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2.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
3.
Enferm. intensiva (Ed. impr.) ; 30(3): 135-143, jul.-sept. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182972

RESUMO

Objetivos: Determinar la incidencia y categoría más incidente de úlceras por presión (UPP). Conocer las características clínicas de las UPP. Determinar si se realiza un registro adecuado de UPP y las medidas de prevención utilizadas. Método: Estudio observacional, descriptivo y retrospectivo realizado durante el año 2014 en la UCI del Hospital Universitario Araba (HUA)-Txagorritxu. La población de estudio fueron todos los pacientes ingresados con UPP, obtenidos mediante muestreo accidental. Los datos se recogieron a través de los registros informatizados del programa Metavisión de valoración del riesgo, valoración clínica y tratamiento de UPP, los cuales se analizaron con estadística descriptiva y se procesaron mediante el paquete estadístico SPSS, versión 22.0. El estudio fue aprobado por el Comité Ético de Investigaciones Clínicas del HUA. Resultados: La incidencia de pacientes con UPP durante el 2014 alcanzó el 6,78%. La localización de UPP más frecuente fue en la zona sacra y en los talones. La categoría de UPP más incidente fue la II, seguida de la I. De las 98 UPP tratadas en nuestros pacientes, 43 se produjeron fuera del servicio y 55 en la UCI del HUA. La ausencia de registro, en todas las variables descritas sobre las UPP, fue de un 19,01%. Conclusiones: La incidencia de UPP alcanzó un porcentaje inferior a lo existente en la literatura actual. La categoría, localización y características clínicas más frecuentes se asimilan a estudios previos. Existe una elevada tasa de no registro de las características de las UPP declaradas. Se efectuaron unas buenas medidas de prevención de UPP y registro de las mismas


Objectives: The aim of this paper is to determine the incidence and most incident pressure ulcers (PU) category. Establish the main clinical characteristics of these PU. Determine whether there is adequate documentation of PU and of the measures used to prevent them. Method: Observational descriptive and retrospective study during 2014 at Intensive Care Unit (ICU)-University Hospital of Araba. Study sample, all patients suffering from PU at the time of the study by accidental sampling. Computerised records regarding risk assessment, clinical assessment and pressure sore treatment, provided by the 'Metavision' computer programme and descriptive statistics using SPSS version 22.0. Approval from the Ethics Committee for Clinical Research of the University Hospital of Araba was obtained. Results: The incidence of patients suffering from PU during 2014 was 6.78%. The most common locations for PU were the sacral region and the heels: the most incident pressure ulcers category was grade II, followed by grade I. Out of the 98 PU treated in our patients, 43 occurred outside the ICU and 55 in the unit itself. The lack of records, in all the variables described about PU, was 19.10%. Conclusions: The incidence of pressure ulcers was lower than in the current literature. The most frequent category, location and clinical characteristics are comparable to previous studies. There is a high rate of failing to record the characteristics of the PU declared. Good PU prevention measures and recording were carried out


Assuntos
Humanos , Idoso , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Registros de Enfermagem , Controle de Formulários e Registros , Unidades de Terapia Intensiva , Estudos Retrospectivos , Análise de Dados
4.
Gerokomos (Madr., Ed. impr.) ; 30(3): 134-141, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185321

