Uso de la metodología de paquete de cuidados (care bundle) aplicada a la prevención de lesiones por presión adquiridas en hospital en pacientes adultosrevisión exploratoria
- Luis Real-López
- Laura Parra-Anguita 1
- Pedro L. Pancorbo-Hidalgo 1
- M. Carmen Enrique-Arias
-
1
Universidad de Jaén
info
ISSN: 1134-928X
Year of publication: 2023
Volume: 34
Issue: 1
Pages: 68-77
Type: Article
More publications in: Gerokomos: Revista de la Sociedad Española de Enfermería Geriátrica y Gerontológica
Abstract
Abstract Objective: To explore the state of knowledge regarding the care bundle (CB) approach in the prevention of hospital-acquired pressure injuries (PI) in hospital wards in adult patients. Methodology: Scoping review from 10 bibliographic databases. Publications related to adult patients admitted to conventional hospital wards were included. A narrative description was made without analysis of methodological quality. Results: 31 articles were selected with different designs, identifying 9 CB. As quantitative results, reductions in the incidence of PI were obtained from 8% to 90%, in the prevalence from 37% to 94%, or increases in the number of days without PI from 50% to 59%. Other effects were a 36% increase in the use of the Braden scale for the assessment of PI risk, or a 13% improvement in the completion of PI records. From a qualitative point of view, the professionals considered the application of a CB as feasible and acceptable, highlighting the increased communication, knowledge and participation in the prevention of PI as benefits. Patients considered the application of CB as acceptable by increasing their participation in care, promoting interaction with staff and providing easy to understand information. Conclusion: The CB methodology improves the prevention of PI in hospitalized adults. More and higher quality studies are needed to assess its effectiveness. It would be advisable to standardize the use of a unique indicator of results that would allow comparison between CB with different contents, preferably the incidence or prevalence of PI hospital acquired.
Bibliographic References
- Resar, R,Griffin, F,Haraden, C,Nolan, T. (2012). Using care bundles to improve health care quality. IHI Innovation.
- Resar, R,Pronovost, P,Haraden, C,Simmonds, T,Rainey, T,Nolan, T. (2005). Using a Bundle Approach to Improve Ventilator Care Processes and Reduce Ventilator-Associated Pneumonia. Jt Comm J Qual Patient Saf. 31. 243
- Langley, GL,Moen, R,Nolan, KM,Nolan, TW,Norman, CL. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2. Publishers J-B. California.
- Berwick, DM,Calkins, DR,Joseph McCannon, C,Hackbarth, AD. (2006). The 100 000 lives campaign: Setting a goal and a deadline for improving health care quality. J Am Med Assoc. 295. 324
- McCannon, CJ,Hackbarth, AD,Griffin, FA. (2007). Miles to go: An introduction to the 5 million lives campaign. Jt Comm J Qual Patient Saf. 33. 477
- Institute for Healthcare Improvement. 5 Million Lives Campaign.
- Morris, AC,Hay, AW,Swann, DG,Everingham, K,McCulloch, C,McNulty, J. (2011). Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle. Crit Care Med. 39. 2218
- NHS75. The NHS Patient Safety Strategy.
- Gibbons, W,Shanks, HT,Kleinhelter, P,Jones, P. (2006). Eliminating facility-acquired pressure ulcers at ascension health. Jt Comm J Qual Patient Saf. 32. 488
- Bale, S. (2012). Preventing skin damage: A welsh perspective. Wounds UK. 8. 74-81
- (2011). Healthcare Improvement Scotland. SSKIN care bundle.
