Pressure sores no more: a quality improvement project.

Review of staff performance in the area of pressure sore prevention revealed that nursing practice was adequate. But the staff's belief that it could do a better job provided the impetus for a quality improvement project. Based on research data a planned change was implemented, and follow-up study reflected positive outcome results. This successful project integrated the concepts of research, cost effectiveness, and patient outcome.

Esophagogastrectomy.

The diagnosis of esophageal cancer continues to stimulate much research to find the most effective methods of treatment. Combined radiotherapy and chemotherapy may produce results as good as if not better than those with operation plus radiotherapy and chemotherapy. Esophagogastrectomy is performed using any one of several surgical approaches. The individual status of the patient is an important determinant when selecting the surgical approach. There is no clear evidence that one approach is superior to another. Patients should be evaluated appropriately and prepared for operation so that they have the best chance for having a benign postoperative course. Postoperative nursing management requires complex assessment and intervention skills. The optimal approach to the management of esophageal cancer has yet to be defined. Esophagogastrectomy remains primarily a palliative, not curative, approach to patient management. The prevention of postoperative complications through astute assessment and intervention will improve the quality of patient outcomes.

Effects of position and mattress overlay on sacral and heel pressures in a clinical population.

A comparison of pressure reducing properties of alternating air, static air, and water mattress overlays was conducted with 57 patients in a surgical intensive care unit. Sacral and heel pressures in both recumbent and semi-Fowler's positions were tested for each surface using a repeated measures design. Mean pressures for the alternating air mattress were significantly higher than pressures with other surfaces, regardless of position or site. There were significant main effects for position and site, with higher pressures in the semi-Fowler's position and at the sacral site. A significant interaction between surface, site, and position was found. Pressure sores developed in eight patients, but the incidence was not significantly different across groups. A pressure measuring device constructed from available clinical materials proved to be both sensitive and reliable. The findings suggest alternating air overlays should be avoided, and that positioning and periodic position change to reduce sacral pressures for patients requiring prolonged upper body elevation is important.