Download or read book Pressure Ulcer Risk Assessment and Prevention Comparative Effectiveness written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-06-29 with total page 362 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pressure ulcers are defined by the National Pressure Ulcer Advisory Panel (NPUAP) as “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” A number of risk factors are associated with increased risk of pressure ulcer development, including older age, black race, lower body weight, physical or cognitive impairment, poor nutritional status, incontinence, and specific medical comorbidities that affect circulation such as diabetes or peripheral vascular disease. Pressure ulcers are often associated with pain and can contribute to decreased function or lead to complications such as infection. In some cases, pressure ulcers may be difficult to successfully treat despite surgical and other invasive treatments. In the inpatient setting, pressure ulcers are associated with increased length of hospitalization and delayed return to function. In addition, the presence of pressure ulcers is associated with poorer general prognosis and may contribute to mortality risk. Recommended prevention strategies for pressure ulcers generally involve use of risk assessment tools to identify people at higher risk for developing ulcers in conjunction with interventions for preventing ulcers. A variety of diverse interventions are available for the prevention of pressure ulcers. Categories of preventive interventions include support surfaces (including mattresses, integrated bed systems, overlays, and cushions), repositioning, skin care (including lotions, dressings, and management of incontinence), and nutritional support. Each of these broad categories encompasses a variety of interventions. The purpose of this report is to review the comparative clinical utility and diagnostic accuracy of risk-assessment instruments for evaluating risk of pressure ulcers and to evaluate the benefits and harms of preventive interventions for pressure ulcers in different settings and patient populations. The following Key Questions are the focus of this report: KQ1. For adults in various settings, is the use of any risk-assessment tool effective in reducing the incidence or severity of pressure ulcers compared with other risk-assessment tools, clinical judgment alone, and/or usual care? KQ1a. Do the effectiveness and comparative effectiveness of risk-assessment tools differ according to setting? KeQ1b. Do the effectiveness and comparative effectiveness of risk-assessment tools differ according to patient characteristics and other known risk factors for pressure ulcers, such as nutritional status or incontinence? KQ2. How do various risk-assessment tools compare with one another in their ability to predict the incidence of pressure ulcers? KQ2a. Does the predictive validity of various risk-assessment tools differ according to setting? KQ2b. Does the predictive validity of various risk-assessment tools differ according to patient characteristics? KQ3. In patients at increased risk of developing pressure ulcers, what are the effectiveness and comparative effectiveness of preventive interventions in reducing the incidence or severity of pressure ulcers? KQ3a. Do the effectiveness and comparative effectiveness of preventive interventions differ according to risk level as determined by different risk-assessment methods and/or by particular risk factors? KQ3b. Do the effectiveness and comparative effectiveness of preventive interventions differ according to setting? KQ3c. Do the effectiveness and comparative effectiveness of preventive interventions differ according to patient characteristics? KQ4. What are the harms of interventions for the prevention of pressure ulcers? KQ4a. Do the harms of preventive interventions differ according to the type of intervention? KQ4b. Do the harms of preventive interventions differ according to setting? KQ4c. Do the harms of preventive interventions differ according to patient characteristics?
Download or read book Pressure Ulcer Risk Assessment and Prevention written by and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Pressure Ulcer Risk Assessment and Prevention written by Roger Chou and published by . This book was released on 2013 with total page 358 pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVES: While pressure ulcers commonly occur and are associated with significant health burdens, they are potentially preventable. This report systematically reviews the evidence on (1) risk-assessment scales for identifying people at higher risk of pressure ulcers and (2) preventive interventions to decrease incidence or severity of pressure ulcers. The Agency for Healthcare Research and Quality also commissioned a separate report on effectiveness of interventions to treat pressure ulcers. DATA SOURCES: Articles were identified from searches of MEDLINE(r) (1946 to July 2012), CINAHL (1988 to July 2012), the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (through July 2012), clinical trials registries, and reference lists. Review methods. We used predefined criteria to determine study eligibility. We selected randomized trials and cohort studies on the effects of use of risk-assessment tools and preventive interventions on clinical outcomes. We also selected prospective studies on the diagnostic accuracy of risk-assessment tools for predicting incidence of pressure ulcers. The quality of included studies was assessed, data were extracted, and results were summarized. RESULTS: Of the 4,733 citations identified at the title and abstract level, we screened and reviewed 747 full-text articles. A total of 120 studies (in 122 publications) were included. One good- and two poor-quality studies evaluated effects of using a risk-assessment tool on clinical outcomes, with the good-quality randomized trial showing no difference between use of the Waterlow scale or the Ramstadius tool compared with clinical judgment in subsequent risk of pressure ulcers. Studies of diagnostic accuracy found that commonly used risk-assessment instruments (such as the Braden, Norton, and Waterlow scales) can help identify patients at increased risk for ulcers, but appear to be relatively weak predictors, with no clear difference among instruments in diagnostic accuracy. Fair-quality randomized trials consistently found