ASSIGNMENT TASK 1

Grace Levens
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Word Count: 1802

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Antonio, T & Conrad, K 2013, 'Clinical and economic
improvements in pressure injury care at Ballarat Health Services',
Wound Practice & Research, vol. 21, no. 1, pp. 4-10.
In this article Antonio & Conrad aim to find whether the implementation of
the Wound Care Improvement program not only shows a reduction of
pressure ulcers present on patients but also improve the economic
outcomes within Ballarat Health Services. The aim was to implement the
Wound Care Improvement program and then audit pressure injury
prevalence, prevention, and treatment methods and also determine the
education needs of the staff in order to improve care of patients. The
research procedure chosen for this study was first practiced in Ontario,
Canada. It required an initial benchmark assessment of the organisations
outcomes, performance and educational needs and after the several
years of the Wound Care Improvement program being in place, there was
another audit of pressure injury prevalence and economic improvements
conducted. The pressure point survey that was initially conducted took
into consideration; demographic, pressure injury risk, continence, falls
risk, Intravenous therapy treatments and skin condition. The staff skills
survey involved; level of staff knowledge in relation to pressure points,
confidence in accurately assessing and grading pressure wounds, types of
dressings used for treatment and the frequency of dressing changes.
They found that there was a 66% decrease in pressure point injury
prevalence and improvement in the staffs dressing and wound care skills.
From August 2009 to June 2012 there were over 10,000 bed days saved
and in terms of economic improvements, an estimation of around $4.4
million was saved. After the implementation of this program for some

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years, Ballarat Health Services were found to have one of the lowest
international pressure point occurrence rates. Resources were also more
effectively used by the staff which is where the also saved a lot of money.
The main limitations of this study was that there wasnt a complete
statistical analysis done during the years the program when being
implemented and rather than it being a randomised trial with a
experimental and control group, it was an overall intervention for the
Ballarat Health Services. Ballarat Health services didnt have a control
group (no Wound Care Improvement program implementation), to
compare to to see just how effective implementing the program was. This
is an extremely useful article because the program and evidence-based
practice implemented in this setting has improved patient outcomes. It is
also in an acute health care setting which is the scope the research
question has asked and there was an overall successful implementation.

Barker, A, Kamar, J, Tyndall, T, White, L, Hutchinson, A, Klopfer, N

& Weller, C 2013, 'Implementation of pressure ulcer prevention
best practice recommendations in acute care: an observational
study', International Wound Journal, vol. 10, no. 3, pp. 313-20.
The observational study conducted by Marker et al. was used to determine
whether

implementing

evidence

based

pressure

ulcer

prevention

programs reduces the occurrence of pressure ulcers acquired in a health

care setting. It also aimed to determine whether the staff of these health
care environments are following the right pressure ulcer care guidelines
on a daily basis. This study was conducted over nine years and aimed to
assess three practice points; (1) nurse compliance with pressure ulcer risk

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assessment and intervention checklist, (2) accuracy of pressure ulcer risk
assessment scoring and (3) use of prevention strategies. The initial
prevalence of pressure ulcers acquired in hospital assessment data was
obtained from surveys from 1045 adult patients in 2003, 2004, 2006,
2007 and 2011. There was data collected form 4368 patients medical
records for part 1 between 2003 and 2011. There was a sample of 270
patients, within The Northern Hospital, from different demographics, ages,
genders, pressure ulcer risk and falls risk used for studying part 2 and 3 of
the practice points.
It was found at the end of the observational study that there was a
highly effective integration of the pressure ulcer prevention programs into
daily nursing practice, a decreased prevalence of pressure injuries and
there was no longer an underestimation of pressure injury risk for
patients. By conducting an observational study, it meant that the
investigator/authors of the article werent responsible for how well the
pressure ulcer reduction program was implemented but just for witnessing
and noting how effective it is. This trial is useful to the research question
as it was based in an acute based health care setting and there was an
implementation of evidence practice with a substantially effective and
positive outcome. The study was limited by the fact that it was not a
randomised controlled trial and that it wasnt possible to be a blind study.
Due to the fact that the statistics and data gathered in this piece were
only in relation to one hospital it is harder to generalise that to other
health care environments.

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Donnelly, J, Winder, J, Kernohan, W & Stevenson, M 2011, 'An RCT

to determine the effect of a heel elevation device in pressure
ulcer prevention post-hip fracture', Journal of Wound Care, vol.
20, no. 7, pp. 309-18.
Donnelly et al. conducted a study to determine whether heel elevation
techniques are more effective than standard care in patients that had
sustained a hip fracture within the previous 48 hours. It aimed to find the
differences in pressure injury prevalence and also pressure injury severity
between complete offloading of pressure from the heel and standard care
of the heel. The patients used in this trial had to meet very specific
criteria; over 65 years of age, suffered a fractured hip within the previous
48 hours, no previous history of pressure ulcers and currently within a
fracture trauma unit. There were 120 patients allocated to receive
experimental intervention and 119 patients randomly allocated to receive
standard interventions. In the end, the study finished with 116 completing
the standard intervention group and 111 finishing in the experimental
intervention group. This study was followed up with objective data as both
groups were asked to complete a satisfaction questionnaire when
discharged. The experimental intervention in this case was for the patient
to receive heel elevation alongside pressure redistributing support
surfaces, in this case a heel lift suspension boot was used. The results of
this study concluded that no subjects in the intervention group had
developed a pressure injury anywhere on the heels, ankles or feet. The
device used in the experimental group was considered as comfortable for
59% of the patients. On the other hand, there were 29 patients in the

