Bethany Sobesto. Describe the method used by the author of the study. Discuss the sample size used in the study. The study was an observational cohort study which used a patient and family centered care model. They viewed retrospective data from electronic health records of patients who were placed prone and had covid as well as ARDS. One group of patients had a certified wound and skin care nurse, and a multiprofessional prone positioning team, who oversaw pressure injury prevention strategies for the patients. The other group of patients did not have a certified wound and skin care nurse or multiprofessional prone positioning team to help prevent pressure ulcers. The study used data from August 1st, 2020 to August 30th, 2020. The study did not include patients younger than 21, patients not placed prone, or patients unable to be prone for at least an hour. 130 ICU patients were included in the study. Discuss the limitations of the article. Some of the comparisions between the intervention group and the control group were not fair. For example the acuity and number of commorbidities of the patients differed. Patients with higher acuity are more likely to have factors which contribute to faster skin breakdown. Also, a higher percentage of patients in one group had specialty matresses which help prevent skin breakdown. Additionally, the length of stay varied for the patients. The longer the length of stay, the greater the odds of developing a pressure ulcer. The article states that future prospective studies are needed to overcome some of the limitations of the study.
1. How does this research article compare to our practice, policy and/or procedure? In the article, a core pronation team was used, which is a multidisciplinary team of 10 people. This team includes the following persons: a certified wound and skin care specialist, a critical care physician, a respiratory therapist or anesthesiologist or both, a critical care nurse and surgical technician(s). Before the patient is proned, the wound care nurse applies an ophthalmic lubricant to protect the patient's sclera. The patient is then placed on a swim position with a foam headrest, which protects the face from directly lying on the ETT. The patient stays in a prone position for 16-18 hours and then returned supine. While the patient is proned, the respiratory therapist assists the critical care nurse every 4 hours to reposition the head to prevent pressure injuries. In the ICU, a proning team is also utilized to prone COVID patients. We also have the same steps before and during proning of these patients. The patient is in a prone position for 16-18 hours and then placed supine.
2. Discuss the sample size used in the study. 130 patients were used in the study. 40% of these patients were in the intervention group. Patients in the comparison group have a higher median of comorbidities than in the intervention group.
Describe the method used by the author of the study. The method used by the author was observational cohort study which was specific to a patient and family centered model. They used data from patient records, patient that had covid and ARDS and those patient were placed prone to improve oxygenation and reduce mortality risk. One group had multi professional team including certified wound care nurse and the other group did not include certified wound care nurse and other multi professional team. Also the study did not include patient younger than 21 year old. Discuss the sample size used in the study. 130 ICU patients were included in this study, 40 % of these patients were the intervention group. The characteristic and demographic differed significantly between intervention and comparison groups, which made the comparison group have higher median of comordidties.
Describe the method used by the author of the study?
The method used by the author was an observational cohort study using a patient – family centered care model. The data gathered was from prior health records of patients who were laid in a prone position during their bouts of covid or ARDS. Using two different groups, one with a certified wound care nurse, with the use of a multi professional prone position team, and another group who did not have those resources.
Discuss the sample size used in this study.
The sample size used within this study was conducted within an ICU, with a total of 130 patients that had Covid or Ards. It did not include patients younger than 21, and patients who were unable to tolerate being laid down in a prone position.
Discuss the limitations of the Article
According to the article, the comparisons between both groups did not reflect the study properly. Each patient suffered from different acuity's, or comorbidities which can contribute to skin faster skin break down. Additionally each patients length of stay varied, so data would be inconclusive. /
How does this research article compare to our practice, policy and/or procedure?
In this article a core pronation team was used in the ICU. In our practice, we would see a prone team if you floated to the ICU, where Mutiple nurses, and a respiratory therapist would come in and help prone the patient for a certain time in a swim position on a foam headrest. However, this was only done in the ICU, as a prone turn team was not used on the telemetry floors who were on vents. Instead, we would just educate, and remind patients to lay prone.
Describe the Method used by the author of the study. The study was done by using an observational cohort study, that as based on a family centered care model. They gathered all the data from prior health records of patients laying prone. Two groups were used one who had a certified wound care nurse, plus the use of multiple resources like a lift time, while one group had none of those resources available.
