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Background: Sub-optimally treated wounds and mismanagement of underlying medical conditions lead to poor patient outcomes (sepsis, amputation, and death) due to overuse of substandard wound care not supported by research and underuse of four key evidence-based wound care practices: 1) vascular studies to assess leg ulcers, 2) compression for venous leg ulcers, 3) off-loading diabetic foot ulcers, and 4) clinical decision support tool use. However, many primary care providers do not receive formal education on wound care management. Objective: Investigators evaluated primary care provider knowledge, attitudes, practice comfort, and confidence with wound care using an education session on four evidence-based wound practices. Design/Sample/Setting: This was a pre- and post-test quality improvement project conducted for primary care providers working in ambulatory care settings of a health maintenance organization (HMO). Methods: The one-hour education session offered on a virtual platform focused on four key evidence-based wound care practices. The investigators developed the 28-question pre- and post-tests with corresponding clinical vignettes to measure wound care knowledge, attitudes, practice comfort, and confidence with total scores calculated. Data was analyzed using descriptive statistics and paired t-tests. Results: Of the 28 participants, 61% were female, 68% were Medical Doctor or Doctor of Osteopathic Medicine (MD or DO), 25% were Nurse Practitioner (NP)/Advance Practice Registered Nurse (APRN) or Physician Assistant (PA), and 54% had prior wound education. Mean knowledge scores significantly increased by more than one point from pre-test to post-test (7.03, standard deviation [SD] 2.0 vs. 8.25, SD 1.0; p=0.002). Mean attitudes (12.75, SD 1.9 vs. 14.64, SD 2.5; p<0.001), mean practice comfort scores (9.93, SD 3.21 vs. 11.61 SD 3.87; p=0.003), and mean confidence level (1.86, SD 0.8 vs. 2.29, SD 0.85; p<0.001) significantly improved. Conclusions: The pr

Purpose: To examine the use of music therapy in nursing home (NH) residents living with dementia with agitation and aggressive behaviors and receiving as needed psychotropic medications.Background: Agitation and aggressive behaviors associated with dementia occur in 15 to 20% of NH residents. In California, 14% of NH residents with dementia and related behavioral symptoms receive psychotropic medications despite an increased risk of side effects which can lead to falls and injury. Providers often prescribe psychotropic medications as first-line treatment for symptoms associated with dementia. Non-pharmacological approaches such as music therapy may improve dementia-related behaviors and decrease the use of psychotropic medications among residents with dementia.Methods: This was a pretest-posttest quality improvement project with two-weeks pre-intervention and eight weeks of intervention in a single NH. Ten NH residents experiencing dementia with associated agitation and aggressive behaviors and on as needed psychotropic medications were recruited. They participated in twice-weekly, 30-minute, individualized passive music therapy delivered with MP3 device players and headphones. Residents and family were contacted to determine music choices. Prior to intervention, one 60-minute training session was provided to nursing and activity staff. Participants’ demographic and medical information were collected from electronic medical records and the most recent Minimum Data Set 3.0. Pre-intervention and intervention data on frequency and severity of agitated and aggressive behaviors and frequency of as needed psychotropic medication administration was collected from medication administration records (MAR) and an investigator-developed behavior monitoring tool (IDBM). Mean frequencies of as needed psychotropic medications, agitation and aggressive behaviors and mean severity level for agitation and aggressive behaviors pre-intervention and post-intervention were compared from

