Author(s): Koushal Dave, Ruchika Duggal Choudhary

Email(s): kaushal442@gmail.com , duggal.ruchika2008@gmail.com

DOI: 10.5958/2454-2652.2020.00061.X   

Address: Dr. Koushal Dave1, Ruchika Duggal Choudhary2
1College of Nursing, ABVIMS and Dr. R. M. L. Hospital. Delhi.
2Department of Psychiatry, ABVIMS and Dr. R. M. L. Hospital, New Delhi.
*Corresponding Author

Published In:   Volume - 8,      Issue - 4,     Year - 2020


ABSTRACT:
Introduction: Many critically ill patients admitted in ICUs are sedated, on mechanical ventilation and unable to change the position themselves. Therefore, these patients are at high risk of impaired skin integrity and leads to development of pressure ulcers. Objective: This study was done to assess the effectiveness of pressure ulcer prevention package in reducing the incidences of pressure ulcers among patients admitted in intensive care units (ICUs). Design: Experimental design (Pre test post test control group). Methods: Seventy patients from different ICUs of Dr. R. M. L. Hospital, Delhi were randomly allocated into two groups i.e. experimental and control groups. Experimental group received the intervention of pressure ulcer prevention package and the control group received routine skin care. Demographic and clinical data were collected by using demographic profile tool; standardised skin assessment tool and pressure ulcer staging tool. All the subjects were followed every third day from admission to discharge, death and up to a maximum 20 days. Data were analyzed using STATA 11.1 with the level of significance at p < 0.05. Descriptive and inferential statistics were used. Findings: The total seventy numbers of patients were recruited: 35 in experimental group and 35 in control group. Findings show that the sacrum and then heels were the most common areas of pressure ulcers among ICU patients. Pressure ulcer prevention package was significantly (p< 0.001) effective to delay the pressure ulcers related adverse events among patients of experimental group. Pressure ulcers related adverse events were developed earlier in control group i.e. 14% in experimental and 41% in control group. Number of pressure ulcers development were significantly (p<0.001) lower in experimental group (08/35) compared to control group (20/35). The experimental group had significantly less Stage I and Stage II pressure ulcers development compared to control group (p<0.001). Conclusions: Pressure ulcers prevention package was found to be significantly effective to reduce incidences, severity and total number of pressure ulcers among patients admitted in ICUs.


Cite this article:
Koushal Dave, Ruchika Duggal Choudhary. Effectiveness of a Pressure Ulcer Prevention Package (PUPP) for patients admitted in Intensive Care Units: An Experimental Study. Int. J. of Advances in Nur. Management. 2020; 8(4):273-278. doi: 10.5958/2454-2652.2020.00061.X


