PROTECT - 试验：一项群组 RCT 研究，旨在评估一种体位重置辅助工具和定制化体位重置方案对提高体位重置依从性的效果。

PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance.

机构信息

Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.

Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.

出版信息

J Adv Nurs. 2019 May;75(5):1085-1098. doi: 10.1111/jan.13932. Epub 2019 Jan 25.

DOI:10.1111/jan.13932

PMID:30549321

Abstract

AIM

To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact.

BACKGROUND

Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking.

DESIGN

Multicentre, cluster, three-arm, randomized, controlled pragmatic trial.

METHODS

Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group.

RESULTS

Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group.

CONCLUSION

This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education.

TRIAL REGISTRATION

This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.

摘要

目的

研究定制翻身和翻身转位系统对以下方面的效果：（a）护士对翻身频率的依从性；（b）翻身后患者的身体姿势；（c）压疮和失禁相关性皮炎的发生率；（d）护士和患者的偏好、舒适度和可接受性；以及（e）预算影响。

背景

针对压疮预防，为患者量身定制系统翻身是关键。迄今为止，缺乏临床决策工具，压疮预防指南的依从性较低。关于市售翻身转位系统的研究也很少。

设计

多中心、集群、三臂、随机、对照实用性试验。

方法

2016 年 2 月至 2017 年 12 月，在 16 家医院的 29 个病房招募了 227 名有发生压疮风险的患者。病房被随机分配到两个实验组和一个对照组。

结果

当患者卧床时，实验组护士对翻身频率的依从性显著提高（94.6%对 69%和 84.9%对 71.4%）。使用翻身转位系统与患者体位显著改善相关（30-45°侧卧位）（69.6%对 34.6%）。压疮和失禁相关性皮炎的发生率较低。患者和护士对干预措施均持积极态度。对照组在卧床翻身方面的劳动力成本较高。