Preventing Pressure Ulcers with Repositioning Frequency and Precipitating Factors

 描述(由申请人提供)：这项9个疗养院(NH)群随机研究的目的是确定是否可以在不影响PRU发病率的情况下，为低、中、高压力溃疡(PRU)发展风险和粘弹性(VE)高密度泡沫支撑面的NH居民延长重新定位频率。我们还将确定医疗严重程度的变化如何与风险水平和重新定位时间表的变化相互作用，以预测PrU的发展。PRUS主要是由于骨质隆起上方的压力造成的，阻止了流向组织的血液流动。目前的PRU预防方案建议至少每2小时重新安置中、高和严重风险居民。我们建议将低风险居民包括在内，因为研究表明，他们也会患上PRU。新的压力重新分配床垫可能会使2小时的重新定位变得不必要，但重新定位之间的最佳时间仍不清楚。目标是1)使用VE表面并以2、3和4小时的频率重新定位，确定NH居民(低、中、高风险级别)中新的PRU发生率的差异；以及2)确定医疗严重程度组成部分(通过修改的综合严重性指数测量)、临床评估风险水平(根据Braden量表测量的低、中、高)的变化、重新定位时间表及其相互作用如何与PrU的发展相关联；一个探索性目标：通过比较干预资源成本(VE表面、Leaf服务/传感器的使用、用于培训和重新定位的固定和可变劳动力成本)和PrU每%减少成本的增量成本-效果比来评估重新定位2、3或4小时的NH组之间的PRU预防干预方法，以及2)调查工作人员和居民对干预方法的满意度。我们将在提供标准护理的同时，将每个NH随机分配到3个研究组中的一个(2，3，4小时)。Leaf(R)三轴加速度计将连续佩戴到 监视器重新定位。将定期进行安全和护理检查，以确保皮肤完整性。在6周的干预期间，被允许学习NHS至少3天的居民，没有现有的PRU，没有使用专门的支撑面，以及PrU发展的低、中或高风险将被包括在基于治疗意图的分析中。PRU发病率没有差别的结果，将决定是否可以延长低、中、高风险居民的重新定位频率。将检查医疗严重程度部分和临床评估的风险水平，以评估与PRU发展相关的评估变化，从而确定与新PRU相关的严重程度部分。调查人员每天都会监控数据。数据分析和管理将由HSIR执行。卫生署工作人员和居民对干预方法的满意度将通过焦点小组进行调查。这项研究将促进对重新定位频率和临床评估的与医疗严重程度相关的PRU风险水平的了解。这项研究的结果将有助于未来更精确的预防性护理实践的指南和PRU预防指南的完善。

 DESCRIPTION (provided by applicant): The purpose of this 9 nursing homes (NH) cluster randomized study is to determine whether repositioning frequency can be extended for NH residents who are low, moderate, and high risk for pressure ulcer (PrU) development and on visco-elastic (VE) high-density foam support-surfaces without compromising PrU incidence. We also will determine how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development. PrUs result primarily from pressure over bony prominences that occlude blood flow to tissues. Current PrU prevention protocols recommend repositioning moderate, high, and severe risk residents a minimum of every 2 hours. We propose to include low risk residents because studies suggest they too develop PrUs. New pressure redistribution mattresses may make 2 hour repositioning unnecessary, but optimal time between repositioning remains unclear. Aims are 1) determine differences in incidence of new PrUs in NH residents (low, moderate, high risk level) using VE surfaces and repositioned at 2, 3, and 4 hour frequencies; and 2) determine how medical severity components (measured by a modified Comprehensive Severity Index), changes in clinically assessed risk-level (low, moderate, high as measured by Braden Scale), repositioning schedule, and their interactions are associated with PrU development; and an Exploratory Aim: Evaluate PrU prevention intervention approach between NH groups repositioned at 2, 3, or 4 hour by: 1) comparing the intervention resource costs (VE surfaces, Leaf service/sensor use, fixed and variable labor costs for training and repositioning) and incremental cost-effectiveness ratio of cost per % reduction in PrUs, and 2) exploring staff and resident satisfaction with intervention approach. We will randomly assign each NH to one of 3 study arms (2, 3, 4 hour) while providing standard nursing care. Leaf(r) triaxial accelerometers will be worn continuously to monitor repositioning. Periodic safety and care checks will be performed to ensure skin integrity. Residents admitted to study NHs for at least 3 days during the 6 week intervention, without an existing PrU, not using a specialty support surface, and of low, moderate, or high risk for PrU development will be included in analysis based on intention to treat. The outcome, no difference in PrU incidence, will determine whether repositioning frequency can be extended for low, moderate, high risk residents. Medical severity components and clinically assessed risk level will be examined for assessment to assessment change in relation to PrU development, thus identifying severity components associated with new PrUs. Data will be monitored by investigators daily. Data analysis and management will be performed by HSIR. NH staff and resident satisfaction with the intervention approach will be explored using focus groups. This study will advance knowledge about repositioning frequency and clinically assessed PrU risk-level in relation to medical severity. Outcomes of this research will contribute to future guidelins for more precise preventive nursing practices and refinement of PrU prevention guidelines.