How does this research article compare to our practice, policy, and or/procedure. In this article they had a dedicated pronation team used in the ICU, while at Saint Joseph we leaned on using multiple Nurses, and an RT to manage patients vents if ventilated and we kept them in a swimmers prone position. We would only see this type of teamwork being done in ICU on ventilated patients, while on the South tower, if they were tele, we leaned on educating patients to prone to help their diagnosis.
What are the advantages and disadvantages to the proposed recommendations in the article? The article proposed including a wound care specialty nurse in the multidisciplinary proning team for ARDS in the setting of COVID-19. The advantage to this recommendation is clearly reflected in the numbers reported. The group in the study whose proning team included a wound care nurse had an overwhelming 97% lower adjusted odds ratio of developping a pressure ulcer. However, the disadvantages are that while there is a definite association between having a wound care nurse on the team and decreased incidences of pressure injuries from proning, they are not causal. Subsequently, adding another member to the team may be costly. Also, the difficulty in coordinating with an additional team member's schedule may delay the initiation of the proning treatment.
Discuss the limitations of this article As mentioned in the previous question, this study established a relationship, or association, between having a wound care nurse on the proning team and decreased incidence of pressure injury from proning. This does not establish causation. There are a multitude of other factors that affect the development of pressure injuries. One of the main factors noted in the article is that of comorbidities. Additionally, COVID-19 sequelae such as microemboli can be mistaken for deep tissue injuries particularly on the toes. Also, length of proning treatment, days of mechanical ventilation, and severity of illness play a role in pressure injury development. Furthermore, this study was a retrospective review of intervention and control groups that were developed in the context of a global pandemic with other factors to consider such as the availability of equipment, resources, and personnel. Additionally, the inclusion of a wound care nurse in the teams was not structures as an intervention but only identified in reviewing the electronic health records. Lastly, this study looked at patients aged 21 and over. Naturally, this would exclude the pediatric population and the adult population in the 18 to 20 years of age range.
Bethany Sobesto
ReplyDeleteBethany Sobesto. Describe the method used by the author of the study. Discuss the sample size used in the study.
ReplyDeleteThe study was an observational cohort study which used a patient and family centered care model. They viewed retrospective data from electronic health records of patients who were placed prone and had covid as well as ARDS. One group of patients had a certified wound and skin care nurse, and a multiprofessional prone positioning team, who oversaw pressure injury prevention strategies for the patients. The other group of patients did not have a certified wound and skin care nurse or multiprofessional prone positioning team to help prevent pressure ulcers. The study used data from August 1st, 2020 to August 30th, 2020. The study did not include patients younger than 21, patients not placed prone, or patients unable to be prone for at least an hour. 130 ICU patients were included in the study.
Discuss the limitations of the article.
Some of the comparisions between the intervention group and the control group were not fair. For example the acuity and number of commorbidities of the patients differed. Patients with higher acuity are more likely to have factors which contribute to faster skin breakdown. Also, a higher percentage of patients in one group had specialty matresses which help prevent skin breakdown. Additionally, the length of stay varied for the patients. The longer the length of stay, the greater the odds of developing a pressure ulcer. The article states that future prospective studies are needed to overcome some of the limitations of the study.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteIn the article, a core pronation team was used, which is a multidisciplinary team of 10 people. This team includes the following persons: a certified wound and skin care specialist, a critical care physician, a respiratory therapist or anesthesiologist or both, a critical care nurse and surgical technician(s). Before the patient is proned, the wound care nurse applies an ophthalmic lubricant to protect the patient's sclera. The patient is then placed on a swim position with a foam headrest, which protects the face from directly lying on the ETT. The patient stays in a prone position for 16-18 hours and then returned supine. While the patient is proned, the respiratory therapist assists the critical care nurse every 4 hours to reposition the head to prevent pressure injuries.
In the ICU, a proning team is also utilized to prone COVID patients. We also have the same steps before and during proning of these patients. The patient is in a prone position for 16-18 hours and then placed supine.
