Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD, Australia.
Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.
Worldviews Evid Based Nurs. 2020 Dec;17(6):465-475. doi: 10.1111/wvn.12473. Epub 2020 Nov 22.
Formal assessment by nurses of a patient's pressure injury (PI) risk level is often highlighted as being key to PI prevention. However, if no action is taken to address the determined risk (i.e., if appropriate preventative interventions are not implemented), the patient remains vulnerable to PI development, and the assessment process is rendered pointless.
To explore the relationship between the prescription (planning) and implementation of PI preventative interventions by nurses following formal risk assessment.
Using an exploratory, descriptive design, the charts and bedside areas of 200 adult patients admitted across four hospital wards were examined. Data collected included PI risk level, documented prescribed preventative interventions, and interventions for which there was evidence of implementation.
Of the final sample (n = 187), 66.8% of cases were categorized as being "at-risk" or above. As the risk category of patients increased, proportionately more patients in each category were prescribed each intervention. However, in most cases, significantly fewer interventions were actually implemented than were prescribed, except for several interventions that were implemented in more cases than were prescribed. There were 14 cases, including four at-risk and three high-risk patients, in which no preventative interventions were prescribed, while 88.7% of not at-risk patients had (unnecessary) preventative interventions prescribed.
These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. The results indicate a significant mismatch between these two steps of PI prevention.
These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. A significant mismatch between these two steps of PI prevention was evident. Following patient risk assessment, there should be a greater focus on appropriate preventative intervention prescription (planning) with regular review and audit to help ensure that interventions are implemented as prescribed. Improved implementation of preventative interventions should, in turn, help to reduce hospital-acquired pressure injuries.
护士对患者压力性损伤（PI）风险水平的正式评估通常被认为是 PI 预防的关键。然而，如果不采取行动来解决确定的风险（即，如果不实施适当的预防干预措施），患者仍然容易发生 PI 发展，并且评估过程变得毫无意义。
探讨护士在正式风险评估后对 PI 预防干预措施的开具（计划）和实施之间的关系。
采用探索性、描述性设计，检查了四个病房的 200 名成年患者的图表和床边区域。收集的数据包括 PI 风险水平、记录的规定预防干预措施以及有实施证据的干预措施。
在最终样本（n=187）中，66.8%的病例被归类为“有风险”或以上。随着患者风险类别的增加，每个类别的患者规定的每种干预措施的比例也相应增加。然而，在大多数情况下，实际实施的干预措施明显少于规定的干预措施，除了几种实施数量多于规定数量的干预措施。有 14 例，包括 4 例有风险和 3 例高风险患者，未规定预防干预措施，而 88.7%的无风险患者则规定了（不必要的）预防干预措施。
这些结果表明，干预措施的开具与评估的风险水平相对应增加；然而，干预措施的开具和实际实施的比率并不理想。这表明 PI 预防的这两个步骤之间存在显著的不匹配。
这些结果表明，干预措施的开具与评估的风险水平相对应增加；然而，干预措施的开具和实际实施的比率并不理想。PI 预防的这两个步骤之间存在显著的不匹配。在对患者进行风险评估后，应更加关注适当的预防干预措施开具（计划），并定期进行审查和审计，以帮助确保干预措施按规定实施。预防干预措施的实施得到改善，反过来又有助于减少医院获得性压力性损伤。
