Implementation of evidence in preventing medical device‐related pressure injury in ICU patients using the i‐PARIHS framework

2021 ◽  
Author(s):  
Songmei Cao ◽  
Mengqian Gu ◽  
Man Feng ◽  
Yingying Jia ◽  
Yanyan Zhao ◽  
...  
Keyword(s):  
Medical Device ◽  
Icu Patients ◽  
Pressure Injury ◽  
Parihs Framework

scholarly journals Hospital acquired pressure injury prediction in surgical critical care patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jenny Alderden ◽  
Kathryn P. Drake ◽  
Andrew Wilson ◽  
Jonathan Dimas ◽  
Mollie R. Cummins ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Model Performance ◽  
Routine Care ◽  
Predictor Variables ◽  
Classification Algorithms ◽  
Data Set ◽  
Icu Patients ◽  
Pressure Injury ◽  
Surgical Icu ◽  
Hospital Acquired

Abstract Background Hospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5–10% of surgical intensive care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for every patient because of the cost or intensity of nursing care. Therefore, recommended standards of practice include HAPrI risk assessment at routine intervals. However, no HAPrI risk-prediction tools demonstrate adequate predictive validity in the ICU population. The purpose of the current study was to develop and compare models predicting HAPrIs among surgical ICU patients using electronic health record (EHR) data. Methods In this retrospective cohort study, we obtained data for patients admitted to the surgical ICU or cardiovascular surgical ICU between 2014 and 2018 via query of our institution's EHR. We developed predictive models utilizing three sets of variables: (1) variables obtained during routine care + the Braden Scale (a pressure-injury risk-assessment scale); (2) routine care only; and (3) a parsimonious set of five routine-care variables chosen based on availability from an EHR and data warehouse perspective. Aiming to select the best model for predicting HAPrIs, we split each data set into standard 80:20 train:test sets and applied five classification algorithms. We performed this process on each of the three data sets, evaluating model performance based on continuous performance on the receiver operating characteristic curve and the F1 score. Results Among 5,101 patients included in analysis, 333 (6.5%) developed a HAPrI. F1 scores of the five classification algorithms proved to be a valuable evaluation metric for model performance considering the class imbalance. Models developed with the parsimonious data set had comparable F1 scores to those developed with the larger set of predictor variables. Conclusions Results from this study show the feasibility of using EHR data for accurately predicting HAPrIs and that good performance can be found with a small group of easily accessible predictor variables. Future study is needed to test the models in an external sample.

scholarly journals Patient safety may be compromised if study conclusions are generalized to products that make similar claims but have no equivalent research evidence

2018 ◽  
Vol 24 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Amit Gefen ◽  
Nick Santamaria ◽  
Sue Creehan ◽  
Joyce Black
Keyword(s):  
Patient Safety ◽  
Medical Device ◽  
Cost Benefit ◽  
Well Being ◽  
Product Selection ◽  
Specific Product ◽  
Medical Claims ◽  
Published Evidence ◽  
Pressure Injury ◽  
Pressure Injury Prevention

This paper addresses a fundamentally important issue in health care, namely how to make informed decisions on product selection when two products, from different manufacturers, appear to be similar and have medical claims that sound comparable. In such cases, manufacturers of competing products often use each other’s evidence. They argue that the published evidence is generally applicable even if the original bioengineering tests and clinical trials were performed on a specific product, and no equivalence was obtained for their product that has similar medical claims. In this work, we use prophylactic dressings for pressure injury prevention as a good demonstrative example on how patient safety may be compromised if study conclusions are generally projected to such unstudied products. The medical device industry is regulated differently than the pharmaceutical industry, and consequently, voids in current medical device regulation are sometimes used to promote commercial interests. This paper analyzes gaps and potential pitfalls that occur where guiding documentations (e.g. guidelines, standards) do not cope well with medical technology. We explain how that can eventually lead to potential compromises to the well-being of patients, primarily if nurses are unaware of the aforementioned pitfalls. We conclude that currently, there is no alternative to rigorousness: Clinicians and decision-makers need to scrutinize up-to-date literature, decide which products have the best portfolio of bioengineering and clinical research to support the claims made, and which products have the best cost–benefit models. This is fundamentally different from simply buying the least expensive product because of appealing sale arguments.

