Mejora de la valoración del riesgo y la prevención de las lesiones por presión durante la implantación de una Guía de buenas prácticas clínicas / Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline

Objetivo: Evaluar los indicadores de calidad asistencial en lesiones por presión (LPP) antes y tras 6 meses de la implantación de la Guía de buenas prácticas clínicas de la Registered Nurses’ Association of Ontario en la unidad geriátrica del Hospital Universitario Santa María de Lleida. Método: Estudio observacional descriptivo longitudinal a lo largo de la implantación de la Guía de buenas prácticas clínicas Valoración del riesgo y la prevención de lesiones por presión realizada por la Asociación Profesional de Enfermeras de Ontario. De las historias clínicas electrónicas se extrajeron las principales variables —incidencia y categorización de LPP nosocomiales, valoración del riesgo de LPP durante las primeras 24horas de ingreso, valoración continuada según el riesgo de LPP y registro de una superficie especial para el manejo de la presión en el plan de cuidados en los pacientes con riesgo— para su posterior análisis descriptivo y contraste de hipótesis para la comparación de proporciones. Resultados: Se incluyeron un total de 154 sujetos, siendo mayoritariamente mujeres (57%), edad media de 86 años y estancia media de 8 días. Con la implantación de la guía globalmente se consiguió mejorar los indicadores de calidad, aunque no en todos los casos con significación estadística. Los indicadores de calidad: la incidencia de LPP disminuyó un 14,54%, las valoraciones del riesgo de LPP a las 24horas de ingreso aumentaron un 2,90% y las periódicas en función del riesgo un 280,35%, registrando un 48,19% frente al 12,67% de la situación basal, y el registro de superficies especiales en el manejo de la presión aumentó un 13,33%. Conclusiones: La implantación de la Guía de buenas prácticas clínicas de la Registered Nurseś Association of Ontario mejoró los resultados relacionados con la valoración y prevención de las LPP, repercutiendo positivamente en los indicadores de calidad asistencial.(AU)

Objective: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses’ Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. Method: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) “Risk Assessment and Pressure Injury Prevention” carried out by the Ontario Nurses’ Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. Results: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. Conclusions: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.(AU)

Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline. / Mejora de la valoración del riesgo y la prevención de las lesiones por presión durante la implantación de una Guía de buenas prácticas clínicas.

OBJECTIVE: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses' Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. METHOD: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) "Risk Assessment and Pressure Injury Prevention" carried out by the Ontario Nurses' Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. RESULTS: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. CONCLUSIONS: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.

Resultado de la intervención Enseñanza: Dieta prescrita en la consulta de enfermedad renal crónica avanzada / Result of the intervention "Education": diet prescribed in advanced chronic kidney disease

En la consulta de enfermedad renal crónica avanzada (ERCA), se proporcionan cuidados a los pacientes con enfermedad renal crónica con un filtrado glomerular (FG) < 30 ml/min. Estos incluyen diferentes intervenciones de enfermería. Una de ellas es la intervención 5614 Enseñanza: dieta prescrita. Objetivo: Analizar la eficacia de la intervención 5614 Enseñanza: dieta prescrita, en pacientes ERCA realizada en la consulta de enfermería, en la primera visita. Material y métodos: Estudio cuasiexperimental. Se incluyeron 92 pacientes incidentes en la consulta ERCA en 2014. Se realizó la intervención 5614 Enseñanza: dieta prescrita y se evaluaron indicadores de resultado 1004 Estado nutricional a los 2 meses de la intervención. Se llevó a cabo una estadística descriptiva de las variables pre y post intervención. Resultados: Edad media 69,5±15 años, 64,1% (n=59) hombres, 35,9% (n=33) mujeres, 41,3% diabéticos. Después de la intervención el 62% de los pacientes disminuyeron el valor del K, el 54,3% el del P, el 55,4% el del colesterol total, el 59,8% el del colesterol-LDL, y el 44,6% el del ácido úrico. El 67,4% de los pacientes presentó pérdida ponderal. En estos pacientes la variación media de la albúmina fue -0,005±0,0028 mg/dL. El FG permaneció estable en el 63% de los pacientes. La PAS media disminuye en el 42,4% de los pacientes y la PAD media en el 38%. Conclusiones: Tras la intervención 5614 Enseñanza: dieta prescrita realizada a los pacientes ERCA en la primera visita, se observa disminución del peso y valores plasmáticos de P, K, colesterol- LDL, colesterol total y ácido úrico. La Función renal permanece estable. La concentración de albúmina en los pacientes que perdieron peso se mantiene estable. La diferencia de la media para los valores de K y colesterol total fue estadísticamente significativa (AU)

Advanced chronic kidney disease (ACKD) units provide care to chronic kidney disease patients <30 ml/min glomerular filtration rate (GFR). These include different nursing interventions as 5614 intervention teaching: prescribed diet intervention. Goal: To analyze the effectiveness of 5614 Education: prescribed diet intervention in ACKD unit patients, on the first visit. Material and methods: Quasi-experimental study. 92 incident ACKD unit patients in 2014 were included. 5614 Teaching: prescribed diet intervention was performed. 1004 nutritional status outcome indicators were evaluated 2 months after nursing intervention. Descriptive statistics of the variables pre and post intervention was performed. Results: Mean age 69.5 ± 15 years, 64.1% (n = 59) men, 35.9% (n = 33) women, 41.3% diabetic. After nursing intervention, 62% of patients decreased the K values, 54.3% with P, 55.4% in total cholesterol, 59.8% in LDL-C, and 44.6% of uric acid. 67.4% of patients lost weight. In these patients the average variation of albumin was -0.005 ± 0.0028 mg /dL. The FG remained stable in 63% of patients. SBP mean decreased in 42.4% of patients and DBP mean in 38% patients. Conclusion: After 5614 Teaching: prescribed diet intervention at first ACKD unit visit weight loss and plasma levels of P, K, LDL-cholesterol, total cholesterol and uric acid were observed. Kidney function remained stable. Albumin concentration in patients who lost weight remained stable. The mean difference for the K values and total cholesterol was statistically significant (AU)

Evaluation of psychological outcomes following the intervention 'teaching group': study on predialysis patients.

GOALS: Aims of the study were to evaluate the effects of the intervention 'Group education' (NIC 5604) on patients' coping, fear control, anxiety and the association between demographic and clinical variables with the outcomes. MATERIALS AND METHODS: We studied all predialysis patients treated, at Lleida University Hospital, from 1 January 2007 till 31 March 2008, who received the total intervention for six months. RESULTS: There were 41 patients, 33 male and 8 female. They had a mean age of 60.56 years (SD 13.96); 66% declared family support. Forty-one percent had a low educational level. The Charlson Comorbidity test showed a mean of 5.07 (SD 1.77). All patients were independent, using the Karnofsky scale and Barthel index. Patients reported a significant improvement in all the outcomes evaluated (anxiety, coping and fear response). Logistic regression showed that the reduction in anxiety and the improved nursing outcomes were not related to demographic and clinical variables. CONCLUSION: The group educational programme was effective on the defined psychological outcomes in predialysis patients. Hence, it should be available for all clients.