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control group that did present with a pressure ulcer, considered category
1 or above in terms of pressure injury damage.
They established that offloading pressure from the heel area in
fractured hip patients reduces the prevalence of pressure ulcers. This
study could be colluded by the assessors not being blinded. Grade 1
pressure ulcers were considered a negative outcome, and this category of
pressure ulcers is not a severe outcome. These conclusions have been
made within a very narrow scope as the participants were from a very
specific field of patients. This study would not be very useful to the
research question as there was not a variety of patients used or different
pressure ulcers taken into consideration. The question wants to know
about a general consensus of the implementation of evidence-based
practice interventions are programs and how effective they are across an
acute health setting, therefore this would not provide a general
consensus.

Latimer, S, Chaboyer, W & Gillespie, B 2014, 'Patient participation

in pressure injury prevention: giving patients a voice',
Scandinavian Journal of Caring Sciences, vol. 28, no. 4, pp. 64856.
The focal point of this study undertake by Latimer et al. is the involvement
of patients in their individual and tailored pressure injury prevention
programs. It aimed to give patients a voice in terms of understanding
their feelings towards how they are cared for regarding pressure injuries
and also to find their perceptions of pressure injury care and prevention.
The research design involved semi-structured interviews which had 10

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questions asked over ten to fifteen minutes to minimize the annoyance of
patients. The sample included 20 participants across two medical wards at
two metropolitan hospitals in Australia. The participants were required to
be; over 18, have been in hospital for at least three days and required
some sort of assistance for ambulation. The findings were split into three
main categories that took into consideration: the experiences of pressure
injuries, the participation of patients in their pressure injury care and
pressure injury prevention treatment. Through the interviews it was
concluded that effective nurse/patient relationships were critical to patient
care and and how the well the patient received that care. It was also
imperative that hospitals start not only continually educating nurses but
also patients on pressure injury prevention and treatments to build their
knowledge on their own personal care.
The usefulness of this article was demonstrated by obtaining subjective
rather than objective data. The study was also conducted within an acute
health care setting which is in line with the scope posed by the research
question. The question asked about processes in pressure injury treatment
and in this study the processes were evaluated subjectively, unlike most
pressure injury studies that are evaluated objectively. It evaluates how the
patient feels about how their nurse cares for them and also their
involvement in their own care plan. Despite this, the study had limitations,
including the results not being generalisable because it was such a small
sample, there were more females than males in this study, the interviews
were brief and not in depth, and the structure of the interviews could have

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made the patients feel like they wanted to provide the correct answer
rather than the way they felt.
McInnes, E, Jammali-Blasi, A, Cullum, N, Bell-Syer, S & Dumville, J
2013, 'Support surfaces for treating pressure injury: A Cochrane
systematic review', International Journal of Nursing Studies, vol.
50, no. 3, pp. 419-30.
This article undertook a review of eighteen separate trials and studies
with a total of 1309 participants to examine the effectiveness of healing
pressure ulcers with pressure relieving support surfaces. They originally
set out to see which study was the most valid and reliable when collecting
data regarding support surfaces in pressure injury treatment to ultimately
find the most effective support surface to reduce the chance of pressure
ulcers. All the trials were randomised control trials that may or may not
have been published. The trials must have also included objective data
regarding pressure ulcers and support surface effectiveness. Even though
they originally set out to find the best surface for pressure injury
prevention, their findings suggested that there was an absence of good
evidence to support the most effective type of support surface for the
treatment or prevention of pressure injuries. McInnes et al. concluded that
more comprehensible studies needed to be completed in order to clearly
prove that one type of pressure relief surface is better than another.
The are several reasons why this article will not help explain the
research project, firstly because the trials chosen were conducted in too
wide a variety for the scope the question asks for, acute health care
services. The reason why this review article is not useful is because it
undermines all the other studies and when trying to prove effect

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prevention and treatment methods for pressure ulcers it is contradictive.
The observation states that it was found all studies were not valid for
several reasons and these reasons included; being outdated, the question
requires evidence in the form of studies rather than reviews and this
article falsifies everything that pressure ulcer prevention techniques have
theorized. It is irrelevant to the question because it takes it up a level in
the sense that it evaluates studies that evaluate the effectiveness of
certain treatments regarding pressure ulcers.