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Hospital acquired pressure ulcer

Thomas R O'Toole, Natalie Jacobs, Brian Hondorp, Laura Crawford, Lisa R Boudreau, Jill Jeffe, Brian Stein, Phillip LoSavio
Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head...
February 1, 2017: Otolaryngology—Head and Neck Surgery
Jacqueline Magurn, Joanne McGovern, Michelle Jetter, Sarah Beadling, Dorothy Gregoire
: 230 Background: Developing and maintaining a culture of safety and quality in delivering patient care is critical in the intensive care unit (ICU) especially an oncology ICU. Incorporating the Lean Six Sigma program into daily operations of the ICU achieves, simplifies, and sustains continuous improvement in the delivery of safe quality patient care. This program engages the ICU team through visual management of quality, safety, and budget indicators including medication scanning, falls, sharps exposure, infection prevention including blood stream, catheter, hospital and ventilator acquired pneumonias, venous embolism prevention, and staffing compliance...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Reza Kazemi, Ali Mosleh, Meghan Dierks
In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment-caused injuries while in the hospital. While risk cannot be entirely eliminated from health-care activities, an important goal is to develop effective and durable mitigation strategies to render the system "safer." In order to do this, though, we must develop models that comprehensively and realistically characterize the risk...
January 27, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
Kumar Dharmarajan, Sunil Swami, Ray Y Gou, Richard N Jones, Sharon K Inouye
OBJECTIVES: (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. DESIGN: Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. SETTING: Large academic hospital. PARTICIPANTS: Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only...
December 30, 2016: Journal of the American Geriatrics Society
Mine Yoshimura, Norihiko Ohura, Junko Tanaka, Shoichi Ichimura, Yusuke Kasuya, Oruto Hotta, Yu Kagaya, Takuya Sekiyama, Mitsuko Tannba, Nao Suzuki
Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton-Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient...
December 7, 2016: International Wound Journal
Julia Warner, Mary Ann Raible, Gina Hajduk, Jacqueline Collavo
The State of Pennsylvania Hospital Engagement Network, in collaboration with a hospital system in Southwestern Pennsylvania, established a goal of reducing hospital-acquired pressure ulcers by 20%. A 6-month unfavorable trend of nurse-sensitive clinical indicators called for immediate process improvement. A retrospective chart review resulted in identification of predominant risk factors placing the burn patient at high risk for pressure ulcer formation. Implementations of pressure ulcer prevention measures were inconsistent...
January 2017: Critical Care Nursing Quarterly
Kimberly D Hall, Rebecca C Clark
Patients in critical care areas are at risk for developing hospital-acquired pressure ulcers (HAPUs) due to their physical conditions and limited ability to reposition themselves. A prospective, 2-phase quality improvement study was conducted from September to November 2011 and from February to April 2012 in 1 medical and 1 surgical ICU to investigate the impact of a turn-and-assist device on the incidence of HAPUs and the time and personnel required to reposition patients reported as person/minutes (staff x minutes)...
November 2016: Ostomy/wound Management
Peggy Kalowes, Valerie Messina, Melanie Li
BACKGROUND: In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. OBJECTIVES: To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Jianghua He, Vincent S Staggs, Sandra Bergquist-Beringer, Nancy Dunton
BACKGROUND: Time trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient outcomes in recent years. It is unknown whether these changes were associated. METHODS: Quarterly unit-level nursing data in 2004-2012 were extracted from the National Database of Nursing Quality Indicators® (NDNQI®). Units were divided into groups based on patterns of missing data. All variables were aggregated across units within these groups and analyses were conducted at the group level...
2016: BMC Nursing
Nahla Tayyib, Fiona Coyer
BACKGROUND: Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention...
December 2016: Worldviews on Evidence-based Nursing
Peter R Worsley, Glenn Smith, Lisette Schoonhoven, Dan L Bader
AIM: The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). DESIGN: A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. METHODS: Demographic and pressure ulcer related data were collected from patients at risk of developing a pressure ulcer, collated by a single observer using a standardized tool...
July 2016: Nursing Open
Chantal Backman, Saskia E Vanderloo, Toba B Miller, Lisa Freeman, Alan J Forster
OBJECTIVE: This study aimed to compare classification of pressure ulcers from administrative data with a gold standard assessment, specifically; pressure ulcers confirmed by an independent physical assessment performed by trained nurse surveyors. SETTING: A retrospective analysis of pooled cross-sectional samples of inpatients assessed across 3 consecutive prevalence surveys in a large academic health sciences centre between 2012 and 2013. PARTICIPANTS: There were 2001 patients for whom physical and chart assessments were completed, and for whom a discharge abstract was also available at the time of analysis...
