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Tom Defloor - One of the best experts on this subject based on the ideXlab platform.
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patient risk factors for Pressure Ulcer development systematic review
International Journal of Nursing Studies, 2013Co-Authors: Susanne Coleman, Tom Defloor, Lisette Schoonhoven, Amanda Farrin, Ruud J G Halfens, Andrea E Nelson, Claudia Gorecki, Jose S Closs, Julia BrownAbstract:OBJECTIVE: To identify risk factors independently predictive of Pressure Ulcer development in adult patient populations? DESIGN: A systematic review of primary research was undertaken, based upon methods recommended for effectiveness questions but adapted to identify observational risk factor studies. DATA SOURCES: Fourteen electronic databases were searched, each from inception until March 2010, with hand searching of specialist journals and conference proceedings; contact with experts and a citation search. There was no language restriction. REVIEW METHODS: Abstracts were screened, reviewed against the eligibility criteria, data extracted and quality appraised by at least one reviewer and checked by a second. Where necessary, statistical review was undertaken. We developed an assessment framework and quality classification based upon guidelines for assessing quality and methodological considerations in the analysis, meta-analysis and publication of observational studies. Studies were classified as high, moderate, low and very low quality. Risk factors were categorised into risk factor domains and sub-domains. Evidence tables were generated and a summary narrative synthesis by sub-domain and domain was undertaken. RESULTS: Of 5462 abstracts retrieved, 365 were identified as potentially eligible and 54 fulfilled the eligibility criteria. The 54 studies included 34,449 patients and acute and community patient populations. Seventeen studies were classified as high or moderate quality, whilst 37 studies (68.5%) had inadequate numbers of Pressure Ulcers and other methodological limitations. Risk factors emerging most frequently as independent predictors of Pressure Ulcer development included three primary domains of mobility/activity, perfusion (including diabetes) and skin/Pressure Ulcer status. Skin moisture, age, haematological measures, nutrition and general health status are also important, but did not emerge as frequently as the three main domains. Body temperature and immunity may be important but require further confirmatory research. There is limited evidence that either race or gender is important. CONCLUSIONS: Overall there is no single factor which can explain Pressure Ulcer risk, rather a complex interplay of factors which increase the probability of Pressure Ulcer development. The review highlights the limitations of over-interpretation of results from individual studies and the benefits of reviewing results from a number of studies to develop a more reliable overall assessment of factors which are important in affecting patient susceptibility.
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knowledge and attitudes of nurses on Pressure Ulcer prevention a cross sectional multicenter study in belgian hospitals
Worldviews on Evidence-based Nursing, 2011Co-Authors: Dimitri Beeckman, Tom Defloor, Lisette Schoonhoven, Katrien VanderweeAbstract:Background: Evidence-based guidelines for Pressure Ulcer prevention have been developed and promoted by authoritative organizations. However, nonadherence to these guidelines is frequently reported. Negative attitudes and lack of knowledge may act as barriers to using guidelines in clinical practice. Aims: To study the knowledge and attitudes of nurses about Pressure Ulcer prevention in Belgian hospitals and to explore the correlation between knowledge, attitudes, and the application of adequate prevention. Methods: A cross-sectional multicenter study was performed in a random sample of 14 Belgian hospitals, representing 207 wards. Out of that group, 94 wards were randomly selected (2105 patients). Clinical observations were performed to assess the adequacy of Pressure Ulcer prevention and Pressure Ulcer prevalence. From each participating ward, a random selection of at least five nurses completed an extensively validated knowledge and attitude instrument. In total, 553 nurses participated. A logistic regression analysis was performed to evaluate the correlation between knowledge, attitudes, and the application of adequate prevention. Results: Pressure Ulcer prevalence (Category I-IV) was 13.5% (284/2105). Approximately 30% (625/2105) of the patients were at risk (Bradenscore Conclusions: Knowledge of nurses in Belgian hospitals about the prevention of Pressure Ulcers is inadequate. The attitudes of nurses toward Pressure Ulcers are significantly correlated with the application of adequate prevention. No correlation was found between knowledge and the application of adequate prevention.