- McIntyre, L. (2014). Implementing a regional strategy to reduce avoidable pressure ulcers. Wounds UK. 10. 8-13
- Anthony, D,Hodgson, H,Horner, J. (2017). Reducing avoidable pressure ulcers. Wounds UK. 14
- Van Gaal, BG,Schoonhoven, L,Hulscher, ME,Mintjes, JA,Borm, GF,Koopmans, RT. (2009). The design of the SAFE or SORRY? study: A cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events. BMC Health Serv Res. 9. 58
- Van Gaal, BGI,Schoonhoven, L,Mintjes, JAJ,Borm, GF,Koopmans, RTCM,Van Achterberg, T. (2011). The SAFE or SORRY? programme. Part II: Effect on preventive care. Int J Nurs Stud. 48. 1049
- Van Gaal, BGI,Schoonhoven, L,Mintjes, JAJ,Borm, GF,Hulscher, MEJL,Defloor, T. (2011). Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. Part I: Primary outcome of a cluster randomised trial. Int J Nurs Stud. 48. 1040
- Baldelli, P,Paciella, M. (2008). Creation and implementation of a pressure ulcer prevention bundle improves patient outcomes. Am J Med Qual. 23. 136
- Carson, D,Emmons, K,Falone, W,Preston, AM. (2012). Development of pressure ulcer program across a university health system. J Nurs Care Qual. 27. 20
- Chaboyer, W,Bucknall, T,Webster, J,McInnes, E,Gillespie, BM,Banks, M. (2016). The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. Int J Nurs Stud. 64. 63-71
- Fremmelevholm, A,Soegaard, K. (2019). Pressure ulcer prevention in hospitals: A successful nurse-led clinical quality improvement intervention. Br J Nurs. 28. 6-11
- Padula, WV,Makic, MBF,Mishra, MK,Campbell, JD,Nair, KV,Wald, HL. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. Jt Comm J Qual Patient Saf. 41. 246
- Staines, A,Amherdt, I,Burnand, B,Rotzetter, M,Currat, P,Roux, S. (2020). Impact of a Swiss pressure ulcer prevention breakthrough collaborative. J Eval Clin Pract. 27. 1143
- Al-Otaibi, YK,Al-Nowaiser, N,Rahman, A. (2019). Reducing hospital-acquired pressure injuries. BMJ Open Qual. 8.
- Lovegrove, J,Fulbrook, P. (2018). Prescription of pressure injury preventative interventions following risk assessment: An exploratory, descriptive study. Int Wound J. 15. 985
- Reddy, M,Gill, SS,Rochon, PA. (2006). Preventing pressure ulcers: A systematic review. J Am Med Assoc. 296. 974
- Soban, LM,Hempel, S,Munjas, BA,Miles, J,Rubenstein, LV. (2011). Preventing pressure ulcers in hospitals: A systematic review of nurse-focused quality improvement interventions. Jt Comm J Qual Patient Saf. 37. 245
- Niederhauser, A,Van Deusen Lukas, C,Parker, V,Ayello, EA,Zulkowski, K,Berlowitz, D. (2012). Comprehensive programs for preventing pressure ulcers: A review of the literature. Adv Ski Wound Care. 25. 189
- Sullivan, N,Schoelles, KM. (2013). Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review. Ann Intern Med. 158. 410
- Lavallée, JF,Gray, TA,Dumville, J,Russell, W,Cullum, N. (2017). The effects of care bundles on patient outcomes: A systematic review and meta-analysis. Implement Sci. 12. 142
- Gaspar, S,Peralta, M,Marques, A,Budri, A,Gaspar de Matos, M. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review. Int Wound J. 16. 1087
- Lozano-Montoya, I,Vélez-Díaz-Pallarés, M,Abraha, I,Cherubini, A,Soiza, RL,O'Mahony, D. (2016). Nonpharmacologic Interventions to Prevent Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons (SENATOR) Definition of Optimal Evidence. J Am Med Dir Assoc. 17. 1-10
- Moore, ZEH,Webster, J,Samuriwo, R. (2015). Wound-care teams for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 9.
- Joyce, P,Moore, ZE,Christie, J. (2018). Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 12.
- Porter-Armstrong, AP,Moore, ZE,Bradbury, I,McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. Cochrane Database Syst Rev. 5.