2. Discuss the sample size used in the study.
130 patients were used in the study. 40% of these patients were in the intervention group. Patients in the comparison group have a higher median of comorbidities than in the intervention group.
Describe the method used by the author of the study.
ReplyDeleteThe method used by the author was observational cohort study which was specific to a patient and family centered model. They used data from patient records, patient that had covid and ARDS and those patient were placed prone to improve oxygenation and reduce mortality risk. One group had multi professional team including certified wound care nurse and the other group did not include certified wound care nurse and other multi professional team. Also the study did not include patient younger than 21 year old.
Discuss the sample size used in the study.
130 ICU patients were included in this study, 40 % of these patients were the intervention group. The characteristic and demographic differed significantly between intervention and comparison groups, which made the comparison group have higher median of comordidties.
Describe the method used by the author of the study?
ReplyDeleteThe method used by the author was an observational cohort study using a patient – family centered care model. The data gathered was from prior health records of patients who were laid in a prone position during their bouts of covid or ARDS. Using two different groups, one with a certified wound care nurse, with the use of a multi professional prone position team, and another group who did not have those resources.
Discuss the sample size used in this study.
The sample size used within this study was conducted within an ICU, with a total of 130 patients that had Covid or Ards. It did not include patients younger than 21, and patients who were unable to tolerate being laid down in a prone position.
Discuss the limitations of the Article
According to the article, the comparisons between both groups did not reflect the study properly. Each patient suffered from different acuity's, or comorbidities which can contribute to skin faster skin break down. Additionally each patients length of stay varied, so data would be inconclusive. /
How does this research article compare to our practice, policy and/or procedure?
In this article a core pronation team was used in the ICU. In our practice, we would see a prone team if you floated to the ICU, where Mutiple nurses, and a respiratory therapist would come in and help prone the patient for a certain time in a swim position on a foam headrest. However, this was only done in the ICU, as a prone turn team was not used on the telemetry floors who were on vents. Instead, we would just educate, and remind patients to lay prone.
Describe the Method used by the author of the study.
ReplyDeleteThe study was done by using an observational cohort study, that as based on a family centered care model. They gathered all the data from prior health records of patients laying prone. Two groups were used one who had a certified wound care nurse, plus the use of multiple resources like a lift time, while one group had none of those resources available.
How does this research article compare to our practice, policy, and or/procedure.
In this article they had a dedicated pronation team used in the ICU, while at Saint Joseph we leaned on using multiple Nurses, and an RT to manage patients vents if ventilated and we kept them in a swimmers prone position. We would only see this type of teamwork being done in ICU on ventilated patients, while on the South tower, if they were tele, we leaned on educating patients to prone to help their diagnosis.
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article proposed including a wound care specialty nurse in the multidisciplinary proning team for ARDS in the setting of COVID-19. The advantage to this recommendation is clearly reflected in the numbers reported. The group in the study whose proning team included a wound care nurse had an overwhelming 97% lower adjusted odds ratio of developping a pressure ulcer. However, the disadvantages are that while there is a definite association between having a wound care nurse on the team and decreased incidences of pressure injuries from proning, they are not causal. Subsequently, adding another member to the team may be costly. Also, the difficulty in coordinating with an additional team member's schedule may delay the initiation of the proning treatment.
Discuss the limitations of this article
As mentioned in the previous question, this study established a relationship, or association, between having a wound care nurse on the proning team and decreased incidence of pressure injury from proning. This does not establish causation. There are a multitude of other factors that affect the development of pressure injuries. One of the main factors noted in the article is that of comorbidities. Additionally, COVID-19 sequelae such as microemboli can be mistaken for deep tissue injuries particularly on the toes. Also, length of proning treatment, days of mechanical ventilation, and severity of illness play a role in pressure injury development. Furthermore, this study was a retrospective review of intervention and control groups that were developed in the context of a global pandemic with other factors to consider such as the availability of equipment, resources, and personnel. Additionally, the inclusion of a wound care nurse in the teams was not structures as an intervention but only identified in reviewing the electronic health records. Lastly, this study looked at patients aged 21 and over. Naturally, this would exclude the pediatric population and the adult population in the 18 to 20 years of age range.