RESUMO

Objetivos: Obtener indicadores epidemiológicos actualizados para las lesiones por presión (LPP) y otras lesiones cutáneas relacionadas con la dependencia (LCRD) en centros de Atención Primaria de Salud (APS) españoles, tanto globales como ajustados. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia) (ENP), dirigido a centros de APS. Recogida de datos mediante formulario en línea seguro. Variables: características de los centros, número de pacientes con cada tipo de LCRD, clasificación de cada lesión, tamaño y tiempo de evolución. Se calcularon tres valores de prevalencia: prevalencia cruda poblacional, en mayores de 65 años y en personas en programas de atención domiciliaria. Resultados: Se han obtenido datos de una población de casi 763.000 personas atendidas en 98 centros de APS españoles. Un 14,3% de los centros declararon no tener ninguna persona con LCRD atendida en el momento de obtener los datos. En el grupo de personas en programas de atención domiciliaria (ATDOM), la prevalencia de LCRD fue del 6,11%. Según tipo de lesiones fueron: presión, 4,79%; humedad, 1,39%; fricción, 1,81%; combinadas, 1,05%, y desgarros cutáneos, 1,05%. Las lesiones se originaron en el mismo domicilio del paciente en un 83,3% de los casos, y solo un 16,7% eran de origen nosocomial. Conclusiones: La prevalencia de LCRD en pacientes atendidos en programas de ATDOM fue del 6,11%, siendo las LPP las lesiones más frecuentes, con un 4,79% de prevalencia (cifras similares a las del 3er ENP y suponen un ligero descenso sobre las encontradas en el 4º ENP). Tanto las LPP como el resto de LCRD son mayoritariamente producidas en el domicilio, a diferencia de la situación en hospitales en los que predominan las de origen nosocomial. La prevención de las LCRD en personas atendidas en ATDOM debe ser una prioridad


Aims: To obtain updated, global and adjusted epidemiological indicators for pressure injuries (PI) and others dependence-related skin lesions (DRSL) in Spanish primary healthcare (PHC) centres. To describe the clinical features of both people with DRSL and the lesions. Methods: Observational, cross-sectional study through a survey (5th National Prevalence Study), aimed to PHC in Spain. Data collected through a secure on-line form. Variables: characteristics of the centres, number of patients with each type of DRSL, classification of each lesion, size and time of evolution. Three prevalence values were calculated: crude population prevalence; in people over 65 years of age; and in people in home care programs (HCP). Results: Data have been obtained for a population of almost 763,000 people attended at Spanish PHC in 98 centers. 14.3% of the centres stated that they did not have any person with DRSL attended at the time of obtaining the data. In the group of persons in home care programmes, the prevalence of DRSL was 6.11%. According to the type of lesions: pressure 4.79%, moistureassociated lesions (MAL) 1.39%, friction 1.81%, combined 1.05% and skin tears 1.05%. The lesions originated in the patient's own home in 83.3% of cases, and only 16.7% were of nosocomial origin. Conclusions: The prevalence of DRSL in patients treated in was 6.11%, with PI being the most frequent lesion. Prevalence value is similar to that found in 2009 and slightly lesser than that of 2014. Both the PI and others DRSL are mostly developed in the home, unlike the situation in hospitals, where hospital-acquired injuries are predominant. So, prevention of DRSL in people in home care programmes should be a priority


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Pele/lesões , Lesão por Pressão/epidemiologia , Atenção Primária à Saúde , Enfermagem Primária , Lesão por Pressão/terapia , Estudos Transversais , Inquéritos Epidemiológicos , Inquéritos e Questionários , Análise de Dados , Medição de Risco
5.
J Wound Ostomy Continence Nurs ; 46(4): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276451

RESUMO

PURPOSE: To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD). DESIGN: Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data. SUBJECTS AND SETTING: Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada. METHODS: IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population. RESULTS: Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores. CONCLUSIONS: Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.


Assuntos
Dermatite/etiologia , Incontinência Fecal/complicações , Incontinência Urinária/complicações , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Dermatite/classificação , Dermatite/epidemiologia , Incontinência Fecal/epidemiologia , Feminino , Humanos , Modelos Logísticos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia , Incontinência Urinária/epidemiologia
6.
J Wound Ostomy Continence Nurs ; 46(4): 291-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274856

RESUMO

PURPOSE: The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record. METHODS: Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models. RESULTS: Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03). CONCLUSIONS: The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.


