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7TH
EPUAP OPEN MEETING, TAMPERE, FINLAND
Pressure Ulcer Prevention and Management, Poster Abstracts, September
2003
(continued from Volume 5, Issue 3, 2003)
THE IMPACT OF A NEW CAVILON SKIN CARE PROTOCOL
FOR PATIENTS CARED FOR IN NURSING HOMES IN THE UK
Bale, S., Tebble, N., Jones, V. and Price, P.
Wound Healing Research Unit, UWCM, Cardiff, Wales, UK
Introduction:
Patients cared for in Nursing Homes are vulnerable to skin problems, particularly
pressure ulcers and incontinence dermatitis. This study is concerned with
skin care in elderly, incontinent patients cared for in Nursing Homes.
It explores the extent to which a new skin care protocol could be implemented,
and its effects on patients’ skin condition, and staff time.
Methods:
A longitudinal, pre and post intervention study design was employed in
this study. Data were collected on current skin conditions and skin care
procedures, prior to, and following the introduction of a new skin care
protocol. A supportive education programme was delivered to staff. Nurses
and carers were observed as they undertook skin care following episodes
of incontinence. The time taken, products and amounts used were recorded.
The presence and severity of incontinence dermatitis was recorded, together
with the presence and severity of pressure ulceration. The new sacral
skin care protocol comprises using a skin cleanser, a barrier cream and
a barrier film* supplied by 3M Health Care.
All patients with incontinence, and all staff working in six Nursing Homes
were included in this study. Two Nursing Homes were randomly selected
to participate in detailed skin assessments, and documentation of skin
care procedures and product usage.
Results:
164 patients were included in the detailed assessments, 79 pre-intervention,
85 post-intervention. 49 were male (29.9%) and 115 female (70.1%). Only
3% of patients were under 70 years of age, with 72% over 80 years of age.
These patient profiles were very similar at both time points, indicating
a frail, elderly population of patients. Pre-intervention 29.1% were incontinent
of urine only, 64.6% were doubly incontinent and 6.3% were catheterised.
Post-intervention 29.4% had urinary incontinence, 65.9% were doubly incontinent,
and 4.7% were catheterised.
Staff adhered well to the new skin care protocol; during the observations,
the care for only one patient did not follow the protocol. Skin condition
was maintained or improved using the new skin care protocol. The presence
of a pressure ulcer did not significantly differ between time points although
the grade of ulcer was found to change significantly between time points
(p = 0.005). The presence of Grade 1 (EPUAP) pressure ulcers was found
to significantly decrease over time (p = 0.041). The presence of incontinence
dermatitis was found to be significantly lower after introducing the skin
care protocol (p = 0.021).
There was significant reduction in time taken to deliver skin care post-intervention
(p < 0.001). There was a mean time saving of 5 minutes and 44 seconds,
per patient per procedure. If the procedure is carried out an average
of 8.5 times (ten and seven times in the two nursing homes used) this
gives a time saving of 45 minutes and 55 seconds per patient, per day
using the new skin care protocol.
Summary:
Staff adherence to the new skin care protocol was good, with only one
observed episode when the protocol was not followed, suggesting a high
degree of success in its implementation. In this study we demonstrated
that the introduction of a new skin care protocol, supported by an educational
programme, maintained or improved patients’ skin condition, and
significantly reduced the time involved in delivering nursing care.
* 3M ‘Cavilon’ Durable Barrier Cream and 3M ‘Cavilon’
No Sting Barrier Film and a proprietary skin cleanser were supplied by
3M Health Care.
REVIEW OF THE EVIDENCE . . . ONE SUPPORT SURFACE
FOR PREVENTION & TREATMENT
Cynthia J. Sylvia, MA CWOCN RN
Educational Services Administrator, Gaymar Industries, Inc.
Jeanne Perla, PhD RN, Medical Research Scientist
Introduction:
Pressure and treatment of pressure ulcers is an important health care
initiative. Patients can be spared the pain and suffering of pressure
ulcers and patients and caregivers can avoid the financial burden of costly
medical equipment, by the wise care management of patient populations
at risk for and being treated for pressure ulcers. The clinical experience
can best be shared by documentation in the literature. It is the responsibility
of every clinician to publish their experiences for the wound care community.
The evidence can be critically analyzed and used by other clinicians in
making the most appropriate decisions for quality outcomes management.
Methods:
Literature review of evidence related to the clinical outcomes of using
a static air overlay (Sof·Care® Air Overlay). Search of the
literature in Pub Med (1980 to the present) limited to English, human
subjects only. Guideline for strength of evidence was proposed by the
Agency for Health Care Policy and Research (now the AHRQ) in Clinical
Practice Guidelines #3 and #15. Level A = Good research-based evidence;
Level B = Fair research-based evidence; Level C = Expert Opinion. Content
of articles is reviewed for outcomes related to use of static air overlay.
Results:
A search of the literature reveals a total of eleven articles on this
static air overlay (Sof·Care® Air Overlay). Three articles
are clinical trials, eight articles are descriptive studies on clinical
and financial outcomes of resource allocation. According to criteria for
strength of evidence, Level A = three articles and Level B = eight articles.