scholarly journals Medical Device-Related Pressure Injury to the Ear from a Mask

2021 ◽  
Vol 34 (7) ◽  
pp. 380-383
Author(s):  
Jeffrey M. Levine ◽  
Elizabeth A. Ayello ◽  
Balwant Persaud ◽  
Ruth Spinner
Keyword(s):  
Medical Device ◽  
Pressure Injury

36 Using Pressure Mapping to Understand and Prevent Hospital-Acquired Pressure Injuries in the Burn ICU

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S28-S28
Author(s):  
Leen El Eter ◽  
Pooja S Yesantharao ◽  
Vidhi Javia ◽  
Emily h Werthman ◽  
Carrie A Cox ◽  
...  
Keyword(s):  
Real Time ◽  
Time Pressure ◽  
Cost Savings ◽  
Pressure Monitoring ◽  
Mapping Data ◽  
Significant Cost ◽  
Icu Patients ◽  
Pressure Mapping ◽  
Pressure Injury ◽  
Hospital Acquired

Abstract Introduction Real-time pressure mapping devices may help prevent hospital-acquired pressure injury (HAPI) in Burn ICU (BICU) patients who are at a high baseline risk for HAPIs. While prior studies have demonstrated the utility of pressure monitoring devices in preventing pressure injuries, there has been little investigation into using pressure mapping data to better understand HAPI development, and to determine specific predictors of HAPIs. Such data could help risk stratify patients upon admission to the BICU and result in improved patient care as well as cost savings. This study retrospectively investigated the utility of pressure mapping data in predicting/preventing pressure injury among BICU patients, and estimated HAPI-related cost savings associated with the implementation of pressure monitoring. Methods This was a retrospective chart review of real-time pressure mapping in the BICU. Incidence of HAPIs and costs of HAPI-related care were determined through clinical record review, before and after implementation of pressure mapping. Multivariable-adjusted logistic regression was used to determine predictors of HAPIs, in the context of pressure mapping recordings. Results In total, 122 burn ICU patients met inclusion criteria during the study period, of whom 57 (47%) were studied prior to implementation of pressure mapping, and 65 (53%) were studied after implementation. The HAPI rate was 18% prior to implementation of pressure monitoring, which declined to 8% after implementation (chi square: p=0.10). HAPIs were more likely to be less severe in the post-implementation cohort (p< 0.0001). Upon multivariable-adjusted regression accounting for known predictors of HAPIs in burn patients (BMI, length of stay, co-morbidities, age, total body surface area burned, mobility), having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95%CI 1.0–1.5, p=0.04). When comparing patients who developed HAPIs to those who did not, pressure mapping demonstrated that patients who developed HAPIs were significantly more likely to have had unsuccessful repositioning efforts prior to HAPI development, defined as persistent high pressure in the at-risk area (60% versus 17%, respectively; p=0.02). Finally, implementation of pressure mapping resulted in significant cost savings ($2,063 prior to implementation, versus $1,082 after implementation, p=0.008). Conclusions The use of real-time pressure mapping decreased incidence of HAPIs in the burn ICU patients and resulted in significant cost savings.

scholarly journals Medical Device Related Pressure Injury in the Treatment of Chronic Pain: An Early Sign of Explantation in Suspected Infection

2018 ◽  
Vol 1 (21;1) ◽  
pp. E235-E246 ◽  
Author(s):  
Nerea Sanchis-López
Keyword(s):  
Drug Delivery ◽  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Study ◽  
Medical Device ◽  
Spinal Cord Stimulation ◽  
Secondary Outcome ◽  
Intrathecal Drug Delivery ◽  
Pressure Injury ◽  
Hospital General