Assuntos
Lesão por Pressão/etiologia , Medição de Risco/métodos , Medição de Risco/normas , Atividades Cotidianas/classificação , Adulto , Estudos de Casos e Controles , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Percepção , Complicações Pós-Operatórias/epidemiologia , Lesão por Pressão/epidemiologia , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco/tendências , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas
7.
J Wound Ostomy Continence Nurs ; 46(4): 298-304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274857

RESUMO

Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how the system can improve to reduce the number and severity of pressure injuries. The process of RCA begins with being certain the wound is a pressure injury using differential diagnoses of similar appearing skin disease and injury, followed by an examination of the processes of care (human roots) for missed actions or inactions that are linked to development of a particular pressure injury. The final step of RCA is a critical examination of the system (including people and processes) to look for modifiable trends or patterns are identified that are used to prevent recurrences.


Assuntos
Lesão por Pressão/etiologia , Análise de Causa Fundamental/métodos , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Lesão por Pressão/classificação , Lesão por Pressão/epidemiologia , Melhoria de Qualidade , Análise de Causa Fundamental/classificação , Estados Unidos/epidemiologia
8.
J Clin Nurs ; 28(21-22): 4119-4127, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216388

RESUMO

AIMS AND OBJECTIVE: To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36 hr of their hospital admission in Australia. BACKGROUND: Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. DESIGN: Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our sample comprised of 1,047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. METHODS: Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36 hr of hospitalisation. RESULTS: From our sample, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36 hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36 hr of hospitalisation. CONCLUSIONS: Our findings confirm that older adults, those with multiple comorbidities and individuals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. RELEVANCE TO CLINICAL PRACTICE: Many older patients come to hospital with a community-acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.


Assuntos
Hospitalização/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Lesão por Pressão/diagnóstico , Lesão por Pressão/terapia , Prevalência , Estudos Prospectivos , Medição de Risco
9.
J Wound Care ; 28(6): 409-415, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166863

RESUMO

OBJECTIVE: To analyse the treatment of pressure ulcers (PU) in long-term care. METHOD: In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment. RESULTS: In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs. CONCLUSION: PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.


Assuntos
Casas de Saúde , Padrões de Prática em Enfermagem/estatística & dados numéricos , Lesão por Pressão/terapia , Idoso , Idoso de 80 Anos ou mais , Tornozelo , Bandagens , Curativos Hidrocoloides , Nádegas , Estudos Transversais , Desbridamento , Feminino , Finlândia/epidemiologia , Calcanhar , Quadril , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Prevalência , Qualidade da Assistência à Saúde , Região Sacrococcígea , Creme para a Pele , Irrigação Terapêutica
10.
Adv Skin Wound Care ; 32(8): 365-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162147

RESUMO

OBJECTIVE: To evaluate if the use of a pressure injury (PI) risk assessment is associated with the more frequent use of international evidence-based guideline interventions in patients at risk of PI. METHODS: Data were collected through a multicenter cross-sectional prevalence study conducted on November 14, 2017. Study authors analyzed data from 532 patients 65 years at risk of PI or older in Austrian hospitals. MAIN OUTCOME MEASURES: Repositioning, mobilization, floating heels/heel devices, moisture/barrier cream, patient education, malnutrition screening, referral to a dietitian, and hydration/nutrition management. MAIN RESULTS: The risk assessment was documented on admission for 80% (n = 435) of the at-risk patients. Patients for whom a PI risk assessment was conducted were older and more care dependent, and nearly 20% had a PI compared with patients for whom no risk assessment was conducted upon admission. Conducting a risk assessment led to a statistically significantly higher number of internationally recommended PI preventive interventions being performed for at-risk patients, such as provision of moisture/barrier cream, mobilization specific for PI, malnutrition screening, and floating heels or heel suspension devices. CONCLUSIONS: These results showed that conducting and documenting a risk assessment led to more recommended interventions being performed. Although such interventions are recommended for all patients, these findings are especially relevant for patients at mild or moderate risk of PI who might be otherwise overlooked, which in turn could reduce hospital-acquired PI rates.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Lesão por Pressão/diagnóstico , Lesão por Pressão/prevenção & controle , Medição de Risco/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Lesão por Pressão/epidemiologia , Prevalência , Fatores de Risco
11.
Gerokomos (Madr., Ed. impr.) ; 30(2): 76-86, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183946

