PURPOSE: The aim of this scoping review was to identify and describe available evidence regarding factors that guide health care professionals to refer to physical therapy (PT) for treatment of chronic wounds. METHOD: Scoping review. SEARCH STRATEGY: We searched the MEDLINE, CINAHL, Scopus, and PEDro databases using the key words wounds and injuries, wound healing, wound care, physical therapy modalities, and referral and consultation. In addition, we searched the Canadian grey literature using the Google search engine. No language limits were imposed; the search was limited to elements published from 1993 to 2024. We limited records to studies of adults aged 19 years or older. We included studies focusing on chronic wounds such as venous leg ulcers, diabetic foot ulcers, peripheral arterial ulcers, mixed ulcers, and pressure injuries. FINDINGS: Data were extracted from 37 records that included published studies and grey literature. None directly addressed referral practices to PT in wound care. Grey literature from Canada provided some guidance on referral criteria. However, these 20 records were primarily based on expert opinion rather than original research. IMPLICATIONS: Our review revealed a lack of high-quality evidence and a gap in our understanding of referral pathways to PT. It is essential to investigate how referral practices affect integration of physiotherapy into wound care process to enhance healing, reduce complications, and improve mobility outcomes for patients with chronic wounds. Future recommendations include improving interdisciplinary training programs to foster better collaboration between wound care specialists and physiotherapists, ultimately leading to more holistic and effective patient management.
BACKGROUND: Engaging multigenerational frontline staff in wound, ostomy, and continence (WOC) education is challenging. During a pandemic, it was imperative for our WOC team to develop an innovative method to provide hospital and nursing staff with evidence-based practice (EBP) education. CASE: After reviewing nursing education literature and observing how Generation Z learners engage with information, our WOC team recognized the need to expand our education beyond traditional methods. Our teaching was done at the bedside, during lectures or via the integrated learning management system annual mandatory "Wound Care" module. To engage the new hires and re-energize experienced staff, we created intriguing and easily accessible short videos modeled after the TikTok social media platform. The goal was to deliver practical, accessible content that empowered hospital staff to implement WOC guidelines at the bedside. Our team developed a WOCTok video series and published the videos monthly on the intranet and a summary article in our hospital-wide newsletter. CONCLUSION: Short-form video stories, featuring staff as subject matter experts and actors, increased engagement with WOC education. Staff eagerly anticipated each new video, which expanded learning opportunities and strengthened the integration of EBP.
PURPOSE: This project aimed to implement a new advanced practice provider (APP) protocol to reduce 30-day postoperative dehydration rates for patients with new ileostomies. PARTICIPANTS AND SETTING: Adult patients (n 5 21) with new ileostomies from a large academic urban medical center within the colorectal surgery clinic in eastern North Carolina. APPROACH: Using a pre/post-test quality improvement approach, new ileostomy patients were scheduled for a follow-up visit with an APP within 7 business days of hospital discharge from May to July 2023. Postoperative complication rates were collected and compared with the American College of Surgeons (ASC) National Surgical Quality Improvement Program (NSQIP) data that provide benchmarks to other medical facilities to determine postintervention complication rates. OUTCOMES: The comparison period (January-March 2023) complication rate was 10.3%; the implementation period rate was 2.8%. The relative reduction was 72.8%, thus exceeding the goal of 10%. IMPLICATIONS FOR PRACTICE: Project findings support the importance of a protocol with the follow-up period being conducted earlier (within 1-week postoperative) for new ileostomy patients to identify those patients at a risk of dehydration and postoperative complications. More patient education on monitoring their intake and output should be incorporated into preoperative teaching.
