July 2019 Wound and Ostomy Journal
The Surgical Patients' Pressure Injury Incidence (SPPII) study: a cohort study of surgical patients and processes of care
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Bethany Sobesto 7/31/19
ReplyDeleteDiscuss the limitations of the article.
A limitation of the study is that non-elective surgical patients were not included. This may have made for a healthier batch of patients who were in the study. For example, 87% of the patients in the study could ambulate independently, and 97% of the patients were continent. A better representation of surgical patients as a whole would include elective and non-elective surgical patients. Another limitation of the study is that the patients were only followed for 48hours post op. If the patients were followed for longer they may have developed pressure ulcers after the 48 hours. A third limitation of the study is that the pressure ulcer prevention methods were not mentioned. The article does not go into detail about what the medical staff did to prevent PUs. There was no mention of incontinence containment devices, turning routines, specialized mattresses, prevention foam, or nutrition consults.
Describe the sample size used in the study.
The study was done at an urban, public, 402 bed hospital in Sydney, Australia. Only elective surgical patients were used. 223 patients were assessed for eligibility and from them, 150 were analyzed. The eligible patients were expected to stay in the hospital at least 48 hours. These eligible patients were mostly independent. Only one of the patients lived in a residential support facility. Eleven of the patients lived in their own home with support. 38 of the patients were getting a neurological surgery and 28 of the patients were getting an orthopedic surgery.
Describe the method used by the author of the study
ReplyDelete- The author used a one-sample prospective cohort study design which assessed the incidence of post-surgical PIs and identified gaps in pressure injury prevention for elective patients.
Was the correct method used? Why or why not?
-Yes, the correct method was used because a prospective cohort study design is observational and no clinical intervention is needed. In this study, a prospective cohort design is the most optimal to study incidence.
This study reinforces the importance of the nursing role in regards to pressure injury prevention in surgical patients. The study conducted in Australia focuses on one large inner-city hospital with patients that encountered an elective surgery during their admission with some additional eligibility criterion. As per the authors, the method of study was optimal because it measured the occurrence of an event- in this case pressure injury incidence of surgical patients. The project was a prospective cohort study that attempted to enroll approximately 250 patients, as per statistician recommendation, in order to achieve 95% confidence interval (and therefore margin of error 5%). After exclusions were considered including: consents signed, patients in palliative care, extended lengths of stay beyond the proposed 48 hours, or cancelled surgery, the study ultimately had 150 patients in total.
ReplyDeletewhat are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe main advantage of this article is that it identifies the importance of prevention measures in hospitalized patients that are primarily on pre/intra/postop phase of their care. Prevention is always a key factor in healthcare. A disadvantage mentioned in the these studies are showing limitations in the prevention strategies
which are limited since they do not actually evaluate each specific strategy. There is a huge need to identify EBP prevention methods throughout the entire surgical journey.
Discuss the sample size used in the study.
A one-sample prospective cohort study design.
This study was conducted in a large public (402 beds),Sample size started with 250 patients but then was changed to 150 after evaluation.
Published by: M.Danielyan
DeleteSample Size
ReplyDeleteThis study took place between July 2015 and March 2016 and was conducted in a 402 bed metropolitan tertiary hospital in Sydney, New South Wales, Australia. Patients met eligibility if they were greater than 18 years of age and scheduled for an elective surgery with an expected length of stay > 48 hours. Patients that were admitted through the emergency room (ER) or scheduled for an emergency surgery were excluded. Patient also had to give a signed consent. Initially a statistician estimated a sample size of 250 patients from tables for 95% confidence intervals but as the study progressed and there was a low detection of pressure injuries (PIs) the sample size was changed to 150 patients.
Limitations
There were three limitations discussed in the study. First, was that the study only took place in one large inner-city hospital so that comparisons could not be generalized to rural or small community hospitals. Secondly, only elective surgical patients were selected for the study while ER patients or emergency cases were excluded which could be a potential bias as these patients may not be as healthy and their potential for developing PIs could possibly be higher. Thirdly, there was only a PI assessment made at the 48th hour and did not continue any further. It is possible that a PI could develop after that time-frame but debatable if it could be actually related to the surgical procedure.
Michelle Rios, ICU RN
ReplyDeleteDiscuss the limitations of the article: limited sample size, design flaws, and/or author bias
Expanding the number of participants to include the most vulnerable to PIs would have made this a stronger study. The participants who consented to be part of the study were probably the least at risk for developing SPPIs as they were generally healthy, ambulatory and independent individuals who elected to have surgery. Older, dependent patients with co-morbidities and physical disabilities are at higher risk for PIs and should have been included in this study.
Discuss the sample size used in the study.
The sample size was comprised of 150 surgical patients. Patients had to be +18 years old, scheduled for an elective surgical procedure and expected to have a minimum post-op hospital stay of 48-hrs. They signed consent to be part of the study.
Ariel Glaze, RN
ReplyDelete1. Discuss the Sample Size:
Assuming a pressure ulcer incidence of 20% based on previous studies of high risk surgical patients and consultation with a statistician, the sample size was estimated to be 250 with a 5% margin of error. But sample size was changed to 150 patients after recruitment and low incidence of pressure ulcer incidence.
2. Method used
The author used a one-sample prospective cohort study design in a large 402 bed metropolitan hospital. To be eligible, patients needed to be 18 years of age or more, have an elective scheduled procedure and an expected hospital stay of 48 hours or more following surgery. Emergency surgery patients were excluded from the study.
Skin assessments were recorded at 5 points: prior to surgery, during surgery, after surgery, and at 24 hours and 48 hours after surgery. Data was collected by trained research assistants.