PICOT Question and Literature Research
PICOT Question and Literature Research
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Clinic issue: pressure ulcer (pressure injury)
An Ulcer of Pressure is a localized injury to the skin and underlying tissue, usually over a bony prominence, as a result of pressure alone or pressure in conjunction with shear (Dorner et al., 2009). Today, pressure ulcers rank third in terms of cost after cancers and cardiovascular diseases. This disease has a mortality rate of two to six times higher than most other diseases, with 60,000 deaths occurring every year due to this complication(Schindler et al., 2011). Inpatients are more susceptible to pressure ulcers in the tissues of the extremities and in bony extensions such as the sacrum and heel. Pressure ulcers are most often caused by low physical activity, decreased consciousness, urinary and fecal incontinence, malnutrition, and advanced age (Afzali Borojeny et al., 2011). PICOT Question and Literature Research
In the United States, pressure ulcers are estimated to cause about 2.5 million hospitalizations (Kottner & Dassen, 2010). Pressure ulcers can result in pain, reduced autonomy, increased infection and sepsis risks, more surgical procedures, long hospital stays, and higher costs for patients, families, and health care systems (Stinson et al., 2013). In addition to physical-social and self-care dysfunction, pressure ulcer patients may also experience several complications such as depression, pain, topical infection, osteomyelitis, sepsis, and even death (Senmar et al., 2017).
Despite advances in medicine, pressure ulcers remain one of the most common medical problems. There is currently no consensus on the risk factors of pressure ulcers, so identifying them is the first step in preventing an increase in their incidence (Donnelly et al., 2011). The development of counseling and prevention systems for pressure ulcers in the USA and Europe has become so important because pressure ulcers pose a major concern for patients and healthcare providers(Reddy, Gill, & Rochon, 2006). PICOT Question and Literature Research
PICOT Question
Population: patients who have developed pressure ulcer
The intervention of interest: patients who utilize pressure ulcer prevention strategies
Comparison: patients who are not been used pressure ulcer strategyies
Outcome: better or faster wound healing
Time: in the monitoring phase.
Are those pressure ulcer prevention strategies such as use use of specialty beds, turn and re-position, urinary catheter , nutritional consult better or faster for wound healing and prevention Compare patients who not been used pressure ulcer strategies.
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974.doi:10.1001/jama.296.8.974 | McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews.doi:10.1002/14651858.cd001735 | Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., … Simpson, V. S. (2010). Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care. American Journal of Critical Care, 20(1), 26–35.doi:10.4037/ajcc2011754
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| How Does the Article Relate to the PICOT Question? | This article is relevant to general pressure ulcer prevention strategyies among patients who suffer pressure ulcers | The aim of this systematic review is to determine the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared to standard support surfaces, as well as their comparative effectiveness in ulcer prevention. | This article is relevant to determine nursing strategies associated with a lower incidence of pressure ulcers.
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| Quantitative, Qualitative (How do you know?) | methodological quality of randomized control trial | Randomised controlled trials (RCTs) and quasi-randomised trials
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Randomized clinical trial multivariate logistic regression models
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| Purpose Statement | To systematically review the evidence examining interventions to pre- vent pressure ulcers. | To review which material of mattress or supportive surface can help relieve pressure ulcer | To determine effective interventions associated with low pressure ulcer incident |
| Research Question | Studies assessed three categories of interventions, namely those that addressed impairments of mobility, nutrition, and skin health.
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People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses.
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Effective nursing care with targeted interven- tions can reduce the incidence of pressure ulcers.
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| Outcome | Examed difference approaches: reposition on the special mattress, incontinence care, skin care, nutritional supplement all benefit for decrease or prevention pressure ulcer
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higher-specification foam mattresses show more evidence to prevent pressure injury | In this multisite study, we focused on determining the incidence of pressure ulcers among critically ill and injured infants and children, comparing the characteristics of patients with and without pressure ulcers, and identifying prevention strategies associated with fewer pressure ulcers.