Background Chronic back pain is a prevalent disease and has a high impact in daily life. Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS) systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased exponentially in the last decade. The number of complications, such as infections, are also more prevalent. Infection management guidelines are needed to standarize our clinical practice and define protocols of explantation. Objectives: The primary outcome is to define the likelihood of device explantation regarding some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary outcome is to evaluate performance compared to the results published in the literature. Study Design: Retrospective study. Setting: Hospital General of Valencia. Valencia. Spain. Methods: A retrospective study of 288 implantable device surgeries was conducted at the Hospital General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data were collected. We have followed the “guidelines for the diagnosis, prevention and management of implantable electronic cardiac device infection” due to the lack of a specific guideline in our field. Results: Forty-three out of 288 procedures were identified as suspected device-infected interventions. Half of the patients had microbiologically confirmed infection after wound, blood or lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on discharge also played a role in the decision of device explantation. Limitations: Lack of external validity and others. Conclusion: In this study, presence of decubitus is the defining variable for device explantation when a infection is suspected rather than waiting to culture results. Due to a high variability in infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on accurate data monitoring, rigurous implantation technique and standardized protocols. Key Words: Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug delivery pump, complication, infection, explantation

Relationship between skin temperature and medical device-related pressure injury in intensive care unit

2021 ◽  
Vol 31 ◽  
pp. S614-S617
Author(s):  
Sintawati Majid ◽  
Saldy Yusuf ◽  
Yuliana Syam ◽  
Muhammad Darwis ◽  
Deliaty Bagenda Ali
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Skin Temperature ◽  
Medical Device ◽  
Pressure Injury

Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study

2021 ◽  
Vol 67 (11) ◽  
pp. 26-32
Author(s):  
Itaricely de Assis ◽  
Jonathan Estevam dos Santos ◽  
Maria Valadares Sinicio Abib ◽  
Luana Furtado Bueno ◽  
Manuela de Mendonça Figueirêdo Coelho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Medical Device ◽  
Medical Devices ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Independent Variables ◽  
Pressure Injury ◽  
Stage 1

BACKGROUND: Medical devices can cause pressure injuries. PURPOSE: This study was conducted to determine the prevalence of and factors associated with medical device-related pressure injury (MDRPI) in an intensive care unit (ICU). METHODS: A cross-sectional study was performed among adult patients (at least 18 years of age) admitted to an ICU in a referral hospital in Brazil between December 2019 and February 2020. The skin of patients who consented to participate was assessed for the presence of an MDRPI, and the use of all medical devices was noted. Other independent variables (sociodemographic variables, medical history, pressure injury risk factors, medications, and length of hospitalization) were abstracted from the medical records. Bivariate data analysis included Pearson’s chi-square test or Fisher’s exact test; odds ratio and a confidence interval of 95% also were established. Correlation among independent variables and MDRPI was determined using the ρ Spearman correlation test, and a hierarchical binary logistic regression analysis was performed using statistically significant variables from the bivariate analysis. P < .05 was considered statistically significant. RESULTS: The 125 study participants ranged in age from 15 to 97 years (mean, 63.02 ± 19.2), 76 (60.8%) were men, and 76 (60.8%) were White. Of the 125 participants, 43 (34%) experienced MDRPI; the total number of MDRPIs was 58 (3 patients had 3 injuries, and 7 patients had 2 injuries). Of those 58 MDRPIs, 46 were stage 1, and 12 were stage 2. Polypharmacy (> 4 medications) was a significant risk factor for MDRPI. Use of a nasal catheter, cord for orotracheal tube fixation, oximeter, intra-abdominal pressure equipment, and indwelling urinary catheter was significantly associated with the presence of MDRPI. Renal and respiratory diseases and the presence of infection were positively related to the presence of MDRPI. CONCLUSION: Medical device-related pressure injury was prevalent in this patient population. Most of these injuries were stage 1, which suggests that frequent monitoring and device repositioning (when possible) may help prevent more serious injuries. Additional research involving other hospitals in Brazil is needed to increase the understanding of the prevalence and risk factors of MDRPIs in patients in the ICU.

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