PURPOSE: This survey aimed to characterize carers' perspectives on the impact of continence and toilet-use problems on people living at home with dementia and their family carers. DESIGN: Descriptive online survey. SUBJECTS AND SETTINGS: One hundred thirteen family carers completed the survey. Most were female (n = 89 [78%]) and adult children (n = 66 [58%]). Most were caring for someone with urinary and fecal incontinence METHODS: The survey was developed using existing data from qualitative interviews with family carers, people living with dementia and health care professionals and with input from stakeholders. Participants were family carers of people living at home with both dementia and continence care needs. Descriptive statistics and content analysis were used to summarize results. RESULTS: Around a half of carers thought that incontinence affected the health of the person they cared for and over one-third said it limited the person from taking part in social activities and seeing friends/family. The most common continence problems reported by carers were maintaining toilet-related hygiene, inappropriate removal of absorbent or other continence products, repetitive toilet behaviors/rituals, refusal to wear absorbent or other continence products, refusal to accept help with hygiene, and aggression related to continence care. Carers reported their biggest continence-related challenges to be increased workload, cost of pads, bad smell, lack of knowledge/support, arguments, and difficulties protecting dignity. Carers would like practical help with learning how to care for incontinence, adequate continence pad provision, and proactive sign-posting to continence services. CONCLUSIONS: Continence care can have a substantial and wide-ranging negative impact on people living at home with dementia and their carers. Strategies that can be tailored to individuals (both person with dementia and carer) to reduce the impact of these problems are urgently needed.
PURPOSE: The purpose of this study was to develop operational definitions of peristomal moisture-associated skin damage (PMASD) and peristomal medical adhesive-related skin injury (PMARSI). DESIGN: Methodological study. SUBJECTS AND SETTING: The sample comprised 7 clinicians and/or researchers with expertise in the field of ostomy care; however, 1 was replaced at the end of 30 days owing to lack of response to email communications. All experts resided in Brazil. METHODS: This study is part of a larger research trajectory that aims to assess the prevalence and associated factors to PMASD and PMARSI. Operational definitions for PMASD and PMARSI, along with characteristics of each condition, were developed based on the Assessment, Intervention and Monitoring (AIM) Guide from the Ostomy Skin Tool (OST). Specifically, we used the "assess the cause" item from each domain of the OST, along with a literature review that retrieved best practice documents such as the consensus of PMASD and PMARSI. Once constructed, the ODs were submitted to a committee of 7 content experts who evaluated each for its relevance and representativeness, using a Likert scale. A Content Validity Index (CVI) was used to establish content validity for the ODs used to describe and differentiate PMASD from PMARSI. RESULTS: Nineteen items were created, 5 were related to irritant contact dermatitis, 2 were related to allergic dermatitis, 4 were related to mechanical trauma, 5 were related to skin diseases, and 3 focused on cutaneous infection. The CVI-I of the items varied from 0.57 and 1.0, and the CVI-T was 0.89. Fifteen items showed excellent content validity (CVI >= 0.78), 3 had good content validity (0.60 <= CVI <= 0.77), and 1 had a poor CVI (<= 0.59). Thus, 15 items remained unchanged after the analysis, 1 was edited, and 2 were excluded. Based on the good to excellent OD CVI, the main concepts changes were related to the exclusion of the "irritant contact dermatitis" and "maceration" as complications related to PMARSI. CONCLUSIONS: Adjustments in the theoretical concepts of PMASD and PMARSI after content validation of ODs for each condition may provide theoretical concepts closer to clinical practice by health professionals who take care of people with both types of skin damage. FIndings from this study can support a greater differential diagnostic accuracy between PMASD and PMARSI.