October 5, 2016: BMJ Open
Wendy Chaboyer, Tracey Bucknall, Joan Webster, Elizabeth McInnes, Brigid M Gillespie, Merrilyn Banks, Jennifer A Whitty, Lukman Thalib, Shelley Roberts, Mandy Tallott, Nicky Cullum, Marianne Wallis
BACKGROUND: Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. OBJECTIVE: To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. DESIGN: Pragmatic cluster randomised trial. SETTING: Eight tertiary referral hospitals with >200 beds each in three Australian states...
December 2016: International Journal of Nursing Studies
Diane K Boyle, Ananda Jayawardhana, Mary E Burman, Nancy E Dunton, Vincent S Staggs, Sandra Bergquist-Beringer, Byron J Gajewski
BACKGROUND: Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. OBJECTIVE: The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index. DESIGN: Two-phase measure development study...
November 2016: International Journal of Nursing Studies
Richard F Averill, John S Hughes, Richard L Fuller, Norbert I Goldfield
The Partnership for Patients (PfP) and the Agency for Healthcare Research and Quality (AHRQ) have reported a 23.5% decline in hospital-acquired pressure ulcers (HAPU) over 4 years resulting in a cumulative cost savings of more than $10 billion and 49 000 averted deaths, claiming that this significant decline may have been spurred in part by Medicare payment incentives associated with severe (stage 3 or 4) HAPUs. Hospitals with a high rate of severe HAPUs have a payment penalty imposed, creating a financial disincentive to report severe HAPUs, possibly contributing to the magnitude of the reported decline...
August 30, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
William V Padula, Robert D Gibbons, Peter J Pronovost, Donald Hedeker, Manish K Mishra, Mary Beth F Makic, John Fp Bridges, Heidi L Wald, Robert J Valuck, Adam J Ginensky, Anthony Ursitti, Laura Ruth Venable, Ziv Epstein, David O Meltzer
OBJECTIVE: Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6%, are costly to treat, and result in Medicare reimbursement penalties. Medicare codes HAPUs according to Agency for Healthcare Research and Quality Patient-Safety Indicator 3 (PSI-03), but they are sometimes inappropriately coded. The objective is to use electronic health records to predict pressure ulcers and to identify coding issues leading to penalties. MATERIALS AND METHODS: We evaluated all hospitalized patient electronic medical records at an academic medical center data repository between 2011 and 2014...
August 18, 2016: Journal of the American Medical Informatics Association: JAMIA
Nahla Tayyib, Fiona Coyer
The objective of this review is to identify the effectiveness of pressure ulcer (PU) prevention strategies on the incidence of hospital-acquired PUs in the intensive care unit (ICU).More specifically, the objectives are to identify the effectiveness of utilizing PU prevention strategies such as risk assessment, skin assessment, skin care, nutrition, position and repositioning, education and training, medical devices care or other strategies designed to manage the risk factors for PU development and reduce the incidence of PUs in ICUs...
March 2016: JBI Database of Systematic Reviews and Implementation Reports
Simeon Joel Zürcher, Christa Vangelooven, Natalie Borter, Daniel Schnyder, Sabine Hahn
AIM: The aim of this study was to test psychometrically the Italian and French versions of the Care Dependency Scale. BACKGROUND: The Care Dependency Scale assesses changes in patients' level of care dependency including important functional and mental dimensions. Evaluation of the psychometric properties of the Italian version is still ongoing. The French version has to date not been validated. DESIGN: Nationwide cross-sectional point prevalence study...
December 2016: Journal of Advanced Nursing
AnneMarie Walker-Czyz
OBJECTIVES: The purpose of this study was to measure the impact of an integrated electronic health record (EHR) innovation adoption on the quality of nursing care delivered, including hospital-acquired falls, hospital-acquired pressure ulcers, ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and costs measured in nursing hours. The impact on quality, cost, and nurse satisfaction measured in turnover rates before, during, and after implementation of EHR tools was also investigated...
July 2016: Journal of Nursing Administration
Paul Peter Schneider, Max Geraedts
In this study, we investigated the association between nurse and physician staffing and the incidence of hospital-acquired pressure ulcers in acute care hospitals in Germany. The study population, derived from the Quality Reports of German Hospitals and the Hospital Directory, consisted of 710 hospitals covering 716,281 cases in the first quarter of 2010, and 672 hospitals covering 757,665 cases in the first quarter of 2012. The relationship between staffing variables and the standardized incidence ratios of pressure ulcers was examined using bivariate and multivariable linear regression models...
December 2016: Nursing & Health Sciences
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