Post-operative pain management among surgical trauma patients in an acute ward: a best practice implementation project.

INTRODUCTION: Effective pain management should be one of the main goals of healthcare professionals. The trauma unit of a hospital in an urban area of Spain carried out an implementation project, guided by the evidence-based criteria from JBI, to put in place the processes and initiatives needed to reduce post-operative pain. OBJECTIVES: The aim of this implementation project was to promote evidence-based practice in managing post-operative pain. METHODS: A pre-post implementation audit was implemented using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool. Each audit included 30 post-operative patients from a randomized sample who were evaluated before the project started and six months after key strategies had been implemented. The criteria were audited according to evidence-based process criteria. RESULTS: At the baseline audit, the compliance percentages for the evidence-based criteria ranged from 10% to 43%. Seven obstacles were identified in relation to post-operative pain management. Following the GRiP table, the team established a series of strategies and resources to implement the improvement actions. When the implementation period ended, all the criteria had improved. CONCLUSIONS: The quality improvement cycle allowed us to implement the clinical best practice recommendations, with subsequent outcome improvements for patients. Future audits should be performed to drive new cycles of improvement in evidence-based practice.

Preliminary experience of an expert panel using Triangle Wound Assessment for the evaluation of chronic wounds.

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.

Prevención del deterioro de la integridad cutánea en el sacro mediante la aplicación de una espuma de adhesión atraumática / Prevention of deterioration of the cutaneous integrity in the sacral area through the application of an atraumatic self-adherent foam dressing

OBJETIVO: determinar si la aplicación de una espuma de adhesión traumática (Mepilex Border Sacrum®) disminuye o retrasa la aparición de lesiones en la zona del sacro en los pacientes que presentan un elevado riesgo de desarrollar úlceras por presión (UPP).MÉTODO: ensayo clínico no aleatorizado. La procedencia de los participantes fueron los servicios de Geriatría, Cuidados Paliativos, Oncohematología y la Unidad de Cuidados Intensivos del Hospital Universitario Lucus Augusti, así como la Residencia Asistida de Personas mayores de Castro de Riberas de Lea Sarquavitae.Pasaron a formar parte del grupo de intervención los individuos hospitalizados que presentaban al momento de entraren el estudio un riesgo elevado de desarrollar UPP (entre 6y 12 puntos en la escala de Braden). El grupo control lo formaron los individuos cuyo riesgo al ingreso era bajo o moderado (≥ 13puntos de la escala Braden). El estudio fue aprobado por el Comité Ético de Investigación Clínica de Galicia. RESULTADOS: formaron parte del estudio 46 individuos en cada grupo. En el grupo en el que se aplicó la espuma de adhesión traumática, se produjo un número de eventos de alteración cutánea mucho menor que en el que no se aplicó (2 vs. 20, respectivamente).A su vez, la incidencia de individuos que desarrollaron heridas fue de un 10% menor en el grupo de la espuma. También se observó que el número de días que se tardaba en desarrollar una lesión era significativamente mayor en el grupo de pacientes a los que se les había puesto la espuma de adhesión atraumática (p< 0,05).CONCLUSIONES: la espuma de adhesión atraumática Mepilex Border Sacrum® podría utilizarse como elemento preventivo del deterioro de la integridad cutánea en el sacro, dado que disminuye o retrasa la aparición de lesiones en dicha zona en pacientes que presentan un elevado riesgo de desarrollar úlceras por presión (UPP)

OBJECTIVE: to determine if the application of an atraumatic self-adherent foam dressing (Mepilex Border Sacrum®) will reduce or delay the presentation of lesions in the sacral area in those patients with a high risk of developing pressure ulcers. METHOD: non-randomized clinical trial. The participants were patients from the Geriatrics, Palliative Care and Oncohaematology Departments and the Intensive Care Unit of the Hospital Universitario Lucus Augusti, as well as from the Assisted Living Home for Elderly People Castro de Riberas de Lea Sarquavitae.T he intervention group was formed by those hospitalized persons who presented a high risk of developing pressure ulcers(between 6 and 12 points in the Braden Scale). The control group included those individuals who had low or moderate risk (≥13points in the Braden Scale) at admission. The study was approved by the Ethical Committee for Clinical Research in Galicia. RESULTS: there were 46 individuals in each arm of the study. Within the group in which the atraumatic self-adherent foam dressing was applied, there was a much lower number of cutaneous alteration events than in the group where it was notapplied (2 vs 20, respectively). At the same time, the number of individuals who developed lesions was 10% lower in the foam dressing group. It was always observed that the number of days required for developing a lesion was significantly higher in the group of patients who had received the atraumatic selfadherentfoam dressing (p < 0.05).CONCLUSIONS: the Mepilex Border Sacrum® atraumatic selfadherentfoam dressing could be used as a preventive element for the deterioration of cutaneous integrity in the sacral area, given that it reduces or delays the presentation of lesions in said area in patients with a high risk of developing pressure ulcers

Coste-Efectividad de un apósito de espuma de poliuretano con TLC-NOSF. Estudio en el tratamiento de las úlceras venosas de pierna / Follow-up of the patients in the program of self-management of oat

Las heridas crónicas representan una carga para el sistema sanitario español; hoy en día es necesaria una optimización de los recursos empleados y por esto debe justificarse el uso de unos productos, en detrimento de otros, a través de estudios de coste-efectividad que demuestren beneficio económico para los profesionales y calidad de vida para el paciente. El presente artículo compara el uso de una nueva tecnología aplicada en formato de espuma de poliuretano, la TLC-NOSF, con los productos de uso más habitual en el tratamiento de heridas. Dicha comparativa se realiza mediante un modelo de coste- efectividad (Modelo Markov). Los resultados demuestran que los tratamientos con apósito de espuma de poliuretano con TLC-NOSF son coste-efectivos versus los realizados con espumas de poliuretano de uso más habitual en España(AU)

Development in the implementation of the programme of the anticoagulated patient self-management concludes with the follow-up. Your objective is to guide, support, advise and provide the patient with the necessary support material and training and improve their autonomy and quality of life. Contacts are established through both scheduled and unscheduled visits and phone calls. The article describes this phase interspersed, so serve as a practical example, with the experience which has resulted in our unit. Relates the workloads of different professionals and the most the recurrent causes of consultation. Also lists the contents that must be observed in the contacts: practical problems in the puncture or tables of dosing, assessment of the implementation of the programme, dump the data registered in the coagulometer to the computer system, revision of the autoanalyzer, material supply and treatment settings. Reviews of records that help us detect and assess problems that are resolved by a continuous and permanent health education almost in its entirety should periodically conduct. Finally, we present a study on the incidence of adverse effects occurring in self-controlled patients that we are witnessing in our unit(AU)

[Cost-effectiveness of a TLC-NOSF polyurethane foam dressing]. / Coste-Efectividad de un apósito de espuma de poliuretano con TLC-NOSF.

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain.