Prevention of Pressure Ulcers

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Table of Contents

PICOT Question
Evidence Synthesis
Evaluation Table
References

PICOT Question

Will you have a comparison group or will subjects be their own controls?

As the project focuses on the prevention of pressure ulcers and not on their treatment, it would not be possible to use subjects as their own controls. Based on the evidence collected, using historical data on pressure ulcer incidence could be an option. However, the presence of a comparison group significantly improves the validity of the study because it helps to ensure that the results are not influenced by other factors. Therefore, a control group is required for this study. Whereas patients in the control group will be tended to using regular pressure ulcer prevention strategies, patients in the intervention groups will receive care in accordance with a new pressure ulcer protocol.

Is a ‘time’ appropriate with your question—why or why not?

The project will look at the incidence of pressure ulcers on day 3 of hospitalization. The majority of surgical procedures in the emergency department take place within the first 24 hours of admission. Therefore, if a patient has not developed a pressure ulcer by day 3 of hospitalization, it is unlikely that they will develop it later during their stay. The set time limit is thus appropriate to the PICOT question, and there is no need to adjust it.

Evidence Synthesis

Database: Pubmed	Study #1	Study #2	Study #3	Study #4	Study #5	Synthesis
(p) Population	Intensive care unit patients	Patients with tracheostomy tubes placed in the operating room	Inpatients from 19 hospital units	Patients admitted to trauma services	Trauma and critically ill patients in an emergency department	All studies focus on inpatients in various departments
(i) Intervention	Pressure ulcer documentation	An institutionally adopted quality improvement protocol	A multi-model intervention program	A 7-step care process, acquisition of specialized equipment, and an educational intervention	The use of soft silicone multi-layered foam dressings	Most interventions included a change in care protocols
(c) Comparison	Comparison among the facilities	Data from before the adoption of a protocol	Regular pressure ulcer preventive care	Routine preventive care	Usual pressure ulcer prevention strategies	Most studies compared the results with usual preventive care
(o) Outcome	The correlation between the quality and comprehensiveness of pressure ulcer documentation and pressure ulcer incidence was insignificant	The incidence of pressure ulcers decreased as a result of a comprehensive quality improvement protocol	A significant reduction in pressure ulcer incidence	The intervention was efficient in reducing the incidence of hospital-acquired pressure ulcers	A reduction in the incidence of hospital-acquired pressure ulcers was 10%	Four out of five interventions achieved a reduction in hospital-acquired pressure ulcers
(t) time	13 months	12 months	16 months	3 years	20 months	The minimum recommended data collection time is 1 year, the average length was 19.4 months

Evaluation Table

Citation	Design	Sample size: Adequate?	Major Variables: Independent Dependent	Study findings: Strengths and weaknesses	Level of evidence	Evidence Synthesis
Li, D. (2016). The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital‐acquired pressure ulcer patients in intensive care units. Journal of Clinical Nursing, 25(15-16), 2336-2347.	A retrospective, descriptive, comparative, correlational study.	196 ICU patients, a relatively small sample size	Independent variables: quality and comprehensiveness of pressure ulcer documentation Dependent variable: incidence of pressure ulcers	Strengths: a comprehensive literature review, appropriate study design, well-founded conclusions Weaknesses: small sample size, which makes it impossible to generalize the results to other settings	VI	The study showed that pressure ulcer documentation quality or its comprehensiveness does not have a significant effect on the incidence of hospital-acquired pressure ulcers.
O’Toole, T. R., Jacobs, N., Hondorp, B., Crawford, L., Boudreau, L. R., Jeffe, J.,… LoSavio, P. (2017). Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngology–Head and Neck Surgery, 156(4), 642-651.	A quantitative, comparative, retrospective study	Intervention group: 155 patients Control group: 183 patients Moderate sample size, but adequate given the specificity of the intervention	Independent variable: the adoption of a quality improvement protocol Dependent variable: pressure ulcer incidence	Strengths: evidence-based protocol used for the intervention, reliable data analysis tools used Weaknesses: only one facility included, weak description of the study design	III	Evidence-based protocols can reduce the incidence of pressure ulcers following a tracheostomy tube placement.
Mallah, Z., Nassar, N., & Badr, L. K. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.	A quantitative, descriptive, prospective study	468 patients in the intervention group, a sufficient sample size	Independent variable: the adoption of a multi-model intervention program Dependent variable: pressure ulcer incidence	Strengths: well-documented evidence from prior research, a comprehensive multidisciplinary intervention, data from 19 units was included Weaknesses: a descriptive design, did not consider organizational risk factors, documentation of procedures was provided by nurses	VI	Pressure ulcers are a significant problem affecting patient outcomes and their length of stay. A multi-model intervention is effective in reducing the incidence of hospital-acquired pressure ulcers.
Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.	A quantitative, prospective study design	9,755 patients, an excellent sample size	Independent variable: the adoption of an intervention program Dependent variable: the incidence of pressure ulcers	Strengths: a large sample size, accounted for organizational risks, such as the lack of specialized equipment and education, results supported by other studies Weaknesses: only included the data from trauma units, compared with chronological data rather than a control group	III	Applying a comprehensive program for hospital-acquired pressure ulcer prevention can help in reducing the incidence of pressure ulcers.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal, 12(3), 302-308.	A randomized controlled trial	440 patients, 220 in each group, an adequate sample size	Independent variable: the use of multi-layer soft silicone foam dressings Dependent variable: the incidence of pressure ulcers	Strengths: a randomized controlled trial with a good quality of evidence, a sufficient sample size, uses an evidence-based intervention, provides a thorough review of prior literature Weaknesses: data collectors were not blinded, the results cannot be applied to general patient populations, only to trauma and critically ill patients in emergency departments	II	The use of multi-layer soft silicone foam dressings assisted in the prevention of hospital-acquired patient ulcers.

References

Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.

Li, D. (2016). The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital‐acquired pressure ulcer patients in intensive care units. Journal of Clinical Nursing, 25(15-16), 2336-2347.

Mallah, Z., Nassar, N., & Badr, L. K. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.

O’Toole, T. R., Jacobs, N., Hondorp, B., Crawford, L., Boudreau, L. R., Jeffe, J.,… LoSavio, P. (2017). Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngology–Head and Neck Surgery, 156(4), 642-651.

Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal, 12(3), 302-308.