PURPOSE The aim of this study was to identify the prevalence of peristomal skin complications (PSC) and their association with sociodemographic, clinical, and caregiving characteristics among children with fecal ostomy. DESIGN Cross-sectional study. SUBJECTS AND SETTING Ninety-nine children aged 0 to 12 years participated in the study; they were selected through a convenience sampling method at three children\x{2019}s hospitals in Ho Chi Minh City (HCMC) Vietnam. The final sample comprised 95 children; 55.8% (n=53) were boys and 57.9% (n=55) were aged 1-24 months. These hospitals, accredited by the Ministry of Health, are recognized as Level 1 pediatric hospitals, offering specialized care for the South West region of Vietnam. METHODS A questionnaire designed for purposes of this study was used to collect information on sociodemographic, clinical, and caregiving characteristics. Peristomal skin was photographed and assessed using the Ostomy Skin Tool. Assessments were completed by 3 nurses with expertise in ostomy care. Logistic regression analysis was performed to identify potential risk factors for PSC. RESULTS The prevalence of PSC was 78.9% (n=75). Analysis identified no modifiable independent risk factors for peristomal skin complications. CONCLUSION The prevalence of PSC among children with a fecal ostomy is high. We recommend employing preventive programs that prioritize educating caregivers on the appropriate application of protective skin powder or barrier ointment in children with fecal ostomy.
PURPOSE: The purpose of this study was to evaluate the effect of acupuncture combined with pelvic floor muscle training vs. pelvic floor muscle training alone on quality of life related to urinary incontinence in men after radical prostatectomy. DESIGN: Randomized clinical trial. SUBJECTS AND SETTING: Men who underwent radical prostatectomy in a central major public hospital in Brazil within the prior 2 months and self-reported urinary loss requiring daily use of a pad, diaper, or liner. MATERIAL AND METHODS: Sixty-eight individuals were randomized into 2 groups: control (pelvic floor muscle training) and intervention (acupuncture plus pelvic floor muscle training). Both groups had 8 intervention sessions, delivered once weekly. The data were analyzed at baseline (T0), 5 weeks (T1), and 9 weeks (T2) after the start of treatment. The International Consultation on Incontinence Questionnaire-Short Form and the King's Health Questionnaire were used to assess the quality of life related to urinary symptoms from the physical, social, and emotional aspects. Longitudinal changes were analyzed using Generalized Estimating Equations, including group, time, and group & times; time interaction effects.RESULTS: Compared with baseline, the intervention group showed significantly greater reductions in International Consultation on Incontinence Questionnaire-Short Form scores at T1 (beta = -5.53; 95% CI -7.49 to -3.58) and T2 (beta = -7.21; 95% CI -9.49 to -4.92) than the control group. For the King's Health Questionnaire, significant main effects of time were observed for all domains, indicating overall improvement in quality of life in both groups. Significant group & times; time interaction effects were identified for most domains, with greater improvements in the intervention group, particularly for the impact of urinary incontinence, physical limitations, emotions, and severity measures. No significant interaction effects were observed for perceived health or personal relationships. CONCLUSIONS: Acupuncture associated with pelvic floor muscle training was effective in improving quality of life related to urinary incontinence in following radical prostatectomy.
ABSTRACT:Peristomal skin complications (PSCs) remain one of the most common, yet avoidable, challenges faced by people living with an ostomy. Despite advances in ostomy care and products, wide variation persists in the prevention, terminology, assessment, and management of PSCs across the globe, which has contributed to delayed recognition, inconsistent treatment approaches, and suboptimal outcomes for patients. To address these issues and help guide best practice, an advisory board meeting was convened, where experts discussed gaps in ostomy management. A 4-step protocol, Peristomal Hygiene, was developed that aims to simplify peristomal skin health maintenance and emphasize the prevention and treatment of peristomal skin damage. Peristomal Hygiene is defined as a structured evidence-informed protocol that includes cleansing, assessing, securing, and supporting healthy living with an ostomy to promote peristomal skin integrity and prevent PSCs such as irritation, infection, and breakdown of the peristomal skin.
