January 2019 Wound and Ostomy Journal
How well do perioperative practitioners implement pressure injury prevention guidelines? An observational study
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ReplyDeleteDescribe the method used by the author of the study
ReplyDelete-The method used was an observational study. The observations were done by research students who observed the perioperative teams throughout the patient's time in pre-op, surgery, and post-op. The students kept notes on a number of different categories which surgical position, medical devices used, BMI, length of surgery, temperature on admission to the PACU, and number of pressure ulcer prevention strategies that were used. The number of staff observed by the research students was 278.
Discuss the sample size used in the study.
-The study was done on 73 surgical patients who were from a tertiary facility with 750 beds.
Was the correct method used? Why or why not?
-I think the correct method was used to gather data for this project. Using the observational method, the data collectors were able to audit the number of PIPs implemented during the patient's whole surgical journey. It was found that the number of PIPs implemented, by the staff, rose as the risk for pressure ulcer development increased. Other published research in the surgical setting has relied on retrospective audits and randomized control trials. The observational method seems more reliable and comprehensive than those other methods mentioned.
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ReplyDeleteIt is refreshing that the authors recognize the Hawthorn effect as a limitation to their study. Based on the type of study being "observational," rather than "retrospective," I often wonder how the outcomes may have changed if conducted as the latter. Like all routines being studied by an observer, there is an overwhelming sense of need to adhere to the correct action or method. We often see this in simple studies like handwashing in healthcare settings. Compliance with hand hygiene will likely improve once the practitioner knows they are being watched by an observer. So there are questions that arise in this study. Was a more thorough skin assessment initially completed pre-operatively; perhaps extra positioning aids may have been used.
ReplyDeleteHow has this phenomenon effected this study? I tend to think the study's limitations have provided desirable results.
Method
ReplyDeleteThe study was conducted as a prospective observational study in which a structured data collection tool was developed and then piloted by two trained observers and deemed as an appropriate per the inter-rater reliability. Information collected was patient demographics and clinical data, implementation of pressure injury prevention (PIP) strategies by staff, and data from a systematic head-to-toe skin inspection on post-operative day 2. Results showed that the total number of PIP strategies implemented intra-operatively ranged from 27 to 49, which reinforces the observation that during the intra-op period patients are most vulnerable to developing a HAPI while under anesthesia. There was also a significant relationship between the number of PIP strategies used, length of surgery, number of medical devices and equipment used during surgery. The dilemma is that these factors may be difficult to modify during surgery which therefore can increase the risk of HAPI in the peri-operative setting.
Sample Size
This study was conducted in a large 750 bed tertiary facility with 22 operating rooms in which approximately 16,000 surgeries occur each year. The inclusion criteria required an adult patient with a surgery length over 60 minutes, a minimum length of stay of 48 hours, and the ability to provide informed consent. The study was conducted from August to December during 2016, approximately 300 hours. Seventy three patients were recruited and of those 36 were identified as at-risk of developing PI.
It is evident that more studies need to be conducted in this area because in the United States treatment of HAPIs costs up to approximately 3.6 billion dollars a year.