Tayyib Nahla, Coyer Fiona, Lewis Peter A
Doctoral Candidate, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia and Lecturer. School of Nursing, Umm Al-Qura University, Mecca, Saudi Arabia.
J Nurs Scholarsh. 2015 May;47(3):237-47. doi: 10.1111/jnu.12136. Epub 2015 Mar 21.
This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs).
A two-arm cluster randomized experimental control trial.
Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression.
The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = .002) and Stage II PU development (p = .026).
Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU; PU incidence, severity, and total number of PUs per patient were reduced.
Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome.
本研究旨在测试一项压疮（PU）预防综合措施在降低沙特两个重症监护病房（ICU）危重症患者压疮发生率方面的有效性。
双臂整群随机实验对照试验。
干预组参与者接受PU预防综合措施，而对照组按照当地ICU政策接受标准皮肤护理。收集的数据包括人口统计学变量（年龄、诊断、合并症、入院轨迹、住院时间）和临床变量（Braden量表评分、器官功能严重程度评分、机械通气、压疮存在情况及分期）。所有患者从入院到出院、死亡或最长随访28天，每两天进行一次随访。数据采用描述性相关统计、Kaplan-Meier生存分析和泊松回归进行分析。
共招募了140名参与者：70名对照组参与者（共728天观察期）和70名干预组参与者（784天观察期）。干预组的压疮累积发生率（7.14%）显著低于对照组（32.86%）。泊松回归显示，干预组发生压疮的可能性低70%。干预组I期（p = 0.002）和II期压疮发生率显著更低（p = 0.026）。
在ICU实施PU预防综合措施后，与压疮相关的结果有显著改善；压疮发生率、严重程度及每位患者的压疮总数均有所降低。
通过皮肤评估采用综合措施和标准化护理语言并将知识转化为实践，有可能对护理质量和患者结局产生积极影响。