RESUMO

Objetivo: Obtener indicadores epidemiológicos actualizados para las lesiones por presión (LPP) y otras lesiones cutáneas relacionadas con la dependencia (LCRD) en unidades de hospitalización de adultos de hospitales españoles, tanto globales como ajustados. Analizar las características demográficas y clínicas de las personas con LCRD y de las lesiones. Metodología: Estudio observacional, transversal, tipo encuesta epidemiológica (5º Estudio Nacional de Prevalencia), dirigido a todos los hospitales en España. Recogida de datos mediante formulario seguro online. Variables: características de los hospitales y de las unidades, pacientes ingresados, pacientes con cada tipo de LCRD, clasificación de cada lesión, tamaño y tiempo de evolución. Se estimó la prevalencia bruta global y ajustada por hospitales y por tipo de unidades. Resultados: Participaron 554 unidades de hospitalización de adultos pertenecientes a 70 hospitales de todo el territorio nacional. La prevalencia global de LCRD fue del 8,7%. Según tipo de lesiones, las prevalencias fueron: lesiones por presión (LPP) 7,0%; por humedad 1,4%; por fricción 0,9%; combinadas 1,5%; laceraciones 0,9%. Para las LPP, las unidades con prevalencias más altas fueron: cuidados paliativos (16,7%), UCI (14,9%) y unidades posquirúrgicas y reanimación (14,0%). La mayoría de las lesiones son de origen nosocomial (p. ej., el 72,2% de las LPP), producidas en hospitales o residencias de mayores. Se ha encontrado alta variabilidad en la prevalencia de LCRD y de LPP tanto a nivel de hospitales como de unidades de hospitalización. Conclusiones: La prevalencia de LPP es similar a la de estudios anteriores en hospitales españoles. Por primera vez se han obtenido datos de prevalencia de otros tipos de LCRD. Puesto que la mayoría de las lesiones son producidas en los propios hospitales y otras instituciones, como residencias de mayores, se evidencia la necesidad de mejorar la prevención de las LCRD en estos entornos


Aims: To obtain updated epidemiological indicators for pressure injuries (PI) and other dependence-related skin lesions (DRSL) at adult hospitalization units of Spanish hospitals, both global and adjusted. To analyse both the demographic and clinical characteristics of people with DRSL and the characteristics of the lesions. Methods: Observational, cross-sectional study, as an epidemiological survey (5th National Prevalence Study), focused to all the hospitals in Spain. Data were collected by an on-line secure form. Variables: characteristics of the hospitals and the units, number of patients admitted, number of patients with each type of DRSL, lesions classification, size and time. The crude prevalence was calculated, both overall and adjusted by hospitals and units. Results: In this study have participated 554 units from 70 Spanish hospitals. Overall, the prevalence for DRSL of any kind, was 8,7%. By type of lesion, the prevalence was: pressure injuries (PI), 7,0%; moisture associated lesions, 1,4%; friction, 0,9%; combined lesions, 1,5%; and skin tears, 0,9%. For PI, the units with highest prevalence were: palliative care (16,7%), intensive care (14,9%) and post-surgery and reanimation units (14,0%). Most of the lesions were nosocomial (e.g. 72,2% of the PI), that is, produced at hospitals or nursing homes. This study has shown a high variability in the figures of prevalence of DRSL and PI, both at hospitals and units levels. Conclusions: The prevalence of PI is similar to that of previous studies at Spanish hospitals. This is the first time that the prevalence of other types of DRSL has been calculated. Since most of the dependence-related skin lesions were produced inside the hospitals and other facilities, such nursing homes, there is a need to improve the prevention of these lesions in these settings


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/epidemiologia , Estudos Epidemiológicos , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/classificação , Estudos Transversais , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Lacerações/epidemiologia
12.
Gerokomos (Madr., Ed. impr.) ; 30(2): 93-97, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183948