that more advanced static support surfaces were associated with lower risk of pressure ulcers compared with standard mattresses in higher risk patients (relative risk range, 0.20 to 0.60), with no clear differences among different advanced static support surfaces. Evidence on the effectiveness and comparative effectiveness of other support surfaces, including more advanced dynamic support surfaces, was limited, with some trials showing no clear differences between dynamic and static support surfaces. One fair-quality trial found that stepped care with dynamic support surfaces was associated with substantially decreased risk of ulcers compared with stepped care beginning with static support surfaces. In lower risk populations of patients undergoing surgery, two trials found use of a foam overlay associated with an increased risk of pressure ulcers compared with a standard operating room mattress. Evidence on effectiveness of other preventive interventions (nutritional supplementation; repositioning; pads and dressings; lotions, creams, and cleansers; corticotropin injections; polarized light therapy; and intraoperative warming therapy for patients undergoing surgery) compared with standard care was sparse and insufficient to reach reliable conclusions. CONCLUSIONS: Although risk-assessment instruments can identify patients at higher risk for pressure ulcers, more research is needed to understand how the use of risk-assessment instruments impacts pressure ulcer incidence compared with clinical judgment. More advanced static support surfaces are more effective than standard mattresses for preventing ulcers in higher risk populations. More research is needed to understand the effectiveness of other preventive interventions over usual care and the comparative effectiveness of preventive interventions.
Download or read book Patient Safety and Quality written by Ronda Hughes and published by Department of Health and Human Services. This book was released on 2008 with total page 592 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
Download or read book Fragility Fracture Nursing written by Karen Hertz and published by Springer. This book was released on 2018-06-15 with total page 169 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.
Download or read book Pressure Ulcer Treatment Strategies Comparative Effectiveness written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-06-29 with total page 490 pages. Available in PDF, EPUB and Kindle. Book excerpt: Uninterrupted pressure exerted on the skin, soft tissue, muscle, and bone can lead to the development of localized ischemia, tissue inflammation, shearing, anoxia, and necrosis. Pressure ulcers affect up to three million adults in the U.S. Pressure ulcer healing rates—which depend on comorbidities, clinical interventions, and ulcer severity—vary considerably. Ulcer severity is assessed using a variety of different staging or grading systems, but the National Pressure Ulcer Advisory Panel (NPUAP) staging system is the most commonly used. Comorbidities predisposing toward pressure ulcer development and affecting ulcer healing include those affecting patient mobility (e.g., spinal cord injury), wound environments (e.g., incontinence), and wound healing (e.g., diabetes and vascular disease). Delayed healing can add to the length of hospitalization and impede return to full functioning. Prevalence of pressure ulcers is used as an indicator of quality for long-term care facilities, and progression of pressure ulcers in hospitalized patients is often considered an avoidable complication representing failure of inpatient management. Given the negative impact pressure ulcers have on health status and patient quality of life, as well as health care costs, treatments are needed that promote healing, shorten healing time, and minimize the risk of complications. Pressure ulcer treatment involves a variety of different approaches, including interventions to treat the conditions that give rise to pressure ulcers (support surfaces and nutritional support); interventions to protect and promote healing of the ulcer (wound dressings, topical applications, and various adjunctive therapies, including vacuum-assisted closure, ultrasound therapy, electrical stimulation, and hyperbaric oxygen therapy); and surgical repair of the ulcer. Most ulcers are treated using a combination of these approaches. The following Key Questions are the focus of our report. KQ1. In adults with pressure ulcers, what is the comparative effectiveness of treatment strategies for improved health outcomes, including but not limited to: complete wound healing, healing time, reduced wound surface area, pain, and prevention of serious complications of infection? KQ1a. Does the comparative effectiveness of treatment strategies differ according to features of the pressure ulcers, such as anatomic site or severity at baseline? KQ1b. Does the comparative effectiveness of treatment strategies differ according to patient characteristics, including but not limited to: age, race/ethnicity, body weight, specific medical comorbidities, and known risk factors for pressure ulcers, such as functional ability, nutritional status, or incontinence? KQ1c. Does the comparative effectiveness of treatment strategies differ according to patient care settings, such as home, nursing facility, or hospital, or according to features of patient care settings, including but not limited to nurse/patient staffing ratio, staff education and training in wound care, the use of wound care teams, and home caregiver support and training? KQ2. What are the harms of treatments for pressure ulcers? KQ2a. Do the harms of treatment strategies differ according to features of the pressure ulcers, such as anatomic site or severity at baseline? KQ2b. Do the harms of treatment strategies differ according to patient characteristics, including age, race/ethnicity, body weight, specific medical comorbidities, and known risk factors for pressure ulcers, such as functional ability, nutritional status, or incontinence? KQ2c. Do the harms of treatment strategies differ according to patient care settings, such as home, nursing facility, or hospital, or according to features of patient care settings, including but not limited to nurse/patient staffing ratio, staff education and training in wound care, the use of wound care teams, and home caregiver support and training?
