce the likelihood of musculoskeletal disorders in staff. However, there is little information on the prevalence of lift use or why some patients are more likely to have a lift used than others. Such information is needed to inform public policy, benchmark lift use over time, and contextualize barriers for lift use. OBJECTIVE: To determine the percentage of patients that had a lift used during care in US acute care facilities, identify attributes related to the patient and their hospital stay that affect the lift use, examine whether state legislation increased lift use, and determine whether lift use was correlated with more frequent mobilization out of bed. DESIGN: Retrospective analysis of the 2018 International Pressure Ulcer Prevalence ™ data. PARTICIPANTS: 40,856 patients in 642 US acute care hospitals over the age of 18 with complete data. METHODS: Lift use prevalence was calculated as the percentage of patients that met inclusion criteria that had a lift used for care. Prevalence was then analyzed by patient mobility level. A logistic regression examined the influence of patient and facility related attributes. For patients with limited mobility (that could not stand or turn themselves), a t-test of proportions evaluated whether lift use during a patient's stay was correlated with an increased likelihood of being out of bed at the time of the survey. RESULTS: 3.7% of patients had a lift used during their care. 11.1% of limited mobility patients had a lift used. Lift use was associated with higher body mass, longer length of stay, lower Braden score, pressure injury prevention methods in place, being in an intensive care unit, being in a smaller hospital, and being in a state with safe patient handling and mobility legislation. Limited mobility patients moved with lifts during their stay were more likely to be observed in a bedside chair and less likely to be observed in bed, as compared to patients that never had a lift used. CONCLUSIONS: Despite the benefits to patients and caregivers, US acute care facilities are largely not using lifts to safely mobilize patients. Results suggested that safe patient handling and mobility legislation has increased the rate of lift use. Finally, lift use was correlated with patients being mobilized out of bed.

Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers.

OBJECTIVES: To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]). METHODS: Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data. RESULTS: After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02). CONCLUSIONS: Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.

Towards improving hospital workflows: An evaluation of resources to mobilize patients.

AIM: To characterize resources to safely mobilize different types of hospitalized patients. BACKGROUND: Current approaches to determine nurse-patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. METHODS: Nurse-led mobility sessions were evaluated on two adult hospital units, which consisted of nurse-patient encounters focused on patient mobility only. The resources assessed for each session were time-to-mobilize patient, time-to-document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. RESULTS: In 212 total mobility sessions, the median time-to-mobilize and time-to-document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time-intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. CONCLUSION: This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. IMPLICATIONS FOR NURSING MANAGEMENT: These results could assist nursing management with facilitating appropriate daily nurse-patient ratios and justify the need for assistive devices and staff support to safely mobilize patients.

PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance.

AIM: To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. BACKGROUND: Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. DESIGN: Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. METHODS: Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. RESULTS: Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. CONCLUSION: This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. TRIAL REGISTRATION: This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.

Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries.

OBJECTIVE: Pressure injuries are a significant problem for critically ill patients; they increase morbidity, cost, and duration of hospitalisation. Prolonged immobility is a major risk factor, but evidence guiding how frequently patients should be turned to prevent this complication is limited. We aimed to determine the impact of changing from 5-hourly to 3-hourly turns on pressure injury incidence in critically ill patients. DESIGN: We conducted a pre-post intervention evaluation study, comparing a 6-month period during which patient turns were 5-hourly (1 July 2015 - 31 December 2015) with a 6-month period during which turns were 3-hourly (1 February 2016 - 31 August 2016). These periods were separated by a 3-week wash-in period. SETTING: Intensive care unit in a metropolitan tertiary referral hospital. PARTICIPANTS: All patients admitted during the pre-intervention and post-intervention periods were included. INTERVENTION: A change in turn frequency for critically ill patients from 5-hourly to 3-hourly. MAIN OUTCOME MEASURES: The primary outcome was the number of patients diagnosed with a pressure injury. Secondary outcomes were the total number of pressure injuries, and the number of decubitus injuries. RESULTS: In the pre-intervention period, 1094 patients were admitted; in the post-intervention period, 1165 were admitted. Thirty-eight pre-intervention patients (3.5%) and 23 post-intervention patients (2.0%) developed a pressure injury (P =0.028). The incidence of decubitus injuries was markedly reduced in the post-intervention period (36 v 8 injuries, P < 0.001). After adjusting for Acute Physiology and Chronic Health Evaluation (APACHE) III score, duration of intubation and age, the odds ratio for developing a pressure injury in the post-intervention period was 0.51 (95% CI, 0.27-0.97) (P =0.041). For mechanically ventilated patients, the adjusted odds ratio for developing a decubitus pressure injury in the post-intervention period was 0.22 (95% CI, 0.06-0.85) (P =0.029). CONCLUSIONS: A change in turn frequency from 5-hourly to 3-hourly was associated with a halved incidence of pressure injuries. Critically ill patients may benefit from more frequent turns.

Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project.

BACKGROUND: Hospital-acquired functional decline due to decreased mobility has negative impacts on patient outcomes. Current nurse-directed mobility programs lack a standardized approach to set achievable mobility goals. PURPOSE: We aimed to describe implementation and outcomes from a nurse-directed patient mobility program. METHOD: The quality improvement mobility program on the project unit was compared to a similar control unit providing usual care. The Johns Hopkins Mobility Goal Calculator was created to guide a daily patient mobility goal based on the level of mobility impairment. FINDINGS: On the project unit, patient mobility increased from 5.2 to 5.8 on the Johns Hopkins Highest Level of Mobility score, mobility goal attainment went from 54.2% to 64.2%, and patients exceeding the goal went from 23.3% to 33.5%. All results were significantly higher than the control unit. DISCUSSION: An individualized, nurse-directed, patient mobility program using daily mobility goals is a successful strategy to improve daily patient mobility in the hospital.

A Retrospective Study Investigating: Factors associated with mode of arrival and emergency department management for patients with acute stroke.

BACKGROUND: Presentation by ambulance to the emergency department is critical for stroke patients to receive time dependent treatments. However, little is known of the factors that influence presentation by ambulance. METHODS: Retrospective analysis of all patients with an emergency department medical diagnosis of stroke who presented to one of three Victorian emergency departments over a three-year period (2011-2013). A multivariable model was used to investigate demographic characteristics (including triage assessment category, triage identified as stroke, time to CT, and time to diagnosis within the emergency department) as predictors of arrival by ambulance. RESULTS: 3548 stroke patients were identified; mean age was 70 years, 53% were males, and 92% had an ischemic stroke. Arrival by ambulance occurred in 71% (n=2509) with arrival by private transport accounting for 29% (n=1039) of patients. Factors significantly associated with arrival by ambulance were older age (p=<0.001), being born in Australia (p=<0.001), and speaking English in the home (p=0.003). Arrival by ambulance was independently associated with rapid stroke care in the emergency department, arrival within 2h from symptom onset, attending an advanced stroke service (access to thrombolysis), triaged for stroke, medical assessment within 25min and referral for CT within 45min. CONCLUSION: In this Australian multicenter study, it was identified that patients who arrived by ambulance received faster acute stroke care within the emergency department. Public health education which targets patients who are younger and from a non-English speaking background is needed as these demographics were not associated with timely arrival by ambulance to the emergency department.

Investigating the Efficacy of Web-Based Transfer Training on Independent Wheelchair Transfers Through Randomized Controlled Trials.

OBJECTIVES: To determine the efficacy of a web-based transfer training module at improving transfer technique across 3 groups: web-based training, in-person training (current standard of practice), and a waitlist control group (WLCG); and secondarily, to determine subject factors that can be used to predict improvements in transfer ability after training. DESIGN: Randomized controlled trials. SETTING: Summer and winter sporting events for disabled veterans. PARTICIPANTS: A convenience sample (N=71) of manual and power wheelchair users who could transfer independently. INTERVENTIONS: An individualized, in-person transfer training session or a web-based transfer training module. The WLCG received the web training at their follow-up visit. MAIN OUTCOME MEASURE: Transfer Assessment Instrument (TAI) part 1 score was used to assess transfers at baseline, skill acquisition immediately posttraining, and skill retention after a 1- to 2-day follow-up period. RESULTS: The in-person and web-based training groups improved their median (interquartile range) TAI scores from 7.98 (7.18-8.46) to 9.13 (8.57-9.58; P<.01), and from 7.14 (6.15-7.86) to 9.23 (8.46-9.82; P<.01), respectively, compared with the WLCG that had a median score of 7.69 for both assessments (baseline, 6.15-8.46; follow-up control, 5.83-8.46). Participants retained improvements at follow-up (P>.05). A lower initial TAI score was found to be the only significant predictor of a larger percent change in TAI score after receiving training. CONCLUSIONS: Transfer training can improve technique with changes retained within a short follow-up window, even among experienced wheelchair users. Web-based transfer training demonstrated comparable improvements to in-person training. With almost half of the United States population consulting online resources before a health care professional, web-based training may be an effective method to increase knowledge translation.