REFERENCES:
1.    Nurhusien Nuru, et al. Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC Nursing 2015, 14:34; 2-8.
2.    Abebe Dilie and Daniel Mengistu. Assessment of Nurses’ Knowledge, Attitude and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government Hospitals, Addis Ababa, Ethiopia. Advances in Nursing 2015 (1);1-11.
3.    Uba et al. Knowledge, attitude and practice nurses towards prevention of pressure ulcers in university of Maiduguri teaching hospital, Borno state, Nort eastern Nigeri. International Journal of nursing and midwifery. 2015, 7(4); 54-60.
4.    Vollman, K. M. (2010). Introduction to progressive mobility. Critical Care Nurse, 30(2; Suppl.), S3–S5.
5.    Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In G. A. Compton and D. R. Thomas (Eds.), Pressure ulcers in the aging population: A guide for clinicians (Vol. 1, pp. 19–26). Totowa, NJ: Humana Press.
6.    National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline. In: Haesler Emily, editor. Osborne Park, Western Australia: Cambridge Media; 2014.
7.    D. M. Durkin and R. May, Stop the Pressure, February 2015, http://nhs.stopthepressure.co.uk/whats-happening.html.
8.    J. C. Maravilla, M. H. Lucero, T. E. Y. Alejo et al “The knowledge of nurses in pressure ulcer prevention and their attitude towards the use of Braden scale,” in Proceedings of the Sigma Theta Tau International’s 23rd. International Nursing Research Congress. July 2012.
9.    National Pressure Ulcer Advisory Panel. Pressure ulcers: avoidable or unavoidable? Results of the National Pressure
10.    Takori MSM. Intensive care unit. The internet Journal of Health 2004; 3
11.    Azolay E, Schlemmer B. A multicenter study on Meeting the needs of intensive care unit patient’s family. Am J Respiratory Critical Care Med 2001 Jan;163(1):135-9.
12.    Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care 2008;13(2):71e9.
13.    VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008e2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage 2009;55(11):39e45.
14.    Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol 2005;26(3):293e7.
15.    Krupp AE, Monfre J. Pressure ulcers in the ICU patient: an update on prevention and treatment. Curr Infect Dis Rep 2015;17(3):468.
16.    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009 Dec; 302(21):2323-9.
17.    Dunser MW, Bataar O, Tsenddorj G, Lundeg G, Torgersen C, Romand JA. Differences in critical care practice between an industrialized and a developing country. Wien Klin Wochenschr 2008 Sep;120(19-20):600-7.
18.    J. Beckford-Ball, Strikethrough Resistant Technology Can Meet the Demands of Healthcare, Pressure Ulcer Prevention, 2013. Vol. 4
19.    Robb, E., Jarman, B., Suntharalingam, G., Higgens, C., Tennant, R., and Elcock, K. (2010). Quality improvement report using care bundles to reduce in-hospital mortality: Quantitative survey. British Medical Journal, 340(7751), 861–863.
20.    Horner, D. L., and Bellamy, M. C. (2012). Care bundles in intensive care. Continuing Education in Anaesthesia, Critical Care and Pain, 12(4), 199–202.
21.    Baldelli, P., and Paciella, M. (2008). Creation and implementation of a pressure ulcer prevention bundle improves patient outcomes. American Journal of Medical Quality, 23(2), 136–142.Ulcer Advisory Panel Consensus Conference. Ostomy Wound Manage 2011;57(2):24e37.
22.    Tayyib, N., Coyer, F., and Lewis, P. (2015). Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study. Advance online publication. International Wound Journal. doi:10.1111/iwj.12406.
23.    Horner, D. L., and Bellamy, M. C. (2012). Care bundles in intensive care. Continuing Education in Anaesthesia, Critical Care and Pain, 12(4), 199–202.
24.    Gunningberg, L., Donaldson, N., Aydin, C., and Idvall, E. (2012). Exploring variation in pressure ulcer prevalence in Sweden and the USA: Benchmarking in action. Journal of Evaluation in Clinical Practice, 18(4), 904–910.
25.    Coyer, F., Stotts, N., and Blackman, V. (2014). A prospective window into medical device-related pressure ulcers in intensive care. International Wound Journal, 11(6), 656–664.
26.    Weststrate, J. T. M. and Heule, F. (2001) Prevalence of PU, risk factors and use of pressure ulcer-relieving mattresses in ICU patients. Connect the World of Critical Care Nursing, 1 (3), 77–82.
27.    Inman, K. J., Sibbald, W. J., Rutledge, F. S. and Clark, B. J. (1993) Clinical utility and cost- effectiveness of an air suspension bed in the prevention of pressure ulcers. The Journal of the American Medical Association (JAMA), 269 (9), 1139–1143.
28.    Horner, D. L., and Bellamy, M. C. (2012). Care bundles in intensive care. Continuing Education in Anaesthesia, Critical Care and Pain, 12(4), 199–202.
29.    Soban, L. M., Hempel, S., Munjas, B. A., Miles, J., andRubenstein, L. V. (2011). Preventing pressure ulcers in hospitals: A systematic review of nurse-focused quality improvement interventions. Joint Commission Journal on Quality and Patient Safety, 37(6), 245.
30.    Chaboyer, W., Chamberlain, D., Hewson-Conroy, K., Grealy, B., Elderkin, T., Brittin, M., Thalib, L. (2013). Safety culture in Australian intensive care units: Establishing a baseline for quality improvement. American Journal of Critical Care, 22(2), 93–102.

Recomonded Articles:

International Journal of Advances in Nursing Management (IJANM) is an international, peer-reviewed journal devoted to nursing sciences. IJANM's aim is to promote..... Read more >>>

RNI: Not Available                     
DOI: 10.5958/2454-2652 

Popular Articles


Recent Articles




Tags