PURPOSE:The aim of this study was to describe foot care services requested and received during interdisciplinary wellness visits in low-income senior housing and to identify factors associated with the likelihood of requesting foot care services.DESIGN:Observational, descriptive study.SUBJECTS AND SETTING:The sample comprised 439 residents; their mean age was 79 years (SD = 8), and more than three-quarters (n = 337, 77%) were female. The study setting was 4 senior housing communities in Maryland, located in the MidAtlantic region of the USA. These communities have monthly clinics that provide foot care and other health services.METHODS:Residents completed intake assessments capturing demographics, comorbid conditions, and pertinent health behaviors. Foot care services included assessment, moisturization, nail clipping, and education. Data were collected over a period of 30 months. Data were analyzed using descriptive statistics and binary logistic regression to identify predictors of foot care utilization.RESULTS:Of the 439 residents, 147 (34%) requested foot and nail care; slightly less than half 44% (n = 65) had diabetes mellitus. Common issues included xerosis, hyperkeratosis, and onychomycosis. Logistic regression revealed that age (P = .002) and number of comorbidities (P = .003) were significantly associated with receiving foot care. Each additional year of age increased the odds of seeking and/or receiving foot care services by 1.04 (95% CI: 1.01-1.06), and each additional comorbidity increased the odds by 1.14 (95% CI: 1.04-1.24).CONCLUSION:Foot and nail care is a prevalent need among older adults in senior housing, and particularly among those with diabetes mellitus and multiple comorbid conditions. The interdisciplinary clinic model was effective in delivering care. Future research should explore the impact of foot care services on self-care behaviors, functional outcomes, and health care costs.
PURPOSE:The primary purpose of this quality improvement initiative was to evaluate the effect of a nurse-led skin team (ST) interventions on prevalence of hospital-acquired pressure injuries (HAPIs) of stage 2 and above in our cardiothoracic intensive care unit (CTICU).PARTICIPANTS AND SETTING:Data analysis is based on patients receiving care in our CTICU from 2011 to 2024. The unit is located in the Western US (Los Angeles, CA).APPROACH:A nurse-led ST was established in 2011 to empower and engage clinical nurses in addressing the rising incidence of HAPIs in the CTICU. The team employed the Plan-Do-Study-Act framework to implement both evidence-based and innovative interventions. Project strategies included rounding, monitoring, and educating staff on best practices for pressure injury prevention.OUTCOMES:More than a decade after the team's formation, trend analysis did not demonstrate a significant downward trend in stage 2 and higher HAP prevalence. Nevertheless, our HPAI rates have consistently been below national benchmarksIMPLICATIONS FOR PRACTICE:The ST approach has proved effective in sustaining a reduction of HAPIs within our facility. The team's interventions remain ongoing, supported by facility leadership and continued commitment to quality care.
This narrative review summarizes published data regarding a ceramide-infused skin barrier intended for use in patients who have undergone creation of a fecal or urinary ostomy (colostomy, ileostomy, urostomy). A randomized clinical trial (ADVOCATE) found that the mean total ostomy-related costs of care over a 12-week period were 14% lower among patients randomized to the ceramide-infused skin barrier than among control barriers. Study findings further suggested that the ceramide-infused skin barrier reduced the incidence of peristomal skin complications. Economic models, based in part on findings from the ADVOCATE trial, suggest that the ceramide-infused skin barrier is cost-effective versus other ostomy barriers from a per-patient perspective, and it is associated with cost savings for payers from a population perspective. Information from several studies, both randomized trials and observational studies, indicate quality-of-life benefits and relatively high levels of patient satisfaction associated with the ceramide-infused skin barrier. Collectively, available data indicate that, relative to other skin barriers, the ceramide-infused skin barrier is a cost-effective and cost-saving option that also provides quality-of-life benefits for patients who have undergone ostomy.