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assessing the adequacy of Pressure Ulcer prevention in hospitals a nationwide prevalence survey
BMJ Quality & Safety, 2011Co-Authors: Katrien Vanderwee, Tom Defloor, Dimitri Beeckman, Liesbeth Demarre, Sofie Verhaeghe, Therese Van Durme, Micheline GobertAbstract:Introduction: The development of a Pressure Ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the Pressure Ulcer preventive interventions used in hospitals. Purpose: The aim of this study was to obtain insight into the adequacy of interventions used to prevent Pressure Ulcers in Belgian hospitals. Methods: A cross-sectional, multi-centre Pressure Ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure Pressure Ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention. Results: The total sample consisted of 19 968 patients. The overall prevalence of Pressure Ulcers Category IeIV was 12.1%. Only 10.8% of the patients at risk received fully adequate prevention in bed and while sitting. More than 70% of the patients not at risk received some Pressure Ulcer prevention while lying or sitting. Conclusion: Generally, there is a limited use of adequate preventive interventions for Pressure Ulcers in hospitals, which reflects a rather low quality of preventive care. The implementation of Pressure Ulcer guidelines requires more attention. The Pressure Ulcer prevention used in practice should be re-evaluated on a regular basis.
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Pressure Ulcers: Development and psychometric evaluation of the Attitude towards Pressure Ulcer Prevention instrument (APuP)
International Journal of Nursing Studies, 2010Co-Authors: Dimitri Beeckman, Tom Defloor, Liesbet Demarre, A Van Hecke, Katrien VanderweeAbstract:Abstract Background P ressure Ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure Ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards Pressure Ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards Pressure Ulcer prevention is lacking. Aims and objectives Development and psychometric evaluation of the Attitude towards Pressure Ulcer Prevention instrument (APuP). Design Prospective psychometric instrument validation study. Methods A literature review was performed to design the instrument. Content validity was evaluated by nine European Pressure Ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008. Results A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent Pressure Ulcers (three items); (2) attitude towards the priority of Pressure Ulcer prevention (three items); (3) attitude towards the impact of Pressure Ulcers (three items); (4) attitude towards personal responsibility in Pressure Ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards Pressure Ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC=0.88 (95% CI=0.84–0.91, P α ) was 0.79. Conclusion The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards Pressure Ulcer prevention in patient care, education, and research. In further research, the association between attitude, knowledge and clinical performance should be explored.
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Pressure Ulcer prevention development and psychometric validation of a knowledge assessment instrument
International Journal of Nursing Studies, 2010Co-Authors: Dimitri Beeckman, Katrien Vanderwee, Liesbet Demarre, Louis Paquay, A Van Hecke, Tom DefloorAbstract:Abstract Background Profound knowledge of Pressure Ulcers is important to enable good prevention. Validity and reliability of instruments assessing Pressure Ulcer knowledge are limited evaluated in previous research. Aims and objectives To develop a valid and reliable instrument to assess knowledge of Pressure Ulcer prevention. Design Prospective psychometric instrument validation study. Methods An extensive literature review was performed to develop an instrument to assess knowledge of Pressure Ulcer prevention. Face and content validity were evaluated in a double Delphi procedure by an expert panel of nine trustees of the European Pressure Ulcer Advisory Panel (EPUAP) who each have extensive experience in Pressure Ulcer care and research (PhD level). A convenience sample of 608 nurses and nursing students from Belgium and The Netherlands participated to evaluate validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, internal consistency, and stability of the instrument. The data were collected between February and May 2008. Results A 26-item instrument was developed, reflecting 6 themes expressing the most relevant aspects of Pressure Ulcer prevention. The content validity was excellent (CVI=0.78–1.00). Group scores of nurses with a (theoretically expected) high level of expertise were found to be statistically significantly higher than those of participants with (theoretically expected) less expertise ( P α ) was 0.77. The 1-week test–retest intraclass correlation coefficient (stability) was 0.88. Conclusion The instrument demonstrated acceptable psychometric properties and can be applied in both research and practice for evaluating knowledge about Pressure Ulcer prevention.
