Most Effective Interventions: Pressure Area Injuries in Hospitals

This report addresses the critical issue of pressure area injuries, also known as pressure ulcers, in bedridden patients within hospital settings. It begins by defining pressure ulcers and highlighting the increased risk faced by elderly patients and those with limited mobility. The report summarizes the evidence from systematic reviews and evidence-based guidelines, identifying key recommendations such as frequent patient repositioning, the use of pillows for support, and maintaining clean and dry skin. The search strategy included databases like PubMed and CINAHL, with a focus on studies from 2010 to 2017. The report also acknowledges limitations, including the need for more specific recommendations and further research. The literature matrix provides an overview of the studies reviewed, including their findings and implications for practice, emphasizing the importance of nurses' roles in implementing preventative strategies. The report concludes by highlighting the importance of proactive measures and consistent monitoring to reduce the incidence of pressure ulcers and improve patient outcomes.

What is the most effective intervention for preventing pressure area injuries in
bed ridden patients in hospitals?
Background: Summary of the evidence
Pressure areas can be determined to be the skin where pressure cuts off blood flow and
other circulation to surrounding skin tissue. These are type of issues that are faced mainly
by elderly people. this generally take place when the person from the age of 45 and
above. When a patient have to be in same position for long hours, then it creates high
pressure areas. In other words, it is also known as pressure ulcers. In this, it consist of
people with decreased sensation or individuals who are not able to shift their bodies face
high risk of developing sores. With a time span of two hours, individuals get to develop
pressure ulcers. When these are not properly treated, then they become deep infectious
wounds.
Search Strategies:
There are different type of search that are undertaken related with pressure ulcers. In this
context, following are the data range that are used for searching: 2010 to 2017 in English
language only. PubMed, CINAHL, JBI Database of Systematic Review and QUT data
base. The initial search terms that were made includes: Pressure areas, Ulcers and bed
ridden patients. All the type of search that were made focused on identifying systematic
review and evidence based guidelines. In order to make analysis of the evidence found,
appropriate tool was used: PICO tool.
Limitations:
It is important that there is requirement of further research so that appropriate
recommendations can be used. They type of recommendations that are provided currently
are vague. Further, the study is limited to the care that is provided and the studies that are
covered. Further, it required to have appropriate recommendations that has to be followed
by patients so as to reduce the issue.
Evidence ‘Bottom Line’ Statement
It requires to have time to check over the patients so that they may not face any type of
pressure. Further, strategies need to be made that will enable to maintain the focus over
reducing the pressure.
From the initial searches that are made, about 43 relevant guidelines and
systematic reviews were identified. More specifically, there are two systematic
review and three evidence based guidelines. Further, there are key
recommendations made for the included guidelines and reviews were included
(see Literature matrix).
Recommendations
REFERENCES
There are three different type of recommendations that will enable to overcome
the type of issues that are faced by patients in relation with pressure ulcers are
as follows:
 Changing position of patient frequently: When this is followed, then it becomes
favourable enough to reduce risk of developing pressure ulcers. Proper
consideration to be made so that care providers are able to take care of patents.
 Using pillows: Elderly Patient who have issues for the back, then they should be
given pillows so that they will be able to comfortably be in the same position.
• Keeping skin clean and dry: When the skin is clean and dry, then it is less likely
to develop bed sores.
Gravenstein, N., van Oostrom PhD, J. H., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer risk-
Monitoring interface pressures of at-risk patients. Journal of rehabilitation research and development, 50(4),
477.
Gray-Siracusa, K., & Schrier, L. (2011). Use of an intervention bundle to eliminate pressure ulcers in critical
care. Journal of nursing care quality, 26(3), 216-225.
Jankowski, I. M. (2010). Tips for protecting critically ill patients from pressure ulcers. Critical care
nurse, 30(2), S7-S9.
Tchanque-Fossuo, C. N., & Kuzon Jr, W. M. (2011). An evidence-based approach to pressure sores. Plastic and
reconstructive surgery, 127(2), 932-939.
Webster, J., Gavin, N., Nicholas, C., Coleman, K., & Gardner, G. (2010). Validity of the Waterlow screening tool
and risks for pressure injury in acute care. British Journal of Nursing, 19(6), s14-22.

Literature Matrix
Author/
Date
Research
Question/
Aim
Population Study
Design
Findings Conclusions and
Implications for
Practice
Level of
Evidence12
Limitations
Webster, J.,
Gavin, N.,
Nicholas, C.,
Coleman, K., &
Gardner, G.
(2010)
Validity of the
Waterlow
screening tool
and risks for
pressure injury
in acute care
274 patients
admitted to the
Emergency
Department
Guideline
(systematic
review and
meta analysis
of RCTs)
It is important for
the nurses to make
sure that they
deliver proper
quality of services
to patients.
Provides further evidence
of the poor predictive
validity of the Waterlow
scale.
Summaries1 The study is focused
on particular area,
there are different
other regions on
which similar
research can be
conducted.
Gray-Siracusa,
K., & Schrier,
L. (2011)
Use of an
intervention
bundle to
eliminate
pressure ulcers
in critical care
Focus is made
on patients and
nurses so that
they perform
their roles
carefully.
Systematic
review so no
population.
Critical
appraisal tools
There are about
322 evidence
provided for the
different type of
recommendations
made.
There are different type of
checklist that has to be
followed by patients so
that they are able to
perform their set of role in
effective manner.
Summaries1 There are many other
strategies that could
have been applied.
There are many areas
in which further
research can be
conduced.
Gravenstein, N.,
van Oostrom
PhD, J. H., &
Caruso, L. J.
(2013)
Patient
repositioning
and pressure
ulcer risk-
Monitoring
interface
pressures of at-
risk patients
There are 23
bedridden
patients who are
taken into
consideration.
Guideline
(systematic
review and
meta analysis
of RCTs)
When skin is dry,
then it required to
have proper care
given so that the
rate of issue or risk
can be reduced.
Main focus is to be made
on nurses so that they can
focus on all the areas in
which care is to be
provided.
Syntheses1)) /
)
Level)1)2
The quality of the
evidence provide is of
low quality.
Tchanque-
Fossuo, C. N.,
& Kuzon Jr, W.
M. (2011)
An evidence-
based approach
to pressure
sores
There are
different type of
approaches that
are included in
Critical
appraisal tools
In the policies,
nurses have to
focus on the care
that has to be
When nurses have proper
understanding about the
type of care that has to be
provided by them, then
Summaries1 There are in depth
evidence provided in
the research.