PURPOSE:The purpose of this study was to describe the influence of living with an ostomy on sleep disruptions using data from a self-reported survey and multinational clinical registry of individuals living with an ostomy. DESIGN:Cross-sectional survey and clinical registry. SUBJECTS AND SETTING:Survey data were collected from 5648 respondents living in the US with an ostomy, using any manufacturer's product; these data were collected from October 2021 to April 2022. In addition, clinical registry data were extracted from 206 respondents living in the UK, US, and Canada, using all data available as of December 2022. METHODS:An electronic survey focusing on sleep was distributed through an industry-sponsored ostomy patient support program, product supply distributor, and ostomy patient association. Participation was anonymous, voluntary, and without compensation. Participants in the multinational registry completed monthly or quarterly electronic questionnaires that included information on sleep quality and sleep disruptions. Inferential analyses were conducted using Fisher exact test and chi-square test (χ2). RESULTS:Nearly half of the Sleep Survey respondents (n = 2676 of 5648, 47%) reported their pouching system had disrupted their main sleep period over the past 30 days. Seventy-five percent (n = 1845) experienced disruptions weekly, and 31% (n = 760) reported nightly sleep disruptions. Common causes included the need to empty a pouch (64%, n = 1722), leakage of effluent (40%, n = 1068), and worry about pouching system leakage (25%, n = 677). Respondents reporting peristomal skin problems were 1.5 times more likely to experience sleep disruptions (P < .001), while individuals with ileostomies were 1.3 and 1.6 times more likely to report disruptions compared to individuals with colostomies and urostomies, respectively (P < .001). The proportion of registry respondents who reported sleep disruptions in the preceding 30 days was 39% (n = 79). A vast majority (96%, n = 76) reported being bothered by these sleep disruptions. CONCLUSIONS:The prevalence of sleep disruptions among individuals living with an ostomy is high, especially for those living with an ileostomy.
PURPOSE:The purpose of this study was to determine the relationship between fecal incontinence-specific quality of life and the severity of fecal incontinence and sociodemographic and clinical characteristics in adults aged 65 years or older. DESIGN:Descriptive correlational study. SUBJECT AND SETTING:The sample comprised 102 participants; their mean age was 73.9 (SD 6.6) years; more than half were women. The study was conducted in the internal medicine and surgical clinics (general surgery, otolaryngology, eye) of Kırklareli Education and Research Hospital, Kirklareli, Turkey, between July 2020 and July 2021. METHODS:The Fecal Incontinence Quality of Life Scale (FIQLS) was used to assess fecal incontinence-specific quality of life, and the Fecal Incontinence Severity Index (FISI) was used to measure fecal incontinence severity. Multivariable regression analysis was performed to identify predictors of FIQLS, adjusting for sociodemographic and clinical characteristics. RESULTS:The average FIQLS score was 72.2 (SD = 18.3), while the mean FISI score was 40.56 (SD = 9.8). A moderate correlation was observed between FIQLS and FISI (r = -0.402, 95% CI -0.55 to -0.22, P < .00), indicating that higher incontinence severity is associated with lower quality of life. In multivariable regression analysis, FISI was retained as the primary predictor, alongside urinary incontinence, marital status, coronary artery disease, and education level. The model accounted for 53.46 % of the variance in FIQLS (R2 = 0.5346), with an adjusted R2 of 0.4946 for FISI. CONCLUSIONS:The severity of fecal incontinence is inversely associated with quality of life among older adults. Urinary incontinence is an additional independent predictor of lower FIQLS. These findings highlight the importance of managing both fecal and urinary incontinence in older adults to improve their quality of life.
Artificial intelligence (AI) is rapidly transforming health care by augmenting clinical decision-making and enabling clinicians and researchers to perform literature searches, including systematic literature reviews (SLR). This article describes the methods used to develop an AI-generated SLR, and the lessons learned by the research team (comprised of PI content and AI experts) while completing this project. To generate the SLR, a proprietary explainable AI (XAI) platform was used incorporating generative-discriminative algorithms and reinforcement learning with human feedback. The following research question was posed: "What are best practices for pressure injury prevention in hospitalized patients?" Content experts defined and iteratively refined search parameters and exclusion criteria. The XAI screened 1414 records, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. After study selection, content experts reviewed the draft SLR for citation accuracy, synthesis quality, and clinical validity. This process yielded 110 studies. Among these, 33 studies were originally excluded but were re-incorporated after content expert input. The AI-generated SLR paper contained multiple citation errors and misinterpretations. Narrative quality was mechanical, with unsupported generalizations and factual inaccuracies. We found that content experts are critical to determine the correct search terms and interpret AI-generated results. Similarly, collaboration with AI experts is necessary to improve understanding of AI applications. The need for a detailed review of any AI-generated SLR is essential to ensure evidence fidelity.