Download or read book Prevention and Treatment of Pressure Ulcers injuries written by and published by . This book was released on 2019 with total page 43 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Advances in Patient Safety written by Kerm Henriksen and published by . This book was released on 2005 with total page 526 pages. Available in PDF, EPUB and Kindle. Book excerpt: v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.
Download or read book Prevention and Treatment of Pressure Ulcers written by National Pressure Ulcer Advisory Panel (U.S.) and published by . This book was released on 2014-09-30 with total page 308 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Clinical Practice Guideline presents recommendations and summarizes the supporting evidence for pressure ulcer prevention and treatment. The first edition was developed as a four year collaboration between the National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP). In this second edition of the guideline, the Pan Pacific Pressure Injury Alliance (PPPIA) has joined the NPUAP and EPUAP. This edition of the guideline has been developed over a two year period to provide an updated review of the research literature, extend the scope of the guideline and produce recommendations that reflect the most recent evidence. It provides a detailed analysis and discussion of available research, critical evaluation of the assumptions and knowledge in the field, recommendations for clinical practice, a description of the methodology used to develop the guideline and acknowledgements of the 113 experts formally involved in the development process.
Download or read book Pressure Ulcers in Adults written by and published by . This book was released on 1992 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Long Term Care Risk Management written by Karen S. Clay and published by HC Pro, Inc.. This book was released on 2004 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Science and Practice of Pressure Ulcer Management written by Marco Romanelli and published by Springer Science & Business Media. This book was released on 2005-12-23 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: Only comprehensive reference book on pressure ulcers and their management Only book in its field endorsed by the European Pressure Ulcer Advisory Panel, the leading European authority on pressure ulcers
Download or read book Quick Reference Guide for Clinicians written by and published by . This book was released on 1992 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Initial Assessment Effect on Pressure Ulcer Among Adult Patient with Cancer written by Ahmed Ayoub and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Effective prevention of pressure ulcers (PUs) is a major concern in nursing practice worldwide. PU prevention consists of two interrelated steps: (1) risk assessment and (2) applying preventive interventions and measures based on the assumed PU risk level. Purpose: We conducted a review of research into interventions designed to identify effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice. Method: Search different internet data bases including: using “pubmed,” “science direct,” “highwire” and “scientific Google” database. Sample: 80 articles were found; the review utilized 12 articles which met the inclusion criteria. The incidence and prevalence rates of pressure ulcers are different from one hospital to another and from one country to another Studies included in this review focused on the Use of Pressure ulcer in term of assessment and prevention among adult patient in cancer. Result: Future studies should deal with different kinds of PU in order to be able to provide solid data for nursing practice within the vulnerable group of oncology patients. Furthermore, uniform interventions, assessment instruments, and designs should be used for collecting the results to enable comparability. Conclusion: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Recommendations: Complete an initial assessment of the individual with a pressure ulcer, to include the individual's and family's goals of care, Risk for developing additional pressure ulcers, Functional capacity, particularly in regard to positioning, posture and the need for assistive equipment and personnel and Pain related to pressure ulcers.
Download or read book Pressure Ulcer Risk Assessment and Prevention written by and published by . This book was released on 2001 with total page 14 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Pressure Ulcer Research written by Dan L. Bader and published by Springer Science & Business Media. This book was released on 2005-12-14 with total page 383 pages. Available in PDF, EPUB and Kindle. Book excerpt: Presents both current and future aspects of diagnosis and treatment. Presents evidence-based knowledge of pressure ulcer aetiology. Contains over 90 illustrations. Explores the possiblities of tissue repair using new tissue engineering strategies.
Download or read book Pressure Ulcers in Adults written by and published by . This book was released on 1992 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:
