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Evaluation of a Pressure Injury Prevention Bundle in an Australian Intensive Care Unit: A Before and After Study
Paul Fulbrook1,2,3, Richard McAllister4, Cindy Weatherburn4
1School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.
Insights
The COMHON Index intervention bundle showed a modest reduction in pressure injury (PI) incidence in intensive care units (ICUs). Further research is needed to optimize compliance and effectiveness for preventing PIs.
Area of Science:
- Critical Care Medicine
- Nursing Research
- Patient Safety
Background:
- Pressure injuries (PI) are a significant concern in intensive care units (ICUs).
- Existing PI risk assessment tools lack bundled interventions.
- The COMHON Index is unique in bundling preventative interventions with risk assessment.
Purpose of the Study:
- To evaluate the COMHON Index intervention bundle's effectiveness in reducing PI incidence in an Australian ICU.
- To assess compliance with the COMHON Index bundle implementation.
Main Methods:
- A before-and-after study design was employed in a general ICU.
- The Braden Scale was used for standard care in the before-phase.
- The COMHON Index and its risk-stratified intervention bundle were implemented in the after-phase.
- The primary outcome measured was PI incidence.
Main Results:
- PI incidence decreased by 21% (from 4.9% to 3.9%) after implementing the COMHON Index bundle.
- Factors associated with PI included longer ICU length of stay, high-risk cases, and male gender.
- Overall bundle compliance was 81%, but 'all-or-nothing' compliance was only 30%.
Conclusions:
- The COMHON Index intervention bundle led to a small reduction in PI incidence.
- Poor compliance with certain interventions, like repositioning frequency, was noted.
- Further research is required to understand the interplay between compliance and PI outcomes.
Background:
Recent studies indicate that the incidence of pressure injury (PI) in intensive care is significant. Multiple intensive care-specific PI risk assessment tools are available, but only the COMHON Index has been bundled with preventative interventions based on assessed risk level.
Aims:
Evaluate the effectiveness of the COMHON Index intervention bundle to reduce PI in an Australian intensive care unit (ICU) and to assess compliance with bundle implementation.
Study Design:
Before and after study including all patients admitted to a general ICU during the study period (3-month before/after-phases, 2-month wash-out). Standard care in the before-phase comprised the Braden Scale and interventions selected with clinical judgement. In the after-phase, the COMHON Index and its risk-stratified intervention bundle were implemented. The primary outcome was PI incidence.
Results:
PI incidence reduced from 4.9% in the before-phase (sample n = 296) to 3.9% in the after-phase (sample n = 295), resulting in a 21% relative risk reduction. Three significant factors associated with PI development were identified using logistic regression: intensive care length of stay (odds ratio [OR] 1.2), high-risk cases (OR 4.5) and male gender (OR 3.9). In the after-phase, overall bundle compliance was good (81%) but all-or-nothing compliance was poor (30%) although individual intervention compliance varied (range 53%-100%).
Conclusions:
Implementation of the COMHON index risk-stratified bundle resulted in a small reduction in PI incidence. However, compliance with some interventions was poor, especially repositioning frequency. The relationship between intervention and bundle compliance and PI outcomes requires further research.
Relevance For Clinical Practice:
The results suggest that the use of the COMHON Index intervention bundle may be beneficial to prevent PI in ICU patients. Further research is needed to examine its effectiveness, while controlling for bundle compliance. Future efforts of translation into clinical practice should be underpinned by a relevant implementation framework to enhance local contextualisation and bundle adherence.
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