RESUMO

Objetivo: analizar el riesgo de aparición y la prevalencia de lesión por presión en personas encamadas asistidas por las unidades de atención primaria en el domicilio, además de describir las características sociodemográficas de los participantes del estudio, así como las condiciones clínicas y de tratamiento de los pacientes con lesiones por presión. Método: se trata de un estudio transversal, con 79 participantes encamados y englobados en el programa Estrategia de Salud Familiar. Los datos fueron recogidos mediante entrevista semiestructurada, y el riesgo de aparición de lesiones por presión se estimó mediante la aplicación de la escala de Braden. Resultados: se verificó que la condición clínica de los usuarios que necesitaron cuidados en el domicilio supone un riesgo significativo para el desarrollo de la úlcera por presión o agravamiento de estas lesiones, especialmente en los ancianos. Se evidenció la presencia de lesión por presión en el 15,1%. Conclusión: el estudio pone de relieve el elevado riesgo para el desarrollo de úlcera por presión en la población del municipio


Objective: to analyze the risk of occurrence and the prevalence of pressure ulcer in bedridden people attended by primary care teams. Method: this is a cross-sectional study, with 79 participants bedridden and included in the Family Health Strategy program. The data were collected through a semi-structured interview with the risk of occurrence of pressure ulcer estimated through the application of the Braden Scale. Results: it was verified that the clinical condition of the users who needed home care supposes a significant risk factor for the development of ulcer due to pressure or aggravation of these lesions, especially in the elderly. The presence of pressure injury was evidenced in 15.1%. Conclusion: the study highlights the high risk for the development of ulcer by pressure in the population of the municipality


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Lesão por Pressão/complicações , Lesão por Pressão/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Estudos Transversais , Inquéritos e Questionários
13.
Gerokomos (Madr., Ed. impr.) ; 30(2): 98-106, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183949

RESUMO

En la prevención de las úlceras por presión (UPP) intervienen diferentes factores: estructurales, organizativos y relacionados con los profesionales; entre ellos, el grado de conocimientos que los profesionales sanitarios tengan es un aspecto fundamental. Objetivo: Identificar los instrumentos de medición de conocimientos de los profesionales de enfermería sobre las UPP. Como objetivos específicos: a) resumir las propiedades psicométricas (validez y fiabilidad) de cada instrumento y b) sintetizar el nivel de conocimientos sobre prevención según los estudios seleccionados. Metodología: Revisión narrativa de la literatura sobre los conocimientos en prevención de UPP. Búsqueda de estudios en 10 bases de datos bibliográficas desde el inicio de indexación hasta julio de 2018. Se incluyeron estudios cuantitativos que utilizasen instrumentos, test o cuestionarios, que cuantificasen los conocimientos en profesionales o estudiantes de enfermería. Se realizó una síntesis descriptiva. Resultados: Se seleccionaron 90 artículos, a partir de los cuales se identificaron 7 instrumentos (o alguna variación del cuestionario original) que han sido utilizados en al menos dos estudios publicados y 31 investigaciones, los cuales han desarrollado instrumentos ad hoc. Los dos más utilizados son el cuestionario Pieper Pressure Ulcer Knowledge (PPKUT) y el cuestionario Pressure Ulcer Knowledge Assessment Tool (PUKAT). No todos los instrumentos publicados presentan datos de fiabilidad y validez psicométrica. Entre los 31 estudios que describen un instrumento desarrollado ad hoc para esa investigación, solo en 5 de ellos se presentan datos de fiabilidad y validez. Aunque se han encontrado estudios que utilizan como fuente para la redacción de los ítems guías de práctica clínica (GPC), son muchos otros los que se basan en revisiones de la literatura, parten de instrumentos previos o no indican la fuente original. Los conocimientos descritos, de forma general en los diferentes estudios, están por debajo del punto de corte establecido por los autores. Conclusión: La medición del nivel de conocimientos sobre prevención de las UPP que tienen los profesionales de salud es importante como primer paso dentro de los programas de prevención de estas lesiones. Se han encontrado un elevado número de cuestionarios sin ninguna prueba de fiabilidad ni de validez, pero que han sido usados en estudios, lo cual contribuyen a generar datos poco relevantes y un grado de confusión. Es fundamental que los investigadores utilicen alguno de los cuestionarios que cuentan con evaluación psicométrica y que determinen dichas propiedades en la muestra utilizada en la investigación


