ABSTRACT
Despite advances in the prevention of catheter-acquired urinary tract infections achieved by programs that include removal of the indwelling urinary catheter at the earliest possible time, evidence guiding bladder and incontinence management strategies following discontinuation of a catheter is sparse. To address this gap and guide best practice, the WOCN Society appointed a Task Force to develop an evidence- and consensus-based algorithm guiding clinical decision-making for effective bladder and incontinence management strategies after indwelling urinary catheter removal. This article describes the design and development of the algorithm, consensus-based statements used to guide best practice in this area, and its content validation.
Subject(s)
Urinary Catheters , Urinary Tract Infections , Algorithms , Catheters, Indwelling/adverse effects , Consensus , Humans , Urinary Catheterization/adverse effectsABSTRACT
This article discusses an evidence- and consensus-based support-surface algorithm designed to help clinicians choose the most appropriate support surface for preventing or treating pressure injuries based on patient, nurse, and institutional considerations.
Subject(s)
Algorithms , Beds , Clinical Decision-Making/methods , Nurse Clinicians/psychology , Pressure Ulcer/nursing , Consensus , Evidence-Based Practice , Humans , Risk FactorsABSTRACT
Support surfaces are an integral component of pressure ulcer prevention and treatment, but there is insufficient evidence to guide clinical decision making in this area. In an effort to provide clinical guidance for selecting support surfaces based on individual patient needs, the Wound, Ostomy and Continence Nurses Society (WOCN®) set out to develop an evidence- and consensus-based algorithm. A Task Force of clinical experts was identified who: 1) reviewed the literature and identified evidence for support surface use in the prevention and treatment of pressure ulcers; 2) developed supporting statements for essential components for the algorithm, 3) developed a draft algorithm for support surface selection; and 4) determined its face validity. A consensus panel of 20 key opinion leaders was then convened that: 1.) reviewed the draft algorithm and supporting statements, 2.) reached consensus on statements lacking robust supporting evidence, 3.) modified the draft algorithm and evaluated its content validity. The Content Validity Index (CVI) for the algorithm was strong (0.95 out of 1.0) with an overall mean score of 3.72 (out of 1 to 4), suggesting that the steps were appropriate to the purpose of the algorithm. To our knowledge, this is the first evidence and consensus based algorithm for support surface selection that has undergone content validation.
Subject(s)
Ostomy/nursing , Pressure Ulcer/nursing , Skin Care/methods , Surface Properties , Algorithms , Consensus , Humans , Skin Care/nursingSubject(s)
Medicare/organization & administration , Nurse Clinicians/economics , Nursing Staff, Hospital/economics , Pressure Ulcer/prevention & control , Prospective Payment System/organization & administration , Data Collection , Diagnosis-Related Groups , Documentation , Humans , International Classification of Diseases , Organizational Innovation , Pressure Ulcer/diagnosis , Pressure Ulcer/nursing , Severity of Illness Index , Skin Care/economics , Skin Care/nursing , United StatesABSTRACT
The prevention and treatment of pressure ulcers are major concerns for health care providers across the care continuum. The selection of a support surface is an important component of a comprehensive pressure ulcer prevention program. The accepted standard in clinical practice for pre-venting pressure ulcers and other complications of immobility is to either turn patients manually at frequent intervals or to use a pressure-reducing device. The longer a patient is immobilized, the more profound will be the systemic complications. The costs associated with the complications of immobility are staggering in terms of human suffering, physiologic damage,and real dollars. A variety of specialty beds, mattresses, and overlays have been designed to address pressure, shear, friction, and moisture. Limited data exist regarding the efficacy of these products. Clinicians want to choose a support surface for their patients on the basis of product performance. With the push toward establishing standards for testing methods and reporting information, clinicians can look forward to making support surface decisions based on the evidence and outcome data resulting from controlled clinical studies and expert opinion and consensus.