Michael Clark - One of the best experts on this subject based on the ideXlab platform.
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dressings as an adjunct to Pressure Ulcer prevention consensus panel recommendations
International Wound Journal, 2015Co-Authors: Joyce Black, Carol Dealey, Christopher T. Brindle, Nick Santamaria, Michael Clark, Paulo Alves, Evan CallAbstract:The formulation of recommendations on the use of wound dressings in Pressure Ulcer prevention was undertaken by a group of experts in Pressure Ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum
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Dressings as an adjunct to Pressure Ulcer prevention: Consensus panel recommendations
International Wound Journal, 2015Co-Authors: Joyce Black, Carol Dealey, Christopher T. Brindle, Nick Santamaria, Michael Clark, Paulo Alves, Evan CallAbstract:The formulation of recommendations on the use of wound dressings in Pressure Ulcer prevention was undertaken by a group of experts in Pressure Ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for Pressure Ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for Pressure injury and shear injury were also provided.
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Pressure Ulcer prevalence across welsh orthopaedic units and community hospitals surveys based on the european Pressure Ulcer advisory panel minimum data set
International Wound Journal, 2010Co-Authors: Jane James, Julie Evans, Trudie Young, Michael ClarkAbstract:The survey used the European Pressure Ulcer Advisory Panel (EPUAP) methodology for the collection of Pressure Ulcer prevalence data. The orthopaedic survey was conducted across all National Health Service Trusts in Wales between 2 and 6 July 2007 while the community hospital survey covering 25% of all community hospital beds was conducted between 21 April 2008 and 2 May 2008. Data were gathered upon 1196 patients (581, 48·6% within orthopaedic units with 615 located in community hospitals). Of these patients, 81 (13·9%) and 162 (26·7%) had Pressure Ulcers in orthopaedic and community hospitals, respectively. Where patients presented with multiple Pressure Ulcers, the most severe Pressure Ulcer was recorded. Across both surveys, most Pressure Ulcers were reported to be either category I or II with 91 category I wounds (33 in orthopaedic units and 58 in community hospitals). Severe (categories III and IV) Pressure Ulcers affected 78 patients (19 in orthopaedic units and 59 in community hospitals). Adoption of the EPUAP Pressure Ulcer prevalence methods can help achieve consistent data upon Pressure Ulcer prevalence in different health care organisations and specialities. The adoption of a consistent data collection capture methodology is a clear prerequisite for the compilation of meaningful Pressure Ulcer prevalence data sets at a national level.
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dilemmas in measuring and using Pressure Ulcer prevalence and incidence an international consensus
International Wound Journal, 2009Co-Authors: Mona Mylene Baharestani, Carol Dealey, Joyce Black, Janet Cuddigan, Michael Clark, Nils Lahmann, Tom Defloor, Keryln Carville, Keith Harding, Maarten J LubbersAbstract:Pressure Ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of Pressure Ulcer prevention protocols. In some health care systems, the occurrence of Pressure Ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in Pressure Ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting Pressure Ulcer prevalence and incidence studies. The group’s main findings are summarised in this paper.
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Pressure Ulcer prevalence in europe a pilot study
Journal of Evaluation in Clinical Practice, 2007Co-Authors: Katrien Vanderwee, Carol Dealey, Michael Clark, Lena Gunningberg, Tom DefloorAbstract:Rationale and aims Numerous prevalence studies have been conducted. The problem with these studies is that prevalence proportions cannot be compared with each other, because of differences in performance of each survey. There is no agreed standardized method for determining prevalence proportions. This study aimed to develop and pilot a uniform data collection instrument and methodology to measure the Pressure Ulcer prevalence and to get some insight into Pressure Ulcer prevalence across different patient groups in Europe. Methods Pressure Ulcer experts from different European countries developed a data collection instrument, which included five categories of data: general data, patient data, risk assessment, skin observation and prevention. A convenience sample of university and general hospitals of Belgium, Italy, Portugal, UK and Sweden participated in the study. In each participating hospital, teams of two trained nurses who collected the data on the wards were established. All patients admitted before midnight on the day of the survey and older than 18 years were included. Results The data collection instrument and study procedure of the survey were found to be effective by all participants. 5947 patients were surveyed in 25 hospitals in five European countries. The Pressure Ulcer prevalence (grade 1–4) was 18.1% and if grade 1 Ulcers were excluded, it was 10.5%. The sacrum and heels were the most affected locations. Only 9.7% of the patients in need of prevention received fully adequate preventive care. Conclusion The methodology is sufficiently robust to measure and compare Pressure Ulcer prevalence in different countries. The Pressure Ulcer prevalence was higher than expected and relatively few patients received adequate prevention. This indicates that more attention to prevention is needed in Europe.
