Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project.

OBJECTIVES: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units. SETTING: Four intensive care units in a Norwegian University Hospital. RESEARCH METHODOLOGY: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals. RESULTS: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]). CONCLUSION: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable. IMPLICATIONS FOR CLINICAL PRACTICE: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

Pain and concomitant symptoms in medical and elective surgical inpatients: a point prevalence survey.

AIMS AND OBJECTIVES: This study (1) reports the prevalence of severe pain and other symptoms among both medical and elective surgical patients and (2) examines the co-occurrence of severe pain and other symptoms and symptom-related distress. BACKGROUND: As symptom burden can interfere with patients' rehabilitation, daily activities and quality of life, detection and optimal management of pain and other symptoms is important for good nursing care. DESIGN: Cross-sectional point prevalence survey. METHODS: Data were collected by self-report on 10 predetermined screening days from medical and surgical patients admitted to a local hospital in Oslo, Norway. Patients rated their average level of pain on movement during the last 24 hours on a 0-10 numeric rating scale (severe pain defined as ≥7). The occurrence of other symptoms and symptom distress were measured with 15 items from the Memorial Symptom Assessment Scale. Data on comorbidities were also collected. RESULTS: A total of 602 patients participated in the study (response rate = 71%). Medical patients had a higher incidence of symptoms than surgical patients and reported more symptom distress. Surgical patients reported higher levels of pain than medical patients, but the prevalence of severe pain did not differ between the two groups. In analyses adjusted for age, sex and comorbidities, severe pain among medical patients was associated with severe distress due to concentration difficulties, vomiting, itching and swelling, while severe pain among surgical patients was associated with the occurrence of drowsiness. CONCLUSION: Associations between severe pain and other symptoms differ for medical and elective surgical patients. RELEVANCE TO CLINICAL PRACTICE: Knowledge of concurrent symptoms and comorbidities in medical and surgical patients experiencing severe pain may help nurses to better tailor management of the patients' symptoms and improve quality of care.