Different factors (structural, organizational and related with professionals) intervene in the prevention of pressure ulcers (PU); the degree of knowledge of health professionals is one of the main aspects. Aim: To identify the instruments for measuring the knowledge of nursing professionals about pus. The specific objectives are: a) to summarize the psychometric properties (validity and reliability) of each instrument and b) to synthesize the knowledge on prevention according to the selected studies. Methodology: Narrative review on knowledge about PU prevention. Search in 10 bibliographic databases from the beginning of indexation until July 2018. The studies included were quantitative studies that used instruments, tests or questionnaires, which quantified the knowledge of professionals or nursing students. A descriptive synthesis was carried out. Results: 90 articles were selected, from which 7 instruments were identified (or some variation of the original questionnaire) that have been used in at least 2 published studies and 31 investigations, which have developed ad hoc instruments. The 2 most used tools are the Pieper Pressure Ulcer Knowledge (PPKUT) questionnaire and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) questionnaire. Not all published instruments show data on psychometric reliability and validity. Among the 31 studies that describe an ad hoc instrument, only in 5 of them reliability and validity data are shown. Although some studies used Clinical Practice Guidelines as a source for item elaboration, there are many others that are based only in literature review; modified some previous instruments or did not indicate the original source. The knowledge described in the different studies, in general, are below the cut-off point established by the authors. Conclusions: Measuring the knowledge on PU prevention of health professionals is important as a first step in injury prevention programs. A large number of the questionnaires found have any proof of reliability or validity; nevertheless they have been used in studies, which contribute to the generation of irrelevant data and to create confusion. It is essential that researchers use questionnaires with good psychometric properties and these properties should be evaluated again in the sample used in the research


Assuntos
Humanos , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Reprodutibilidade dos Testes , Competência Profissional , Psicometria/métodos , Prática Profissional/estatística & dados numéricos , Gerenciamento da Prática Profissional/organização & administração , Gerenciamento da Prática Profissional/estatística & dados numéricos , Papel do Profissional de Enfermagem
14.
Crit Care ; 23(1): 161, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064406

RESUMO

BACKGROUND: The optimal securement method of endotracheal tubes is unknown but should prevent dislodgement while minimizing complications. The use of an endotracheal tube fastener might reduce complications among critically ill adults undergoing endotracheal intubation. METHODS: In this pragmatic, single-center, randomized trial, critically ill adults admitted to the medical intensive care unit (MICU) and expected to require invasive mechanical ventilation for greater than 24 h were randomized to adhesive tape or endotracheal tube fastener at the time of intubation. The primary endpoint was a composite of any of the following: presence of lip ulcer, endotracheal tube dislodgement (defined as moving at least 2 cm), ventilator-associated pneumonia, or facial skin tears anytime between randomization and the earlier of death or 48 h after extubation. Secondary endpoints included duration of mechanical ventilation and ICU and in-hospital mortality. RESULTS: Of 500 patients randomized over a 12-month period, 162 had a duration of mechanical ventilation less than 24 h and 40 had missing outcome data, leaving 153 evaluable patients randomized to tube fastener and 145 evaluable patients randomized to adhesive tape. Baseline characteristics were similar between the groups. The primary endpoint occurred 13 times in 12 (7.8%) patients in the tube fastener group and 30 times in 25 (17.2%) patients in the adhesive tape group (p = 0.014) for an overall incidence of 22.0 versus 52.6 per 1000 ventilator days, respectively (p = 0.020). Lip ulcers occurred in 4 (2.6%) versus 11 (7.3%) patients, or an incidence rate of 6.5 versus 19.5 per 1000 patient ventilator days (p = 0.053) in the fastener and tape groups, respectively. The endotracheal tube was dislodged 7 times in 6 (3.9%) patients in the tube fastener group and 16 times in 15 (10.3%) patients in the tape group (p = 0.03), reflecting incidences of 11.9 and 28.1 per 1000 ventilator days, respectively. Facial skin tears were similar between the groups. Mechanical ventilation duration and ICU and hospital mortality did not differ. CONCLUSION: The use of the endotracheal tube fastener to secure the endotracheal tubes reduces the rate of a composite outcome that included lip ulcers, facial skin tears, or endotracheal tube dislodgement compared to adhesive tape. TRIAL REGISTRATION: ClinicalTrials.gov NCT03760510. Retrospectively registered on November 30, 2018.