- O’Connor, T,Moore, ZEH,Patton, D. (2021). Patient and lay carer education for preventing pressure ulceration in at-risk populations. Cochrane Database Syst Rev. 2.
- Aromataris, E,Munn, Z. (2020). JBI Manual for Evidence Synthesis. JBI.
- Peters, M,Godfrey, C,McInerney, P,Munn, Z,Tricco, A,Khalil, H. (2020). JBI Manual for Evidence Synthesis. JBI.
- Tricco, AC,Lillie, E,Zarin, W,O'Brien, KK,Colquhoun, H,Levac, D. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 69. 467
- Sendelbach, S,Zink, M,Peterson, J. (2011). Decreasing pressure ulcers across a healthcare system: moving beneath the tip of the iceberg. J Nurs Adm. 41. 84
- Whitlock, J,Rowlands, S,Ellis, G,Evans, A. (2011). Using the SKIN Bundle to prevent pressure ulcers. Nurs Times. 107. 20
- Birkill, K. (2020). Deal with heels: A pressure ulcer prevention initiative. Br J Community Nurs. 25. 6-10
- Van Gaal, BGI,Schoonhoven, L,Vloet, LCM,Mintjes, JAJ,Borm, GF,Koopmans, RTCM. (2010). The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial. Int J Nurs Stud. 47. 1117
- (2011). Australian Commission on Safety and Quality in Health Care National Safety and Quality Health Service Standards. ACSQHC. Sydney.
- Chaboyer, W,Gillespie, BM. (2014). Understanding nurses' views on a pressure ulcer prevention care bundle: A first step towards successful implementation. J Clin Nurs. 23. 3415
- Roberts, S,McInnes, E,Wallis, M,Bucknall, T,Banks, M,Chaboyer, W. (2016). Nurses' perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nurs. 15. 64
- Roberts, S,Wallis, M,McInnes, E,Bucknall, T,Banks, M,Ball, L. (2017). Patients' Perceptions of a Pressure Ulcer Prevention Care Bundle in Hospital: A Qualitative Descriptive Study to Guide Evidence-Based Practice. Worldviews Evid Based Nurs. 14. 385
- Whitty, JA,McInnes, E,Bucknall, T,Webster, J,Gillespie, BM,Banks, M. (2017). The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial. Int J Nurs Stud. 75. 35-42
- Deakin, J,Gillespie, B,Chaboyer, W,Nieuwenhoven, P,Latimer, S. (2020). An education intervention care bundle to improve hospitalised patients' pressure injury prevention knowledge: a before and after study. Wound Pract Res. 28. 154
- McIntyre, L. (2013). A communication project to prevent pressure ulcers. Nurs Times. 109. 12
- Gillespie, BM,Chaboyer, W,Sykes, M,Oêbrien, J,Brandis, S. (2014). Development and pilot testing of a patient-participatory pressure ulcer prevention care bundle. J Nurs Care Qual. 29. 74-82
- Kiernan, M,Downie, F. (2011). Prevention of pressure ulcers: Could a care bundle approach be a success?. Wounds UK. 7. 157
- Whitlock, J. (2013). SSKIN bundle: Preventing pressure damage across the health-care community. Br J Community Nurs. 32-38
- Downie, F,Perrin, AM,Kiernan, M. (2013). Implementing a pressure ulcer prevention bundle into practice. Br J Nurs. 22. 4-8
- Downie, F. (2014). Pressure ulcer prevention: How documentation can help. Wounds UK. 10. 14
- Chaboyer, W,Bucknall, T,Webster, J,McInnes, E,Banks, M,Wallis, M. (2015). INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial. Int J Nurs Stud. 52. 1659
- Roberts, S,McInnes, E,Bucknall, T,Wallis, M,Banks, M,Chaboyer, W. (2017). Process evaluation of a cluster-randomised trial testing a pressure ulcer prevention care bundle: A mixed-methods study. Implement Sci. 12. 18