BACKGROUND:An ileostomy is a commonly performed procedure in patients with various gastrointestinal conditions. A portion of small bowel (ileum) is brought through the anterior abdominal wall via a surgical opening called a stoma where fecal effluent is collected in an ostomy pouching system. The procedure is associated with potential complications including parastomal herniation, undermining and leakage of the ostomy pouching system, and peristomal skin damage. Leakage under the ostomy pouch system is initially treated conservatively with interventions for skin protection, such as skin barriers, adjusting the fit of the skin to accommodate ostomy size, convexity and an ostomy belt. If conservative measures are unsuccessful, more invasive procedures, such as dermal fillers, may be implemented. CASE:A 42-year-old woman with a history of ulcerative colitis (UC) and an ileostomy experienced recurrent ostomy pouch leakage. This case describes a previously unreported treatment approach using hyaluronic acid (HA)-based filler for managing leakage secondary to scarring and concave areas in the peristomal skin. The use of HA-based fillers improved the adhesion of her ostomy pouch system, resulting in decreased leakage and peristomal irritant contact dermatitis. CONCLUSION:Use of HA-based filler for scarring and concave areas of Ms T's peristomal skin allowed longer ostomy pouching system wear time without leakage, improving her symptoms and health-related quality of life. Further studies are needed to investigate the long-term effectiveness of this procedure and compare outcomes to other types of fillers for peristomal skin.
PURPOSE:The purpose of this study was to compare the sexual quality of life in women with and without urinary incontinence (UI) and the association between sexual quality of life and select sociodemographic and UI characteristics. DESIGN:Cross-sectional/observational. SUBJECTS AND SETTINGS:A total of 167 women, 84 with UI and 83 without UI, were included in the study. METHODS:Data were collected through an online survey system between November 2020 and April 2021. The online questionnaire included a "Personal Information Form," the "International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF)," and the "Sexual Quality of Life Scale-Female (SQL)." Scores form the SQL were compared using the independent sample t test for 2 groups and 1-way ANOVA for more than 2 groups. RESULTS:The mean SQL score of the women in the UI group (27.8, SD = 22.9) was significantly lower than that of the women reporting no UI (78.7, SD = 21.0; P < .001). The mean SQL scores of the women reporting typically leaking small amounts of urine during incontinent episodes (39.8, SD = 27.9) were significantly higher than those of women who typically leaked a moderate amount of urine (25.2, SD = 21.0; P = .02). The mean SQL score of the women who did not report coital incontinence (46.6, SD = 19.5) was significantly higher than that of women with coital incontinence (25.8, SD = 22.5; P = .01). There was no significant relationship between UI types and mean SQL scores of the women (P = .16). CONCLUSIONS:Urinary incontinence had a negative effect on the quality of women's sexual life. Typically, leaking larger volumes of UI and experiencing incontinence during coitus were associated with worse sexual quality of life.
PURPOSE:The purpose of this retrospective study was to evaluate the effect of an organization-level, hospital-acquired pressure injury (HAPI) prevention program over a 15-year period. A secondary aim was to summarize the program priority areas, and the resources used to inform and support its delivery. DESIGN:Retrospective statewide audit. SUBJECTS AND SETTING:Sixteen hospital and health services in Queensland, Australia, provided HAPI-related indicator data between 2013 and 2018, involving up to 4245 hospital inpatients each year. METHODS:A retrospective evaluation was undertaken using statewide audit data from up to 121 hospitals collected annually between 2003 and 2018. Outcomes of interest were HAPI prevalence and related indicators (n = 6). Priority focus areas of the program and supporting resources were extracted from annual reports, strategic plans, meeting minutes, and an internal publishing database. RESULTS:Following commencement of the program in 2006, HAPI prevalence decreased from 14% to 3% in 2018, with corresponding improvements in all 6 related indicators. Program focus areas and supporting resources were multifaceted and evidence based, targeting organizational policy, guidelines, equipment use, procurement, clinical tools, and education. A range of data sources informed the annual program focus including audit, evaluation, and pressure injury clinical incident data. CONCLUSION:The formation of a statewide HAPI prevention program coincided with a sizeable reduction in HAPI prevalence. This evaluation demonstrates that large-scale quality improvement programs to reduce HAPIs can be effective and sustainable.
