Measuring subepidermal moisture to detect early pressure ulcer development: a systematic review.

OBJECTIVE: The aim was to assess evidence related to the measuring of subepidermal moisture (SEM) to detect early, nonvisible development of pressure ulcers (PUs). METHOD: Using systematic review methodology, all quantitative animal and human research studies written in English were considered. In January 2021, PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases were searched. The primary outcome of interest was the validity of SEM measurement to detect early PU development. The secondary outcome was time to PU detection, sensitivity and specificity of SEM measurement, and the impact of SEM measurements on PU prevention. Data analysis was undertaken using RevMan and narrative synthesis. RESULTS: A total of 17 articles met the inclusion criteria. In all studies, a consistent abnormal deviation in SEM measurements corresponded with evidence of visual PU development. Time to PU development, explored in four studies, showed earlier detection of PU development using SEM measurement. RevMan analysis identified the mean difference in time to PU development (SEM measurement versus visual skin assessment, VSA) was 4.61 days (95% confidence interval: 3.94-5.28; p=0.0001) in favour of SEM measurements. The sensitivity of SEM measurements was reported in four studies, and scores varied from 48.3% to 100.0%. Specificity was also reported in four studies and scores ranged from 24.4% to 83.0%. The impact of the detection of abnormal SEM measurements on PU prevention was explored by one study. Results showed a 93% decrease in PU rates when staff acted on the results of the SEM readings. CONCLUSION: The findings of this review identified that SEM measurement detects PU development earlier than VSA. Furthermore, when staff responded to abnormal SEM measurements, prevention strategies were enhanced, with a subsequent reduction in visible PU development. SEM measurement may therefore be a useful addition to PU prevention strategies. DECLARATION OF INTEREST: The School of Nursing & Midwifery, RCSI has a research agreement with Bruin Biometrics. Funding for the study was through an Irish Research Council PhD Enterprise Partnership Scheme with Bruin Biometrics. The authors have no other conflicts of interest.

Hospital-acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders.

AIM: The aim of this study was to understand the perceptions of 11 Portuguese nurses' stakeholders regarding pressure ulcers prevention practice and reality in the hospital setting. METHODS: Convenience sampling was used to recruit nursing stakeholders for a heterogeneous focus group. A semi-structured interview was conducted with 11 nursing stakeholders involved in pressure ulcers prevention and/or patient safety. MaxQda 2020 qualitative analysis software was used in the content analysis and data processing. Informed consent was obtained, and anonymity was guaranteed. RESULTS: Four themes were approached in the interview: (1) Pressure ulcer risk assessment; (2) Nurses and doctors pressure ulcers monitoring; (3) Pressure ulcer risk profiles; and (4) Effective interventions to improve patient safety. The categorisation of the four themes was created aposteriori based on the 'Awareness/Knowledge/Competence, Opportunity, and Motivation - Behaviour Change Wheel' (adapted COM-B system). Interest, responsibility, autonomy, leadership and prioritisation for decision-making were some categories linked to motivation. Braden scale operationalisation, education given during undergraduate degree continued professional health education, missing care, reliability of the records and patients' clinical characteristics emerged as categories associated with awareness/knowledge/competence. Understaffing/nursing hours, health policies, electronic health records systems and clinical language used, access to appropriate equipment and resources, teamwork and clinical support specialist on tissue viability/wound care were some categories related to opportunity. CONCLUSIONS: Pressure ulcer prevention is complex and requires a focussed attitude, robust evidenced-based knowledge and enhanced skills in risk assessment, communication and team collaboration. The highlighted categories could be further analysed at an organisational level to develop tailored strategies that could contribute to successful evidence-based practice implementation. RELEVANCE TO CLINICAL PRACTICE: The findings provide directions for behavioural change in the hospital context related to pressure ulcers prevention through awareness/knowledge/competence, motivation and opportunity to improve care delivered.