Challenges in prospective observational studies evaluating pressure ulcer costs: how to price the items correctly.

OBJECTIVE: Pressure ulcers (PUs) are a significant healthcare problem with a negative impact on patients' quality of life and incurring substantial healthcare expenses. Our study aimed to analyse the costs of treating PUs in hospitalised patients in the Czech Republic, in the context of current treatment procedures and price levels, and to pilot-test the detailed methodology developed. METHOD: A prospective, observational, non-interventional study was conducted at the Clinic of Anesthesiology, Resuscitation and Intensive Medicine, the Internal Medicine Department and the Surgical Department of the University Hospital Ostrava. The study included all hospitalised patients with a PU from March-May 2021. Data were collected using the hospital information system. A bottom-up, person-based approach to cost analysis was used, based on a comprehensive cost structure using accurate patient-specific consumption records. RESULTS: The length of hospitalisations ranged from 1-31 (mean: 12.7) days. The average cost of PU treatment per hospitalisation was calculated at €1579. The average daily cost of PU treatment was €179, including antibiotic therapy (ATB) and €112 without ATB. Most of the costs were associated with ATB (38.6%) and caregivers' time (35.9%). Based on the results, a predictive model was developed to estimate the cost of treating a hospitalised patient with a PU, which could be used in future research to assess the costs of treating these patients. CONCLUSION: We have faced many challenges in the methodology of preparation of cost analysis (e.g., how to count amorphous topical agents and sprays, how to properly identify PUs, how to price the positioning aids and mattresses, and how to relate the ATB treatment to the PU). This analysis provides important input for developing a comprehensive and more accurate methodology for monitoring PU costs in hospitalised patients, applicable in clinical practice for inpatient healthcare providers.

Mortality related to pressure ulcers in Czech Republic - Analyses of national health registries.

BACKGROUND: Pressure ulcers/pressure injuries (PUs/PIs) relate to decreasing quality of life, prolonged hospitalisation, the increased economic cost of care, and increased mortality. That's why this study focused on one of the mentioned factors - mortality. OBJECTIVES: The study analyses national data in the Czech Republic to map the mortality phenomenon comprehensively based on data from national health registries. METHOD: The retrospective, nationwide cross-sectional data analysis of data collected by the National Health Information System (NHIS) has been provided in the period 2010-2019 with a special focus on 2019. Hospitalisations with PUs/PIs were identified by reporting L89.0-L89.9 diagnosis as a primary or secondary hospitalisation diagnosis. We also included all the patients who died in the given year with an L89 diagnosis reported in 365 days prior the death. RESULTS: In 2019, 52.1% of patients with reported PUs/PIs were hospitalised, and 40.8% were treated on an outpatient basis. The most common underlying cause of death mortality diagnosis (43.7%) in these patients was the diseases of the circulatory system. Patients who die in a healthcare facility while hospitalised with an L89 diagnosis generally have a higher category of PUs/PIs than persons who die outside a healthcare facility. CONCLUSION: The proportion of patients dying in a health facility is directly proportional to the increasing PUs/PIs category. In 2019, 57% of patients with PUs/PIs died in a healthcare facility, and 19% died in the community. In 24% of patients who died in the healthcare facility, PUs/PIs were reported 365 days before the death.

Medical device-related pressure injury prevention related to fixation of nutritional and derivative probes: a best practice implementation project.

OBJECTIVES: The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes. INTRODUCTION: The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices. METHODS: The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient's monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline. RESULTS: There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice. CONCLUSION: Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses' increased level of knowledge and usage of appropriate preventative measures.

Financial competencies as investigated in the nursing field: Findings of a scoping review.

AIM(S): This study aims to map the extent of the research activity in the field of financial competencies and nursing and identify main patterns, advances, gaps, and evidence produced to date. BACKGROUND: Financial competencies are important indicators of professionalism and may influence the quality of care in nursing; moreover, these competencies are the basis of health care sustainability. Despite their relevance, studies available on financial competencies in the nursing field have not been mapped to date. EVALUATION: A scoping review was guided according to (a) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review and (b) the Patterns, Advances, Gaps and Evidence for practice and Research recommendations framework. KEY ISSUE(S): A total of 21 studies were included. Main research patterns have been developing/evaluating the effectiveness of education programmes and investigating the nurse's role in the context of financial management, challenges and needs perceived by them, and tool validation to assess these competencies. The most frequently used concept across studies was 'financial management competencies' (n = 19). CONCLUSION(S): The sparse production of studies across countries suggests that there is a need to invest in this research field. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses with managerial roles should invest in their financial competencies by requiring formal training both at the academic and at the continuing education levels. They should also promote educational initiatives for clinical nurses, to increase their capacity to contribute, understand, and manage the emerging financial issues.

