ABSTRACT
PURPOSE: This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning. PARTICIPANTS AND SETTING: The sample comprised 267 patients aged 18 years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76 years; a majority (54%, n = 145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California. APPROACH: A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics. OUTCOMES: Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24 hours (36 ± 12 hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum. IMPLICATIONS FOR PRACTICE: This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.
Subject(s)
COVID-19 , Patient Positioning , Pressure Ulcer , Quality Improvement , SARS-CoV-2 , Humans , COVID-19/nursing , COVID-19/epidemiology , COVID-19/prevention & control , Pressure Ulcer/prevention & control , Middle Aged , Male , Female , Adult , Aged , Prone Position , Patient Positioning/methods , Patient Positioning/standards , California , Skin Care/methods , Skin Care/nursingABSTRACT
AIM: To evaluate the effect of mobilization protocol on mobilization start time, maintenance of mobilization and patient care outcomes in patients who underwent major abdominal open surgery. BACKGROUND: Early mobilization in the first 24 hours postoperatively is recommended. Early mobilization is one of the evidence-based, effective nursing interventions that improve patient care outcomes. DESIGN: A quasi-experimental non-randomised design was used in the study. METHODS: In the study, the groups were followed sequentially and the data of the control group (n = 21) were collected before the intervention group (n = 21). The patients in the control group were mobilised postoperatively by the nurses according to the decision of the nurse and physician in the intensive care unit (ICU) on the day of the operation. There was no standard protocol for mobilization in the ICU. Mobilization training was given to the patients in the intervention group by the researcher nurse the evening before the operation, and a mobilization protocol was applied on the 0th postoperative day. Data on patient care outcomes were collected until the day when the patient was discharged from the hospital. The TREND checklist was followed. RESULTS: According to the postoperative comparison of the patients in the intervention group to those in the control group, patients in the intervention group started mobilization earlier after admission in intensive care unit (6.22 ± 1.95 hours versus 12.21 ± 3.76 hours), had higher postoperative 0th -day total mobilization time (128 minutes versus 34 minutes), had a shorter passage of flatus time and length of intensive care unit and hospital stay and had higher sleep quality and satisfaction scores. CONCLUSIONS: The structured mobilization protocol is effective in the management of early mobilization and improvement of patient care outcomes. RELEVANCE TO CLINICAL PRACTICE: mobilization protocols ensure that the mobilization process is maintained effectively.