Assuntos
Intubação Intratraqueal/instrumentação , Fita Cirúrgica/efeitos adversos , Adulto , Idoso , Extubação/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estado Terminal/epidemiologia , Estado Terminal/terapia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/normas , Estudos Retrospectivos , Estatísticas não Paramétricas , Fita Cirúrgica/estatística & dados numéricos
15.
Intensive Crit Care Nurs ; 53: 68-72, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31036423

RESUMO

OBJECTIVE: Determine the incidence and risk factors for pressure ulcers in a paediatric intensive care unit. Use the information gathered to develop preventive pressure ulcer care bundles. RESEARCH METHODOLOGY: Prospective cohort study using Braden Q Scale for Predicting Pressure Sore Risk and European Pressure Ulcer Advisory Panel Pressure Ulcer Staging tool. SETTING: General paediatric intensive care unit in a tertiary level hospital between May and October 2017. RESULTS: Seventy-seven children were recruited. Most children were male (n = 42, 54.5%) and all nine children (11.7%) that developed a pressure ulcer were male. The main risk factor for developing a pressure ulcer was lack of physical activity. None of the children assessed as high or severe risk developed a pressure ulcer. Eight (89%) pressure ulcers were assessed as grade one. Seven pressure ulcers (77.8%) were on the facial and scalp area and all seven children were receiving airway support at the time the pressure ulcers developed. CONCLUSION: Incidence of pressure ulcers was 11.7%, with the facial and scalp area the most common anatomical areas affected. Medical devices appeared to be the prime causative factor. Based on our data we have modified and launched the SSKIN care bundle for the paediatric intensive care unit setting.


Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pacotes de Assistência ao Paciente/normas , Lesão por Pressão/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/normas , Irlanda/epidemiologia , Masculino , Pacotes de Assistência ao Paciente/métodos , Pacotes de Assistência ao Paciente/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Estudos Prospectivos , Fatores de Risco
16.
J Wound Ostomy Continence Nurs ; 46(3): 194-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083062

RESUMO

PURPOSE: The purpose of this study was to compare the effect of pressure injuries on mortality, hospital length of stay, healthcare costs, and readmission rates in hospitalized patients. DESIGN: A case-control study. SUBJECTS AND SETTING: The sample comprised 5000 patients admitted to a tertiary hospital located in Seoul Korea; 1000 patients with pressure injuries (cases) were compared to 4000 patients who acted as controls. METHODS: We retrospectively extracted clinical data from electronic health records. Study outcomes were mortality, hospital length of stay, healthcare costs, and readmission rates. The impact of pressure injuries on death and readmission was analyzed via multiple logistic regression, hospital deaths within 30 days were analyzed using the survival analysis and Cox proportional hazards regression, and impact on the length of hospitalization and medical costs were analyzed through a multiple linear regression. RESULTS: Developing a pressure injury was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR], 3.94; 95% confidence interval [CI], 2.91-5.33), 30-days in-hospital mortality (OR, 2.18; 95% CI, 1.59-3.00), and healthcare cost (ß = 11,937,333; P < .001). Pressure injuries were significantly associated with an extended length of hospitalization (ß = 20.84; P < .001) and length of intensive care unit (ICU) stay (ß = 8.16; P < .001). Having a pressure injury was significantly associated with an increased risk of not being discharged home (OR, 5.55; 95% CI, 4.35-7.08), along with increased risks of readmission (OR, 1.30; 95% CI, 1.05-1.62) and emergency department visits after discharge (OR, 1.70; 95% CI, 1.29-2.23). CONCLUSIONS: Development of pressure injuries influenced mortality, healthcare costs, ICU and hospital length of stay, and healthcare utilization following discharge (ie, readmission or emergency department visits). Hospital-level efforts and interdisciplinary approaches should be prioritized to develop interventions and protocols for pressure injury prevention.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Lesão por Pressão/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pressão/efeitos adversos , Lesão por Pressão/epidemiologia , Lesão por Pressão/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
17.
J Wound Ostomy Continence Nurs ; 46(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083063

RESUMO

PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting. DESIGN: Mixed methods, pre-/posttest design. SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States. METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant. RESULTS: System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology. CONCLUSIONS: Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.