Dan R Berlowitz - One of the best experts on this subject based on the ideXlab platform.
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deriving a risk adjustment model for Pressure Ulcer development using the minimum data set
Journal of the American Geriatrics Society, 2001Co-Authors: Dan R Berlowitz, Gary H Brandeis, John N Morris, Jennifer J Anderson, Boris Kader, Mark A MoskowitzAbstract:OBJECTIVE: To use the Minimum Data Set (MDS) to derive a risk-adjustment model for Pressure Ulcer development that may be used in assessing the quality of nursing home care. DESIGN: Perspective observational study using MDS data from 1997. SETTING: A large, for-profit, nursing home chain. PARTICIPANTS: Our unit of analysis was 39,649 observations made on 14,607 nursing home residents who were without a stage 2 or larger Pressure Ulcer on an index assessment. MEASUREMENTS: Pressure Ulcer status was determined at an outcome assessment approximately 90 days after an index assessment. Potential predictors of Pressure Ulcer development were examined for bivariate associations, contributing to the development of a multivariate logistic regression model. RESULTS: A stage 2 or larger Pressure Ulcer developed in 2.3% of the observations. Seventeen resident characteristics were found to be associated with Pressure Ulcer development. These included dependence in mobility and transferring, diabetes mellitus, peripheral vascular disease, urinary incontinence, lower body mass index, and end-stage disease. A risk-adjustment model based on these characteristics was well calibrated and able to discriminate among residents with different levels of risk for Ulcer development (model c-statistic = 0.73). CONCLUSION: A clinically credible risk-adjustment model with good performance properties can be developed using the MDS. This model may be useful in profiling nursing homes on their rate of Pressure Ulcer development.
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evaluation of a risk adjustment model for Pressure Ulcer development using the minimum data set
Journal of the American Geriatrics Society, 2001Co-Authors: Dan R Berlowitz, Gary H Brandeis, John N Morris, Jennifer J Anderson, Boris Kader, Mark A MoskowitzAbstract:OBJECTIVE: To validate a previously derived risk-adjustment model for Pressure Ulcer development in a separate sample of nursing home residents and to determine the extent to which use of this model affects judgments of nursing home performance. DESIGN: Retrospective observational study using Minimum Data Set (MDS) data from 1998. SETTING: A large, for-profit, nursing home chain. PARTICIPANTS: Twenty-nine thousand and forty observations were made on 13,457 nursing home residents who were without a Pressure Ulcer on an index assessment. MEASUREMENTS: We used logistic regression in our validation sample to calculate new coefficients for the 17 previously identified predictors of Pressure Ulcer development. Coefficients from this new sample were compared with those previously derived. Expected rates of Pressure Ulcer development were determined for 108 nursing homes. Unadjusted and risk-adjusted rates of Pressure Ulcer development from these homes were also calculated and outlier identification using these two approaches was compared. RESULTS: Predictors of Pressure Ulcer development in the derivation sample generally showed similar effects in the validation sample. The model c-statistic was also unchanged at 0.73, but it was not calibrated as well in the validation sample. On applying the model to the nursing homes, expected rates of Ulcer development ranged from 1.1% to 3.2% (P < .001). The observed rates ranged from 0% to 12.1% (P < .001). There were 12 outliers using unadjusted rates and 15 using adjusted performance. Ten nursing homes were identified as outliers using both approaches. CONCLUSIONS: Our MDS risk-adjustment model for Pressure Ulcer development performed well in this new sample. Nursing homes differ significantly in their expected rates of Pressure Ulcer development. Outlier identification also differs depending on whether unadjusted or risk-adjusted performance is evaluated.