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| Setting
(Where did the study take place?) |
Participants from acute care, long term care, rehab, and mixed setting
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Participants who have hight risk of pressure ulcer or some of them have pressure ulcer | In PEDs ICU |
| Sample | The 59 selected studies enrolled a total of 13 845 patients: 9397 (67.9%) in acute care, 2367 (17.1%) in LTC, 333 (2.4%) in re- habilitation, and 1748 (12.6%) in mixed settings | People receiving health care who were deemed to be at risk of developing pressure ulcers, in any setting, total of included trials to 59 , in comparison 1, participant including
2407
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5346 patients in pediatric inten- sive care units in whom pressure ulcers did and did not develop were compared |
| Method | Based on whether the intervention being evaluated addressed mobility, nutrition, or skin health impairments, RCTs were divided into three categories.
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Randomised controlled trials (RCTs) and quasi-randomised trials .
Trials that evaluated the following interventions included: 1. “Low-tech” CLP support surfaces 2. “High-tech” support surfaces 3. Other support surfaces
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The 29 separate preventive measures evaluated in this way were entered into the multivariate logistic regression models described above in order to determine which preventive measures had the greatest influence on pressure ulcer development..
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| Key Findings of the Study | Re-position on the special mattress, skincare, nutritional supple all affectively reduce incident happen | High special supportive surface show show more benefit for preventing pressure ulcer | Infants and chil- dren sink into low–air loss beds and specialty beds in turning mode, increasing occipital friction and shearing. Pressure ulcers were more likely in children who remained in the pediatric intensive care unit at least 4 days
Some of the pressure ulcers in our patients were related to devices. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets |
| Recommendations of the Researcher | The in-complete reporting in the RCTs may have influenced our assessment. In future studies, the interventions required to prevent pressure ulcers specifically among high-risk populations should be defined. There are several risk factors for pressure ulcers, including being bedridden or chairbound, being unable to reposition without assistance, difficulty ambulating, history of stroke, fecal incontinence (which is highly related to immobility), low body weight, lymphopenia, difficulty feeding independently, impaired nutritional intake, nonblanchable erythema of intact skin (ie, stage 1 pressure ulcer), and dry sacrum. | The study also found that people who used sheepskin overlays for their mattresses tended to develop fewer pressure ulcers. In contrast to high-specification constant low-pressure or alternating-pressure support surfaces, there is little evidence that alternating-pressure mattresses can prevent pressure ulcers more effectively than alternating-pressure overlays. | These patients may benefit from targeted nursing interventions to reduce pressure ulcers. We plan to conduct a prospective randomized clinical trial to confirm that specific nursing interventions improve outcomes. During the study, critical care nurses will have access to a set of interventions that can significantly reduce pressure ulcer risk in critically ill children and infants |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Medical Advisory Secretariat (2009). Community-based care for chronic wound management: an evidence-based analysis. Ontario health technology assessment series, 9(18), 1–24. | Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & social care in the community, 27(4), e417–e427. https://doi.org/10.1111/hsc.12742 | Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey. Journal of nursing management, 25(6), 457–467. https://doi.org/10.1111/jonm.12416 |
| How Does the Article Relate to the PICOT Question? | Managing pressure ulcers with a multidisciplinary wound care team significantly increases wound healing | Assessed pressure ulcer prevention strategies in nursing home | Programs designed to prevent pressure ulcers include nursing interventions such as risk assessments, as well as organizational strategies such as policies and performance monitoring to embed these interventions into routine care. |
| Quantitative, Qualitative (How do you know?) | Randomized controlled trials and Controlled clinical Trials | Quantitative and qualitative data were analyzed using descriptive statistics | A cross-sectional survey ,Descriptive statistics |
| Purpose Statement | To determine the effectiveness of a multidisciplinary wound care team for the management of chronic wounds. | To determine, the implementation bundle effective on pressure ulcer | To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system.
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| Research Question | Multidisciplinary team can help manage Chronic wounds | assessed the feasibility of implementing our pressure ulcer prevention care bundle in a nursing home setting.
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Assess the presence and operationalization of organizational strategies to support implementation of pressure ulcer |
| Outcome | The percentage of persons and/or wounds completely healed. Reduction in healing time, improved quality of life, and pain management.