The Bates-Jensen Wound Assessment Tool (BWAT) is used to assess wound healing in clinical practice. The purpose of this study was to evaluate BWAT use among nursing home residents with pressure injury. Findings and reliability estimates from the BWAT related to pressure injury characteristics (stage, anatomic location) and natural history (resolved, persisted) among 142 ethnically and racially diverse residents are reported. In this prospective 16-week study, 305 pressure injuries among 142 participants (34% prevalence) are described by stage, anatomic location, and BWAT scores. Visual and subepidermal moisture assessments were obtained from sacrum, buttock, ischial, and heel ulcers weekly. Participants were 14% Asian, 28% Black, 18% Hispanic, 40% White with a mean age of 78 ± 14 years, and were 62% female; 80% functionally dependent (bed mobility extensive/total assistance) and at risk (Braden Scale score 14 ± 2.7). The reliability coefficient for BWAT score (all participants, all anatomic locations) was high (r = 0.90; p < 0.0001; n = 1,161 observations). Weighted Kappas for characteristics ranging from 0.46 (skin color surrounding wound) to 0.79 (undermining) were consistent for all participants. BWAT scores showed strongest agreement coefficients for stage 4 pressure injury (r = 0.69), pressure injuries among Asian and White ethnicity/racial groups (r = 0.89, and r = 0.91, respectively), and sacrum anatomic location (r = 0.92) indicating scores are better correlated to fair skin tones. Lower agreement coefficients were demonstrated for stage 2 pressure injury (r = 0.38) and pressure injuries among African American and Hispanic ethnicity/racial groups (r = 0.88 and 0.87, respectively). BWAT scores were significantly different by pressure injury stage (F = 496.7, df = 6, p < 0.001) and anatomic location (F = 33.76, df = 8, p < 0.001). BWAT score correlated with pressure injury natural history (ulcer resolved 18.4 ± 7.4, ulcer persisted 24.9 ± 10.0; F = 70

Background: Pressure injuries (PIs) impose significant human and financial costs on patients and their families and the health care system. Most are considered preventable and therefore are deemed medical errors. Among medical errors, PIs are the costliest. Results from extensive etiology-related and interventional research have been translated into evidence-based clinical guidelines which have been widely disseminated. Yet, hospital acquired pressure injuries (HAPI) have been increasing in recent years while HAPI prevalence rates in intensive care units (ICU) continue being the highest among hospitalized patients. Considering that the majority of PIs are medical errors, researchers and health care organizations have to explore human factors, such asattitudes of main stakeholders, to inform approaches to decreasing HAPIs in ICU patients who are among the most vulnerable of hospitalized patients.Methods: A multi-site, focused ethnographic study was conducted with four major stakeholders in the ICU. Critical care nurses (CCRN), physician and nurse practitioner providers, ICU leaders, and patients and their families from two community hospitals and two academic hospitals participated in interviews or focus groups. Semi-structured interview guides were used to elicit implicit and explicit attitudes of each stakeholder group towards PIP.Results: Findings of three stakeholder groups, CCRNs, providers, and patients and families, are reported here. All participants held preconceptions and misconceptions about PIs and PIP which informed the degree to which they were engaged with PIP processes. Preconceptions and misconceptions affected how they interpreted transition points in the ICU which in turn impacted how they prioritized PIP. Major misconceptions held by both CCRNs and providers were that PIP could not be undertaken with very critical patients, that PIP mostly consisted of side to side turning at various intervals, and that PIs took longer than scientific evidence sug

Background: Spinal cord injury (SCI) can be a devastating event causing a significant burden to individuals, their family members and society. In the United States (US), it is estimated 276,000 individuals are living with a SCI and it is projected that 12,500 new SCI cases are reported each year. Individuals with a physical impairment such as SCI often develop a pressure ulcer (PU), which may be prevented. There is a correlation to the development of PU’s from poor nutritional status and poor nutritional intake. The purpose of this study was to examine the relationships between macronutrient and micronutrient intake, anthropometric measurements, psychosocial, disability, and nutritional status measurements among community dwelling non-ambulatory persons with a (SCI) with and without (PU’s). Methods: Participants were SCI individuals living in the community with and without a PU and were recruited from home health agencies and SCI rehabilitation facilities. Data was collected using structured questionnaires, nutritional assessment tools, skin assessment, and anthropometric measurement over 4 days consisting of one initial visit and a second visit on day four. Macro and micronutrient intake data was collected using a 3-day self-reported food log. Psychosocial factors were measured via structured questionnaire administered during the initial home visit. Nutritional status measurements included the Mini Nutritional Assessment-Short Form.Disability status measurements included World Health Organization Assessment Schedule (WHODAS) 2.0, and Spinal Cord Injury-Secondary Condition Scale (SCI-SCS). The sample included 80 participants, 40 with and 40 without PUs. Results: This study found significant and clinical differences in micro and macronutrient intake among participants with and without PU indicating persons with SCI are at some nutritional risk.Conclusions: Participants consumed inadequate dietary intake in both quantity and quality. Participants with PU are not getti