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2 results

  • Chapter 39 - Pressure Injuries

  • from Section III - Care of the Elderly by Organ System
  • Edited by Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Samuel C. Durso, The Johns Hopkins University, Maryland, Christine Arenson, Thomas Jefferson University, Philadelphia, Rebecca Elon, The Johns Hopkins University School of Medicine, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel
  • Book:
    Reichel's Care of the Elderly
    Published online:
    30 June 2022
    Print publication:
    21 July 2022, pp 477-492

  • Summary

    Pressure injuries are a costly and complex global issue in all health-care settings. Morbidity and mortality are significant for persons who develop facility-acquired pressure injuries and they often fail to proceed through normal wound healing, stalling in the inflammatory phase of healing and remaining in a chronic inflammatory state. Prevention and treatment require multiple approaches and multidisciplinary team involvement for success. Prevention includes attention to risk assessment, daily skin assessment, tissue load management with offloading and support surfaces, mobility and activity interventions, nutrition assessment, and incontinence management. Treatment follows the TIMERS acronym: Tissue management including debridement and cleansing, Infection and inflammation control including management of bacterial biofilms, Moisture balance with use of moisture-retentive dressings, Epithelial edge advancement or frequent and consistent reassessment of healing, Repair and regeneration with use of advanced wound healing and adjunct therapies, and Social factors and those related to the individual.

  • Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan

  • Lindyce A. Kulik, Jean A. Connor, Dionne A. Graham, Patricia A. Hickey
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 9 / September 2018
    Published online by Cambridge University Press:
    06 July 2018, pp. 1151-1162
  • Background

    The description of pressure injury development is limited in children with CHD. Children who develop pressure injuries experience pain and suffering and are at risk for additional morbidity.

    Objectives

    The objective of this study was to develop a standardized clinical assessment and management plan to describe the development of pressure injury in paediatric cardiac surgical patients and evaluate prevention strategies.

    Methods

    Using a novel quality improvement initiative, postoperative paediatric cardiac surgical patients were started on a nurse-driven pressure injury prevention standardized clinical assessment and management plan on admission. Data were recorded relevant to nursing assessments and management based on pre-defined targeted data statements and algorithm. Nursing feedback regarding diversions was recorded and analysed.

    Results

    Data on 674 congenital paediatric cardiac surgical patients who met criteria were collected between May, 2011 and June, 2012. In 5918 patient days, a total of 4603 skin assessments were completed by nurses from the cardiac ICU and the cardiac inpatient unit, representing 77% of the expected assessments. The majority (70%, 21/30) of the 30 pressure injuries were medical-device-related and 30% (9/30) were immobility-related. The overall incidence of pressure injury was 4.4%: device-related was 3.1% and immobility-related was 1.3%. Most pressure injuries were Stage 1 (40%), followed by Stage 2 (26.7%), mucosal membrane injury (26.7%), and suspected deep tissue injuries (6.7%).

    Conclusion

    A nurse-driven pressure injury prevention standardized clinical assessment and management plan supported a programme-based evaluation of nursing practice and patient outcomes. Review of practices highlighted opportunities to standardise and focus prevention practices and ensure communication of patient vulnerabilities.