Identifying the critical physical demanding tasks of paramedic work: Towards the development of a physical employment standard.

Public safety related occupations including police, fire and military commonly apply physical employment standard (PES) to facilitate job matching, an approach to evaluate if candidates demonstrate acceptable physical capabilities as required to perform the job safely and effectively. In Canada, paramedics remain as one of the few public safety occupations without an evidence-based, validated PES. The purpose of this study was to document and describe the physical demands of paramedic work and to identify the most physically demanding tasks. These outcomes are essential to inform the design and development of an evidence-based PES for the paramedic sector. Physical demands of paramedic work were documented and described using a direct observation-based task analysis technique. Five paramedic's were trained to document the physical demands of their work, then applied their training to observe more than 90 calls over the course of 20 full 12-h work shifts. Physical demands data were then listed in a survey, administered service-wide, where 155 frontline paramedics identified critically demanding tasks and rank-ordered physical demands from not physically demanding to very strongly demanding. Critically important and physically demanding tasks were identified such as: transferring a patient; loading or unloading a stretcher in to or out of the ambulance; performing CPR; and, raising and lowering a stretcher. It is important that a paramedic-based PES evaluate a candidate's physical capabilities to perform the critical and physically demanding tasks identified in this study.

Implementation of a Safe Patient Handling Program in a Multihospital Health System From Inception to Sustainability: Successes Over 8 Years and Ongoing Challenges.

Musculoskeletal injuries, especially back injuries, are among the most frequent injuries sustained by direct caregivers who lift, transfer, and reposition patients. These injuries can be debilitating and, for some caregivers, career ending. In the first year following implementation of the safe patient handling program in a multihospital health care system, an 82% reduction in Occupational Health and Safety Administration (OSHA) recordable patient handling injuries was realized, a 94% decrease in days away from work, an 85% reduction in restricted duty days, and an 82% reduction in incurred workers' compensation costs. These reductions have been sustained for an 8-year period since the program's implementation in 2008. The primary focus of the program's first year was training and education. Compliance and retraining efforts began in the second year, followed by a gradual transition to the present emphasis on sustainability. This article describes the development and implementation of a safe patient handling program in a multihospital health system and the impact on caregiver injuries over 8 years. Also presented are key strategies that were used to achieve sustainability.

Linking Incidents in Long-Term Care Facilities to Worker Activities.

This article reports on a study examining staff activities being performed when incidents were reported to have occurred. The risk for injury among health care providers who engage in patient handling activities is widely acknowledged. For those working in long-term care, the risk of occupational injury is particularly high. Although injuries and injury prevention have been widely studied, the work has generally focused on incident rates and the impact of specific assistive devices on worker safety. The purpose of this study was to examine reported staff incidents in relation to staff activities. A multicenter cross-sectional exploratory study used retrospective data from reported staff incidents (2010, 2011, and 2012) and prospective data from 360 hours of staff observations in five long-term care facilities during 2013. Descriptive statistics were used to analyze data. A total of 898 staff incidents were reviewed from the facilities. Incidents were most likely to occur in resident rooms. Resident aides were more likely to be engaged in high-risk activities than other care providers. Times when staff incidents were reported to have occurred were not associated with periods of high staff-to-resident contact. Safe handling during low and moderate risk activities should be promoted. Education on what constitutes a reportable incident and strategies to ensure compliance with reporting policies and procedures may be needed to ensure accuracy and completeness of incident data.

Effects of intervention program for systematic use of transfer equipment on care workers' low back pain in elderly care facilities.