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rating long term care facilities on Pressure Ulcer development importance of case mix adjustment
Annals of Internal Medicine, 1996Co-Authors: Dan R Berlowitz, Gary H Brandeis, Harriet K Brand, Jay L Halpern, Mark A MoskowitzAbstract:Objective : To determine the importance of case-mix adjustment in interpreting differences in rates of Pressure Ulcer development in Department of Veterans Affairs long-term care facilities. Design : A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of Pressure Ulcer development ; the resulting model was validated in a separate sample. Facility-level rates of Pressure Ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Setting : Department of Veterans Affairs long-term care facilities. Patients : The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of Pressure Ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Measurement : Development of a stage 2 or greater Pressure Ulcer. Results : 11 factors predicted Pressure Ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of Pressure Ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Conclusions : Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.
Lisette Schoonhoven - One of the best experts on this subject based on the ideXlab platform.
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patient risk factors for Pressure Ulcer development systematic review
International Journal of Nursing Studies, 2013Co-Authors: Susanne Coleman, Tom Defloor, Lisette Schoonhoven, Amanda Farrin, Ruud J G Halfens, Andrea E Nelson, Claudia Gorecki, Jose S Closs, Julia BrownAbstract:OBJECTIVE: To identify risk factors independently predictive of Pressure Ulcer development in adult patient populations? DESIGN: A systematic review of primary research was undertaken, based upon methods recommended for effectiveness questions but adapted to identify observational risk factor studies. DATA SOURCES: Fourteen electronic databases were searched, each from inception until March 2010, with hand searching of specialist journals and conference proceedings; contact with experts and a citation search. There was no language restriction. REVIEW METHODS: Abstracts were screened, reviewed against the eligibility criteria, data extracted and quality appraised by at least one reviewer and checked by a second. Where necessary, statistical review was undertaken. We developed an assessment framework and quality classification based upon guidelines for assessing quality and methodological considerations in the analysis, meta-analysis and publication of observational studies. Studies were classified as high, moderate, low and very low quality. Risk factors were categorised into risk factor domains and sub-domains. Evidence tables were generated and a summary narrative synthesis by sub-domain and domain was undertaken. RESULTS: Of 5462 abstracts retrieved, 365 were identified as potentially eligible and 54 fulfilled the eligibility criteria. The 54 studies included 34,449 patients and acute and community patient populations. Seventeen studies were classified as high or moderate quality, whilst 37 studies (68.5%) had inadequate numbers of Pressure Ulcers and other methodological limitations. Risk factors emerging most frequently as independent predictors of Pressure Ulcer development included three primary domains of mobility/activity, perfusion (including diabetes) and skin/Pressure Ulcer status. Skin moisture, age, haematological measures, nutrition and general health status are also important, but did not emerge as frequently as the three main domains. Body temperature and immunity may be important but require further confirmatory research. There is limited evidence that either race or gender is important. CONCLUSIONS: Overall there is no single factor which can explain Pressure Ulcer risk, rather a complex interplay of factors which increase the probability of Pressure Ulcer development. The review highlights the limitations of over-interpretation of results from individual studies and the benefits of reviewing results from a number of studies to develop a more reliable overall assessment of factors which are important in affecting patient susceptibility.
