Search

Pressure ulcers are an increasing health care problem. Accurate identification and classification of pressure ulcers impacts patient outcomes, health care costs, and quality initiatives.To identify existing evidence related to answering the question 'Does bedside nursing staff accurately and reliably stage pressure ulcers as evidenced in their documentation?' Further evidence from one large tertiary care center with pressure ulcer identification and staging by nurses is also reported.Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases were searched to identify existing evidence on the accuracy and reliability of pressure ulcer classification by nurses. Two reviewers independently screened results. A total of 54 full-text articles were obtained for review and 10 were included for final review. In addition, the accuracy and consistency of pressure ulcer identification and staging were examined at one large tertiary health system by extracting data from electronic health records for 1488 patient visits and assessments for 1499 patients. Comparisons were done for pressure ulcer documentation from 1 nurse's assessment to the following shift nurse's assessment and from the bedside nurse's assessment to assessments done by pressure ulcer experts.Review of the literature revealed that the reliability of pressure ulcer identification and classification is limited and highly variable. Some reports in the literature suggested nurses had difficulty distinguishing a pressure ulcer from other types of wounds. In addition, inaccuracies in pressure ulcer documentation were also identified. Further analysis of data within one large tertiary health care system revealed unreliable pressure ulcer documentation. [ABSTRACT FROM AUTHOR]

Background: Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies., Objective: To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth., Research Design: Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by investigators using reflection questions., Results: Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board approval process and the short length of time allocated for implementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples revealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching., Conclusions: This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strategies and impact of findings on quality of care.

Unlabelled: The Agency for Healthcare Research and Quality has defined pressure ulcers (PUs) an important patient safety indicator (#3). Despite the existence of evidence-based guidelines for PU prevention and treatment from the United States Department of Health and Human Services, the sustained success in reducing the development of PUs is elusive in many acute care hospitals., Purpose: The specific aim of the study was to determine whether the implementation of an early standardized process for mobility could reduce or eliminate the development of PUs in a surgical intensive care unit., Methods: Patient data were collected pre- and postimplementation of the early mobility protocol., Results: The mobility compliance for patients postimplementation was 71.30% (SD = 12.73), with a range of 25% to 100%. A χ² test for independence (with Yates continuity correction) indicated a significant association between unit-acquired PUs and the pre- and postimplementation mobility groups (χ²(1,1051) = 6.86, P = .009). Specifically, patients in the intervention group had significantly more unit-acquired PUs than the control group. No significant differences were identified between the 2 groups., Implications/conclusions: Despite implementation of the early mobility protocol, we did not see an improvement in the PU rate overall or with time as protocol compliance improved.