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According to this study, a pressure ulcer prevention bundle is acceptable to nursing home staff and can improve care provision. Participants reported an increase in their motivation to provide more comprehensive care.
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Organizational strategies that support pressure ulcer prevention program implementation (policy, oversight committee, wound care specialist, staff education, performance data, and performance improvement activities) were reported at high levels |
| Setting
(Where did the study take place?) |
Nursing home | Nursing home | hospitals
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| Sample | Population includes persons with pressure ulcers (anywhere) and/or leg and foot ulcers
In 2007, control Group 119, experimental 127. Harrison et al, 2005: before 78, after 180 Vu et al, 2007 : 176 residents (342 wounds)
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collected data for 462 resident bed days prior to implementing the bundle; collected data for 1,181 resident bed days during the intervention phase | achieved 97% response rate (N=116/120)
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| Method | Randomized controlled trials and Controlled Clinical Trials (CCT), The intervention includes a multidisciplinary (two or more disciplines) wound care team, The control group does not receive care by a wound care team
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For 5 weeks before implementing the bundle, we collected quantitative data on nursing home staff pressure ulcer prevention behaviors, as well as pressure ulcer incidence rates. After implementation, we collected data for an additional 9 weeks.
The bundle comprised three evidence-based elements: support surfaces,skininspection,repositioning
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A cross-sectional survey of key informants at all VHA acute care hospitals was conducted via email to assess pressure ulcer prevention programs. Surveys were sent to 124 nurse leaders |
| Key Findings of the Study | Using a multidisciplinary wound care team, we’ve been able to reduce the pain and the need for daily wound care. And significantly increases wound healing | Before the implementation of this period, five new pressure ulcers were recorded, and repositioning was the only documented way to prevent pressure ulcers.
Following implementation, no new pressure ulcers developed. Documented prevention strategies included repositioning, skin inspection, and checking support surfaces. |
For the year October 1, 2013 to September 31, 2014, the aggregated mean HAPU rate for acute care hospital medical/surgical units was 1.02% (range 0–3.1%)
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| Recommendations of the Researcher | Evidence for these outcomes is low to very low, so further research will likely have a big impact on how confident we are in the estimate of effect. | Further research is needed to enhance adherence and/or documentation to further investigate a bundle’s potential for preventing pressure ulcers in nursing homes.In spite of low completion rates of the bundle (or the documentation of this), feedback from participants indicates that the bundle was easy to follow, facilitated continuity of care, and resulted in comprehensive pressure ulcer prevention. | Nurse leaders and committees and quality improvement teams play important roles in operationalizing patient safety initiatives such as pressure ulcer prevention.
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Reference
Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171. https://doi.org/10.4103/ijpvm.IJPVM_182_19
Dorner BD, Posthauer ME, Thomas D. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Role of Nutrition in Pressure Ulcer Healing Clinical Practice Guideline. 2009
Donnelly, J., Winder, J., Kernohan, W. G., & Stevenson, M. (2011). An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture. Journal of wound care, 20(7), 309–318. https://doi.org/10.12968/jowc.2011.20.7.309
Kottner, J., & Dassen, T. (2010). Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. International journal of nursing studies, 47(6), 671–677. https://doi.org/10.1016/j.ijnurstu.2009.11.005
Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: a systematic review. JAMA, 296(8), 974–984. https://doi.org/10.1001/jama.296.8.974
Schindler CA, Mikhailov TA, Kuhn EM, Christopher J, Conway P, Ridling D, Scott AM, Simpson VS Am J Crit Care. 2011 Jan; 20(1):26-34; quiz 35.
Stinson, M., Gillian, C., & Porter-Armstrong, A. (2013). A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the OT. British Journal of Occupational Therapy, 76(4), 1-10.
Senmar, M., Azimian, J., Rafiei, H., Habibollahpour, M., & Yousefi, F. (2017). The incidence of pressure ulcer in old patients undergoing open heart surgery and the relevant factors. Journal of Preventive Epidemiology, 2(2), e15-e15.
