Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review.

Objective: This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods: Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results: Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion: The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.

Fotografía digital: Una herramienta para Enfermería en la evaluación de las Lesiones Por Presión (LPP) / Fotografia digital: Uma ferramenta para Enfermagem na avaliação das lesões por pressão / Digital Photography: a Tool for Nursing on the Assessment of Pressure Lesions

Objective. This work sought to assess the inter-observer agreement among expert nurses by using digital photographs and between these experts and the nursing registries in the electronic clinical record in the identification and degree of PL. Methods. This was an observational study, including 225 photographic records (184 patients, 97 with pressure lesion and 128 registries without lesion) randomly selected from the total of photographs registered in the PENFUP clinical trial (without lesion). Three expert evaluators assessed said photographs in masked manner. The notes from nursing of patients included related with the description of PL were evaluated. The Kappa index was calculated along with the composite agreement ratio for each evaluation. Results. Good agreement was observed among expert evaluators of photographic records on the presence of PL and between good-moderate for the degree of PL (I-II). Likewise, upon evaluating the agreement between the nursing registries of PL and the photographic assessment of the three expert evaluators of the same areas, good agreement was observed to determine the presence of PL and moderate agreement for the degrees of PL. Conclusion. Photographic records are a tool that permits recognizing the types of wounds, as well as the visualization of the different layers of skin injured. The study highlights the importance of assessment and validation by experts, given that it permits identifying existing problems that can lead to the underestimation or overestimation of PL when conducted by a single caregiver.(AU)

Objetivo. Evaluar la concordancia interobservador en la identificación y grado de las Lesiones Por Presión ­LPP- entre: i) enfermeros expertos utilizando fotografías digitales y, ii) entre estos expertos y los registros de enfermería en la historia clínica electrónica. Métodos. Estudio observacional, que incluyó 225 registros fotográficos (184 pacientes, 97 con lesión por presión y 128 registros sin lesión) seleccionados al azar del total de fotografías registradas en el ensayo clínico PENFUP. Tres evaluadores expertos valoraron las mismas fotografías de forma encubierta. Se evaluaron las notas de enfermería de los pacientes incluidos relacionadas con la descripción de LPP. Se calculó el índice Kappa y la proporción de acuerdo con el compuesto para cada evaluación. Resultados. Se observó una concordancia buena entre los evaluadores expertos de registros fotográficos sobre la presencia de LPP y entre buena y moderada para el grado de LPP (I-II). Así mismo, al evaluar la concordancia entre los registros de enfermería de LPP y la valoración fotográfica de los tres evaluadores expertos de las mismas áreas, se observó una concordancia buena para determinar la presencia de LPP moderada para la concordancia de los grados de LPP. Conclusión. Los registros fotográficos son una herramienta que permite el reconocimiento de los tipos de heridas al igual que la visualización de las diferentes capas de piel lesionadas. Se resalta la importancia de la evaluación y validación por expertos ya que nos permite identificar problemas existentes que pueden llevar a la subvaloración o sobrevaloración de las LPP cuando los realiza un solo cuidador. (AU)

Objetivo. Avaliar a concordância inter-observador na identificação e grau das Lesões Por Pressão ­LPP- entre: i) enfermeiros especialistas utilizando fotografias digitais e, ii) entre estes especialistas e os registros de enfermagem na história clínica eletrônica. Métodos. Estudo observacional, que incluiu 225 registros fotográficos (184 pacientes, 97 com lesão por pressão e 128 registros sem lesão) selecionados por azar do total de fotografias registradas no ensaio clínico PENFUP. Três avaliadores especialistas avaliaram as mesmas fotografias de forma encoberta. Se avaliaram as notas de enfermagem dos pacientes incluídos relacionadas com a descrição da LPP. Se calculou o índice Kappa e a proporção de acordo composto para cada avaliação. Resultados. Se observou uma boa concordância entre os avaliadores especialistas de registros fotográficos sobre a presença de LPP e entre boa e moderada para o grau de LPP (I-II). Assim mesmo, ao avaliar a concordância entre os registros de enfermagem de LPP e a valorização fotográfica dos três avaliadores especialistas das mesmas áreas, se observou uma boa concordância para determinar a presença de LPP e moderada para a concordância dos graus de LPP. Conclusão. Os registros fotográficos são uma ferramenta que permite o reconhecimento dos tipos de feridas ao igual que a visualização das diferentes capas de pele lesionadas. Se recalca a importância da avaliação e validação por especialistas já que nos permite identificar problemas existentes que podem levar à subvalorização ou sobrevalorização das LPP quando os realiza um único cuidador.(AU)