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knowledge and attitudes of nurses on Pressure Ulcer prevention a cross sectional multicenter study in belgian hospitals
Worldviews on Evidence-based Nursing, 2011Co-Authors: Dimitri Beeckman, Tom Defloor, Lisette Schoonhoven, Katrien VanderweeAbstract:Background: Evidence-based guidelines for Pressure Ulcer prevention have been developed and promoted by authoritative organizations. However, nonadherence to these guidelines is frequently reported. Negative attitudes and lack of knowledge may act as barriers to using guidelines in clinical practice. Aims: To study the knowledge and attitudes of nurses about Pressure Ulcer prevention in Belgian hospitals and to explore the correlation between knowledge, attitudes, and the application of adequate prevention. Methods: A cross-sectional multicenter study was performed in a random sample of 14 Belgian hospitals, representing 207 wards. Out of that group, 94 wards were randomly selected (2105 patients). Clinical observations were performed to assess the adequacy of Pressure Ulcer prevention and Pressure Ulcer prevalence. From each participating ward, a random selection of at least five nurses completed an extensively validated knowledge and attitude instrument. In total, 553 nurses participated. A logistic regression analysis was performed to evaluate the correlation between knowledge, attitudes, and the application of adequate prevention. Results: Pressure Ulcer prevalence (Category I-IV) was 13.5% (284/2105). Approximately 30% (625/2105) of the patients were at risk (Bradenscore Conclusions: Knowledge of nurses in Belgian hospitals about the prevention of Pressure Ulcers is inadequate. The attitudes of nurses toward Pressure Ulcers are significantly correlated with the application of adequate prevention. No correlation was found between knowledge and the application of adequate prevention.
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economic evaluation of Pressure Ulcer care a cost minimization analysis of preventive strategies
Nursing Economics, 2009Co-Authors: Jaappeter Schuurman, Tom Defloor, Lisette Schoonhoven, I Van Engelshoven, B Van Ramshorst, Erik BuskensAbstract:The purpose of this study was to determine the cost for prevention and treatment of Pressure Ulcers from a hospital perspective and to identify the least resource-intensive Pressure Ulcer prevention strategy. Cost analyses were examined from a hospital perspective using direct costs. The study was carried out alongside a prospective cohort study on the incidence and risk factors for Pressure Ulcers. Two large teaching hospitals in the Netherlands with (partly) opposing approaches in prevention, a technological versus a human approach, were analyzed. The main outcome measures were resource use, costs of preventive measures and treatment, and Pressure Ulcer incidence in both hospitals. Pressure Ulcer prevention through a predominantly technical approach resulted in a similar incidence rate as prevention through a predominantly human approach. However, the technical approach was considerably less expensive.
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guideline implementation results in a decrease of Pressure Ulcer incidence in critically ill patients
Critical Care Medicine, 2007Co-Authors: Erik H De Laat, Lisette Schoonhoven, Peter Pickkers, Andre L M Verbeek, Ton Feuth, Theo Van AchterbergAbstract:OBJECTIVE: To describe the short-term and long-term effects of a hospital-wide Pressure Ulcer prevention and treatment guideline on both the incidence and the time to the onset of Pressure Ulcers in critically ill patients. DESIGN: Prospective cohort study. SETTING: Adult intensive care department of a university medical center. PATIENTS: Critically ill patients (n = 399). INTERVENTIONS: A guideline for Pressure Ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific Pressure-reducing device was an important part of this guideline. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, demographics, Pressure Ulcer risk profile at admission, daily Pressure Ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of Pressure Ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median Pressure Ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of Pressure Ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one Pressure Ulcer during the first 9 days was six. CONCLUSIONS: The implementation of a guideline for Pressure Ulcer care resulted in a significant and sustained decrease in the development of grade II-IV Pressure Ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a Pressure Ulcer) was the main indicator for a decrease in Pressure Ulcer development.
