Evidence Summary of risk assessment of pressure injury among surgical patients / 中国实用护理杂志

ABSTRACT

Objective To summarize the best evidence of risk assessment of pressure injury among surgical patients. Methods We searched JBI Library、Cochrane Library、NGC、SIGN、PubMed、CNKI, CBM, etc., to collect documents including guidelines, evidence summaries, best practice information sheets, systematic reviews and expert consensus. Three researchers independently reviewed studies and extracted data from the publications meeting inclusion criteria. Results 8 publications were recruited, including 5 clinical guidelines and 3 evidence summaries. Finally,12 items of best evidence were summarized, as follows. Health care professionals should involve in assessing of patients who are at risk of developing pressure ulcers, including pain related to pressure ulcers, complaints and skin inspections. Use a valid/reliable risk assessment tool in conjunction with the identifcation of additional risk factors (e.g., perfusion and oxygenation, increased body temperature, and advanced age), along with clinical judgment. Consider additional risk factors specific to individuals undergoing surgery includingduration of time immobilized before surgery, length of surgery, increased hypotensive episodes during surgery, low core temperature during surgery; and reduced mobility on day one postoperatively. Assess for intrinsic/extrinsic risk factors. Undertake a reassessment if there is any significant change in the individual′s condition. Include a comprehensive skin assessment as part of every risk assessment to evaluate any alterations to intact skin. Undertake a comprehensive skin assessment that includes skin temperature, color, edema, change in tissue consistency in relation to surrounding tissue, skin moisture, and skin integrity. Inspect the skin under and around medical devices at least twice daily for the signs of pressure related injury on the surrounding tissue. Assess and document physical characteristics includinglocation, category/stage, size, tissue types, color, periwound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Staff education should be a core component of any quality improvement project aimed to improve the accuracy of pressure injury classification and quality of documentation. Health professionals should receive education regarding the prevention, assessment and management of pressure injury. The use of multi_component strategies or a computerized clinical decision support can be considered in quality improvement initiatives for improving pressure injury classification and documentation. Conclusions Medical institutions should strengthen training of nursing staff, especially pressure ulcer assessment and standardization of nursing records. It is also needed to raise awareness of relevant risks. Nursing staff should perform risk assessment dynamically and professionally, in order to timely identify the occurrence of pressure injuries to and ensure patients′safety. Since best evidence would be updated along with research project, researchers should selectively apply evidence based on clinical settings and hospital conditions.