There are no level C articles. Review of outcomes (results) supports the
use of this static air overlay (Sof·Care® Air Overlay) for
management of pressure ulcers.
Summary:
The literature search reveals that over the past two decades there is
A and B Level evidence to support the use of the Sof·Care®
Air Cushion. Clinical and financial outcomes reflect the benefits of using
the Sof·Care® Air Cushion. Review of these eleven articles
indicates results that support the use of this static air overlay for
both prevention and treatment of pressure ulcers. It is suggested that
further research using this static air overlay (Sof· Care®
Air Overlay) be initiated with the goal of increasing the database of
evidence related to outcomes management for prevention and treatment of
pressure ulcers.
References:
Sylvia, C.J. (1993). Determining the right mix of support surfaces to
minimize hospital acquired pressure ulcers. Ostomy Wound Management,
39:8
Shindul-Rothschild J., Long-Middleton, E. and Berry, D. (1997). Ten Keys
to quality care. American Journal of Nursing, 97: 11, 35–43.
Neal, M.E. (1990), A cost-effective alternative to speciality beds for
pressure relief. Rehabilitation Nurse, 15: 4, 202–204.
A NEW APPROACH TO THE MANAGEMENT OF A POST-SURGICAL
WOUND IN A NEUROPATHIC DIABETIC FOOT WOUND
(The Belfast Sandwich)The place of a dressing sandwich of a protease modulating
product, a silicone non-adherent and a hydro-fibre
D O McConville,† D Killough† and B Lee*
†Podiatrist, Belfast City Hospital Trust
*Consultant Vascular Surgeon, Belfast City Hospital Trust
Wound description:
The wound was a post surgical wound resulting from surgical removal of
infected bone and soft tissue drainage. This had resulted from diabetic
foot ulceration complicated by sepsis.
Medical history:
Diabetes mellitus had been diagnosed 20 years previously.
Mass was 97 kg height was 1.85m BMI was 28.34
Medication was Metformin 500 mg tid
The last measured HbA1s were in the range above 11 indicating poor control.
Day 1 – Details of circulatory status and sensory evaluation are
recorded.
Wound presentation:
The patient was admitted to hospital following review at the joint podiatry/vascular
surgical clinic.
Day 7 – Following arteriogram and duplex arteriography a sub-intimal
angioplasty was completed and surgical removal of the first digit.
Day 10 – The post surgical wound was dressed with Inadine Sterile
gauze and surgipad.
Day 13 – Dressing regime was altered to “The Belfast Sandwich”
of Promogran Mepitel and Multi-layer Aquacel.
This regime was employed from this stage until wound resolution at day
161. This case study charts the wound progress in more detail chronologically.
Case learning:
Dressing choice can have a profound influence on the outcome of diabetic
foot ulceration. This case illustrates how occlusive dressing contributed
to maceration in a diabetic foot ulcer complicated by some element of
infection.
THE PREVALENCE
OF DIABETES MELLITUS IN A POPULATION RECEIVING PODIATRIC CARE BY A COMMUNITY
HEALTH CARE PROVIDER: AN ANALYSIS OF THE RESOURCE DEMANDS OF DIABETIC FOOT
ULCERATION FOR PODIATRIC CARE
D.O McConville, Podiatrist, Belfast City Hospital Trust
R. Hamill, Podiatry Manager, Homefirst Community Trust
F Hodkinson, Podiatry Post-graduate Education Facilitator, Department of
Health, Northern Ireland
Aims:
The aim of the study was to determine the level of diabetes in the caseload
of a community health care provider, the frequency of diabetic foot ulceration
and the resource demands of diabetic foot screening and ulceration management.
Methods:
Information on clinical time, task description and primary and secondary
reason for referral to community podiatrist were recorded on a database.
Information pertaining to the level of diabetes in this population was analysed
over a period of one year. Diabetic foot ulceration was studied in a two-week
period. The information from the database was retrieved using of a standard
query language.
Results:
The population of the community trust was 328,850. The population receiving
podiatric care was 34,595. The percentage of the population that received
podiatric care that was registered diabetic was 19.63% Non-insulin requiring
diabetes 5428 (1.65% of community trust population) Insulin requiring diabetes
total was 1363(4.1% of community trust). Total contact time by podiatrists
was 1539,389 minutes on an annual basis. The total contact time by podiatrists
for diabetic foot care was 497,049 minutes (32% of all podiatric care time)
Summary:
Multi-disciplinary management of diabetic foot disease has been shown to
decrease the level of amputation. The level of diabetes (19%) in a community
care provider responsible for foot care is high. Diabetes accounts for a
disproportionate demand on clinical resources in podiatric care. Access
to community podiatric care was determined by level of priority. Diabetes
ensured a high level of priority.
This reflects the importance the trust attaches to the provision of screening
and managing diabetic foot ulceration. The future predicted rise in the
level of diabetes needs planning and structuring in health care delivery
to ensure future adequate service delivery.
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