Subject(s)
COVID-19 , Pressure Ulcer , Artificial Intelligence , Critical Care , Hospitals , Humans , Pressure Ulcer/epidemiologyABSTRACT
BACKGROUND: Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS: Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS: A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS: Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
Subject(s)
COVID-19 , Pressure Ulcer , Humans , Intensive Care Units , Predictive Value of Tests , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Risk Assessment , Risk FactorsABSTRACT
UNSTRUCTURED: The COVID-19 pandemic has been particularly challenging for nursing home (NH) staff and residents. Centers for Medicare and Medicaid Services (CMS) regulation waivers are burdening staff and impacting how care is delivered. Residents are experiencing social isolation that can result in physical and behavioral health issues, particularly for those with dementia. These challenges can be addressed in part through technology adaptations. Full integration of electronic health record systems can improve workflow and care quality. Telehealth can improve access to outside providers, provide remote monitoring, and improve social connectedness. Electronic and audiovisual programs can be used for end-of-life planning and information sharing between nursing home staff and families. Online learning systems and other online resources provide flexible staff education and training options. Investing in and adapting technology can help mitigate workforce stress and improve quality of nursing home care during and after the COVID-19 crisis.