A ten-year follow-up of the prevalence of pressure injuries in the Czech Republic: Analysis of the National Registry.

The study aims to follow up on the analysis of Pressure injuries (PIs) prevalence conducted between 2007 and 2014 and after the new methodological requirements for PIs surveillance establishment at the national level. A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist was collected by the National Health Information System (NHIS). The International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs were used in the period 2010-2019. A total of 264 442 records of patients with diagnoses of L89.0-L89.9 were identified from 2010 to 2019 (26 444 patients per year on average). The numbers are increasing every year, and there is a 40% increase between 2010 and 2019. When comparing recorded PIs, the percentage of PIs occurrence in category I decreased, and the number of PIs in category IV increased in the second analysed period. Still, in absolute numbers, there is an increase across all categories. The age of patients with recorded PIs also rose slightly in the second analysed period. We have proven the PIs prevalence increase in an ageing population.

Economic evaluations of interventions for the prevention and treatment of pressure ulcers: an umbrella review protocol.

OBJECTIVE: The objective of this review is to synthesize the findings of economic evaluations of preventing or treating pressure ulcers. INTRODUCTION: Pressure ulcers are one of the most common preventable complications characterized by local tissue injury. Pressure ulcers increase mortality rates, impair quality of life, increase the length of hospital stay, and alter overall health outcomes. Published studies have found higher costs associated with treating pressure ulcers than preventing them, with treatment cost varying based on the pressure ulcer category (the greater the category, the higher the cost). We will systematically review the evidence on preventing or treating pressure ulcers from an economic perspective. INCLUSION CRITERIA: We will include systematic reviews that investigate both the cost and outcomes associated with the prevention or treatment of pressure ulcers. Systematic reviews dealing with economic evaluation of wound care or management will be excluded if they have not provided separate information for pressure ulcers. METHODS: Epistemonikos, MEDLINE, NHS Economic Evaluation Database, and the Canadian Agency for Drugs and Technologies in Health (CADTH) website will be searched for relevant systematic reviews from inception and without any language restrictions. Titles and abstracts will be screened at the initial stage, followed by full-text screening. Quality assessment will be done using the standard JBI critical appraisal instrument for systematic reviews and research syntheses. Article screening, data extraction, and quality assessment will be performed by two reviewers independently. All economic health outcomes will be considered under the primary outcomes of the study. SYSTEMATIC REVIEW REGISTRATION NUMBER: Open Science Framework (https://osf.io/9y2a7/).

The Use of Personal Protective Equipment in a Biosafety Level 2 Prospective Observational Study.

Adequate safety precautions and proper use of personal protective equipment (PPE) in hospitalized patients with health care-associated infections (HAIs) are the most effective preventions in their spread. Observational study was conducted in one inpatient facility in the Czech Republic before the COVID-19 pandemic (April 2019 to February 2020). Data were analyzed using Minitab at a significance level of .05. The execution of preventative measures in patients hospitalized with a HAI (n = 44) and the use of PPE by health care workers (n = 514) have been observed. The presence of defined PPE items usage differs on the basis of the department type (P = .0004). The correctness of PPE use differs on the basis of profession (P < .001), hand disinfection before PPE use (P < .001), use of all PPE (P < .001), and hand hygiene after PPE use (P < .001). General nurses had a higher observed frequency of hand hygiene (53.3%) than physicians (42.4%). The correct order of operations when using PPE differs on the basis of the department type (P < .001) and their architecture arrangement (open, semiopen, box) (P < .001). Critical preventative measures shortage was found at all units. Insufficient execution of the correct procedure of actions in the use of PPE was observed among health care workers. The best results have been observed among nurses.