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reliability of the european Pressure Ulcer advisory panel classification system
Journal of Advanced Nursing, 2006Co-Authors: Tom Defloor, Lisette Schoonhoven, Vanderwee Katrien, J T M Weststrate, Dries MynyAbstract:AIM: This paper reports a study examining the interrater and intrarater reliability of classifying Pressure Ulcers according to the European Pressure Ulcer Advisory Panel classification system when using photographs of Pressure Ulcers and incontinence lesions. BACKGROUND: Pressure Ulcer classification is an essential tool for assessing Ulcers and their severity and determining which preventive or therapeutic action is needed. Many classification systems are described in the literature. There are only a limited number of studies that evaluate the interrater reliability of Pressure Ulcer grading scales. The intrarater reliability is seldom studied. METHODS: The study consisted of two phases. In the first phase 56 photographs, together with a random selection of nine photographs from the same set, were presented to 473 nurses. In the second phase, the 56 photographs were presented twice to 86 other nurses with an interval of one month and in a different order. All the nurses were familiar with the European Pressure Ulcer Advisory Panel classification. They did not receive any additional training on classification, and were asked to classify the lesions as normal skin, blanchable erythema, Pressure Ulcers (four grades, European Pressure Ulcer Advisory Panel classification) or incontinence lesions. RESULTS: In the first phase, the multirater-Kappa for the 473 participating nurses was 0.37 (P < 0.001). Non-blanchable erythema was often confused with blanchable erythema and incontinence lesions. Also incontinence lesions were frequently not correctly classified. The intrarater agreement was low (kappa = 0.38). In the second phase, the interrater agreement was not significantly different in both sessions. The intrarater agreement was 0.52. CONCLUSION: Both the interrater and intrarater reliability of the European Pressure Ulcer Advisory Panel classification of lesion photographs by nurses was very low. Differentiation between Pressure Ulcers and incontinence lesions seems to be difficult.
Joyce Black - One of the best experts on this subject based on the ideXlab platform.
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dressings as an adjunct to Pressure Ulcer prevention consensus panel recommendations
International Wound Journal, 2015Co-Authors: Joyce Black, Carol Dealey, Christopher T. Brindle, Nick Santamaria, Michael Clark, Paulo Alves, Evan CallAbstract:The formulation of recommendations on the use of wound dressings in Pressure Ulcer prevention was undertaken by a group of experts in Pressure Ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum
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Dressings as an adjunct to Pressure Ulcer prevention: Consensus panel recommendations
International Wound Journal, 2015Co-Authors: Joyce Black, Carol Dealey, Christopher T. Brindle, Nick Santamaria, Michael Clark, Paulo Alves, Evan CallAbstract:The formulation of recommendations on the use of wound dressings in Pressure Ulcer prevention was undertaken by a group of experts in Pressure Ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for Pressure Ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for Pressure injury and shear injury were also provided.
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dilemmas in measuring and using Pressure Ulcer prevalence and incidence an international consensus
International Wound Journal, 2009Co-Authors: Mona Mylene Baharestani, Carol Dealey, Joyce Black, Janet Cuddigan, Michael Clark, Nils Lahmann, Tom Defloor, Keryln Carville, Keith Harding, Maarten J LubbersAbstract:Pressure Ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of Pressure Ulcer prevention protocols. In some health care systems, the occurrence of Pressure Ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in Pressure Ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting Pressure Ulcer prevalence and incidence studies. The group’s main findings are summarised in this paper.
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national Pressure Ulcer advisory panel s updated Pressure Ulcer staging system
Advances in Skin & Wound Care, 2007Co-Authors: Joyce Black, Mona Mylene Baharestani, Janet Cuddigan, Becky Dorner, Laura Edsberg, Diane Langemo, Mary Ellen Posthauer, Catherine Ratliff, George TalerAbstract:The National Pressure Ulcer Advisory Panel (NPUAP) has updated the definition of a Pressure Ulcer and the stages of Pressure Ulcers, based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss
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National Pressure Ulcer Advisory Panel's updated Pressure Ulcer staging system.
Advances in skin & wound care, 2007Co-Authors: Joyce Black, Mona Mylene Baharestani, Janet Cuddigan, Becky Dorner, Laura Edsberg, Diane Langemo, Mary Ellen Posthauer, Catherine Ratliff, George TalerAbstract:The National Pressure Ulcer Advisory Panel has updated the definition of a Pressure Ulcer and the stages of Pressure Ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions were drafted to achieve accuracy, clarity, succinctness, clinical utility, and discrimination between and among the definitions of other Pressure Ulcer stages and other types of wounds. Deep tissue injury was also added as a distinct Pressure Ulcer in this updated system.