Assuntos
Monitorização Fisiológica/métodos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Casas de Saúde/organização & administração , Postura , Lesão por Pressão/epidemiologia , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia
18.
J Stroke Cerebrovasc Dis ; 28(7): 2026-2030, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005562

RESUMO

BACKGROUND: Acute ischemic stroke patients are a group at high risk for pressure sores. It is important to identify risk factors for pressure sores in acute ischemic stroke patients in order to facilitate early adoption of appropriate preventive and treatment measures. METHODS: Data were derived from the China National Stroke Registry. Acute ischemic stroke patients aged >18 years who presented at the hospital within 14 days after the onset of symptoms were eligible for this study. Comprehensive baseline data were collected. The definition of pressure sores was based on assessment at discharge of whether the patient had pressure sores at any time during hospitalization. RESULTS: 12,415 patients with a mean age of 67 years and a mean length of hospitalization of 14 days were included in the study. Among these patients, 97 (0.8%) had pressure sores during hospitalization. In the multivariate analysis of risk factors for pressure sores, age (each increment of 5 years), being unmarried, NIHSS at admission (each increment of 3 points), mRS at admission (3-5 points), diabetes mellitus, hemoglobin at admission (each incremental reduction of 10 units), and history of peripheral vascular disease all were significantly correlated with the occurrence of pressure sores among acute ischemic stroke patients during hospitalization. CONCLUSIONS: Old age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease were risk factors for pressure sores in acute ischemic stroke patients.


Assuntos
Isquemia Encefálica/epidemiologia , Hospitalização , Pacientes Internados , Lesão por Pressão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Anemia/sangue , Anemia/epidemiologia , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , China/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Avaliação da Deficiência , Feminino , Hemoglobinas/análise , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/epidemiologia , Lesão por Pressão/diagnóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Pessoa Solteira , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
20.
Adv Skin Wound Care ; 32(5): 228-233, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31008758

RESUMO

BACKGROUND: Pressure injuries (PIs) represent a significant burden on the healthcare system and have a negative impact on the quality of life of those affected by these wounds. Despite best practice guidelines and other protocols to help healthcare facilities prevent PIs, the prevalence of PIs in Canada across all healthcare settings is concerning. OBJECTIVE: To describe the pattern of PI prevention and identify national priorities and opportunities to address PIs. METHODS: A descriptive, cross-sectional, online survey was created between August and December 2017 to explore Canadian healthcare professionals' knowledge, attitudes, and practices related to PIs. RESULTS: In total, 590 surveys were completed. Eighty-five percent of respondents confirmed that PIs occur in their work environments, and 29% claimed PIs are a frequent occurrence. Most of the respondents (91%) confirmed that they were part of a team that treats PIs. Of the 590 participants, 90% confirmed that they are aware of PI prevention devices and technologies. Between 80% and 90% attest to using offloading devices including prophylactic dressings to prevent PIs, but only 20% instituted measures to address moisture-associated skin damage. CONCLUSIONS: The findings from this survey have highlighted a disconnect between Canadian healthcare professionals' awareness of PIs and the implementation of best practices for PI prevention. It is evident that, although the majority of respondents were aware of PIs and related treatment protocols, barriers still exist that impede optimized care and treatment.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Bandagens , Canadá/epidemiologia , Estudos Transversais , Humanos , Enfermeiras e Enfermeiros , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Lesão por Pressão/terapia , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Local de Trabalho , Cicatrização
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