OBJECTIVE: The purpose of this study was to investigate the effects of an intervention program to prevent care workers' low back pain by the systematic use of transfer equipment at elderly care facilities. METHODS: Questionnaire surveys were administered to administrators and care workers before (baseline), 1 year after, and 2.5 year after starting the program at two elderly care facilities. Care workers at the intervention facility were requested to ensure the use of a transfer's hoist, sliding board, and sliding sheet when assisting in the transfer of residents who were judged as appropriate to use the equipment (27.5% of residents living the intervention facility). Care workers at the control facility received no instructions on the use of transfer equipment. RESULTS: The average response rate of administrators and care workers was 100% and 90.3%, respectively. The number of care workers who responded during all three survey periods was 29 at the intervention facility and 23 at the control facility, and they were subjected to the current analysis. At baseline, transfer equipment was already introduced in both facilities, but it was found that the care workers did not regularly use it for assisting transfer. At 2.5-year follow-up, 31.0% of the intervention group and 4.3% of the control group always used the transfer's hoist. Similarly, 27.6% of the intervention group and 4.3% of the control group always used the sliding board and sliding sheet. Further, 60%-70% of the care workers at both facilities reported of having low back pain, but no statistically significant difference was found between the facilities or over the measurement periods. Among the intervention group, however, the care workers who reported an active use of the transfer's hoist, sliding board, and sliding sheet showed an improvement in low back pain. In the control group, no significant association was found between the active use of transfer equipment and low back pain. CONCLUSION: These results indicated that the prevention of care workers' low back pain requires the introduction of transfer equipment in facilities and its regular use under the implementation program. If the number of residents requiring transfer equipment increases, its systematic use is expected to improve low back pain in care workers. This improvement can translate into safer and healthier workplaces for elderly care.

Evaluación del dolor durante la movilización y la aspiración endotraqueal en pacientes críticos / Evaluation of pain during mobilization and endotracheal aspiration in critical patients

OBJETIVOS: 1) Evaluar la prevalencia de dolor durante 2 procedimientos de enfermería, y 2) analizar la utilidad de ciertos signos vitales y del índice biespectral (BIS) para detectar dolor. MÉTODOS: Estudio prospectivo, observacional y analítico de medidas repetidas en pacientes con ventilación mecánica y sedación. Los procedimientos evaluados fueron la aspiración endotraqueal y la movilización con giro. El dolor se evaluó mediante la Behavioral Pain Scale. Valores más o igual se consideraron dolorosos. Se registraron distintos signos fisiológicos y los valores del BIS. Una variación porcentual > 10% se consideró clínicamente relevante. RESULTADOS: Se analizaron 146 procedimientos en 70 pacientes. La prevalencia de dolor durante los procedimientos fue del 94%. Los signos vitales y los valores del BIS aumentaron significativamente durante los procedimientos respecto el reposo, pero solo la variación del BIS alcanzó relevancia clínica. En un subgrupo de pacientes que recibieron analgesia preventiva antes de los procedimientos, el dolor disminuyó significativamente respecto a los pacientes que no recibieron analgesia preventiva (−2 [RIQ: {−5}-0] vs. 3 [RIQ: 1-4]; p<0,001, respectivamente). CONCLUSIONES: Los procedimientos evaluados son dolorosos. La variación de los signos vitales no es un buen indicador de dolor. La variación del BIS podría ser útil, pero precisa nuevas investigaciones. La administración de analgesia preventiva disminuye la prevalencia de dolor durante los procedimientos

OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of more or equal 3 indicating pain. Various physiological signs and BIS values were recorded, with changes of > 10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (−2 [IQR: {−5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures

Horizontal Slide Creates Less Cervical Motion When Centering an Injured Patient on a Spine Board.

BACKGROUND: A patient with a suspected cervical spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the spine board. OBJECTIVES: We sought to determine which centering adjustment best limits cervical spine movement and minimizes the chance for secondary injury. METHODS: Using five lightly embalmed cadaveric specimens with a created global instability at C5-C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the spine board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5-C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). RESULTS: The nonuniform condition produced significantly less flexion-extension than the uniform condition (p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension (p = 0.015), lateral bending (p = 0.003), and axial rotation (p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral (p = 0.017), axial (p < 0.001), and anteroposterior (p = 0.006). CONCLUSIONS: Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical spine motion and may be the most helpful for minimizing secondary injury based on the study findings.