One constant in the care of patients with wounds and multiple chronic illnesses is the use of pharmacotherapy. While clinicians understand the need for drug use to treat patients' disorders, some may not be aware of their potential impact on wound healing. This article describes wound healing processes, explains how common categories of drugs exert both detrimental and helpful effects on wound healing, and delineates clinical implications for health care providers. Alternative topical use of prescription medications and complementary (herbal) therapy is also described.
PURPOSE:This purpose of this project was to generate best practice recommendations for health care providers caring to individuals at risk of or experiencing a parastomal hernia.METHODS:This project was completed in 2 phases. A scoping literature review was conducted, and results were used to generate best practice statements guiding clinicians caring for persons undergoing or living with an abdominal ostomy. A modified Delphi method was used to generate consensus-based recommendations for care. Finally, these statements underwent external review.SEARCH STRATEGY:A scoping review was conducted that focused on the definitions, etiology, epidemiology, pathophysiology, assessment, prevention, and management of parastomal hernias. Databases and resources searched were CINAHL; EMBASE; Google Scholar; MEDLINE via OVID, Nurses Specialized in Wound, Ostomy and Continence Canada; Nursing and Allied Health Source on ProQuest; Ordre des infirmiers et infirmi & egrave;res du Qu & eacute;bec; PsycInfo; PubMed Registered Nurses' Association of Ontario (RNAO); and the Wound, Ostomy, Continence Nurses Society library.RESULTS:Our search retrieved 187 records; 65 were read in full and included in the scoping literature review used to generate proposed consensus statements. Consensus was reached on 15 statements that achieved a 96% or higher agreement among expert panelists. Twenty-eight professionals participated in expert review, and 96% (n = 27) reported they would recommend these best practice recommendations to support parastomal hernia practices.CONCLUSION:This process generated 15 best practice recommendations that provide guidance to health care providers who care for patients with an ostomy to assess risk, prevent, assess, and manage parastomal hernias.IMPLICATIONS:These recommendations were generated from a structured literature review of current best evidence, supported by consensus among a panel of clinical experts, and supported by external review. While they represent best practice in the prevention and management of parastomal hernias, further research is required to establish evidence-based preventive and treatment recommendations.
PURPOSE:The aim of this quality improvement project was to reduce hospital-acquired deep tissue pressure injuries (DTPIs) within 6 months of implementation using a prevention bundle that focused use of a polymeric membrane dressing.PARTICIPANTS AND SETTING:The project was conducted in the intensive care and progressive care units of a rural hospital in the Midwestern US (Mattoon, IL, USA). Participants included adult patients at risk for PIs and nursing staff responsible for their care. The hospital serves a predominantly rural population, with a patient mix that includes many elderly and critically ill individuals.APPROACH:Guided by the Institute for Healthcare Improvement's Psychology of Change framework, the project used surveys, observations, and chart audits to assess knowledge and protocol adherence. Baseline data informed the project's design, with tools including pre- and post-implementation surveys to measure knowledge and adherence.OUTCOMES:No hospital-acquired DTPIs nor progression of existing DTPIs have been detected since initiation of the project. Surveys show increased nursing knowledge and improved protocol adherence.IMPLICATIONS FOR PRACTICE:This project improved patient care, enhanced decision-making, and reduced hospital-acquired DTPIs, yielding fiscal benefits in the inpatient care unit where it was implemented. Next steps include strategies to sustain improvements and expand the prevention bundle to other hospital units.
