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Organisation of health services for preventing and treating pressure ulcers.
Joyce, Pauline; Moore, Zena EH; Christie, Janice
<p>Organisation of health services for preventing and treating pressure ulcers. <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Joyce%20P%5BAuthor%5D&cauthor=true&cauthor_uid=30536917">Joyce P</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Moore%20ZE%5BAuthor%5D&cauthor=true&cauthor_uid=30536917">Moore ZE</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Christie%20J%5BAuthor%5D&cauthor=true&cauthor_uid=30536917">Christie J</a>. Cochrane Database of Systematic Reviews. 2018;12:CD012132. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</p> <p><strong>BACKGROUND:</strong> Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services. Research is needed to demonstrate clearly the effect of different provider-orientated approaches to pressure ulcer prevention and treatment.</p> <p><strong>OBJECTIVES:</strong> To assess the effects of different provider-orientated interventions targeted at the organisation of health services, on the prevention and treatment of pressure ulcers.</p> <p><strong>SEARCH METHODS:</strong> In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.</p> <p><strong>SELECTION CRITERIA:</strong> Randomised controlled trials (RCTs), cluster-RCTs, non-RCTs, controlled before-and-after studies and interrupted time series, which enrolled people at risk of, or people with existing pressure ulcers, were eligible for inclusion in the review.</p> <p><strong>DATA COLLECTION AND ANALYSIS:</strong> Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence.</p> <p><strong>MAIN RESULTS:</strong> The search yielded a total of 3172 citations and, following screening and application of the inclusion and exclusion criteria, we deemed four studies eligible for inclusion. These studies reported the primary outcome of pressure ulcer incidence or pressure ulcer healing, or both.One controlled before-and-after study explored the impact of transmural care (a care model that provided activities to support patients and their family/partners and activities to promote continuity of care), among 62 participants with spinal cord injury. It is unclear whether transmural care leads to a difference in pressure ulcer incidence compared with usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.53 to 1.64; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).One RCT explored the impact of hospital-in-the-home care, among 100 older adults. It is unclear whether hospital-in-the-home care leads to a difference in pressure ulcer incidence risk compared with hospital admission (RR 0.32, 95% CI 0.03 to 2.98; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).A third study (cluster-randomised stepped-wedge trial), explored the impact of being cared for by enhanced multidisciplinary teams (EMDT), among 161 long-term-care residents. The analyses of the primary outcome used measurements of 201 pressure ulcers from 119 residents. It is unclear if EMDT reduces the pressure ulcer incidence rate compared with usual care (hazard ratio (HR) 1.12, 95% CI 0.74 to 1.68; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the number of wounds healed (RR 1.69, 95% CI 1.00 to 2.87; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the reduction in surface area, with and without EMDT, (healing rate 1.006; 95% CI 0.99 ...
Keyword(s): Health Services; Prevention; Treatment; Pressure Ulcers.; Medicine and Health Sciences
Publication Date:
2018
Type: Journal article
Peer-Reviewed: Yes
Institution: Royal College of Surgeons in Ireland
Citation(s): Joyce P, Moore ZE, Christie J. Organisation of health services for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews. 2018;12:CD012132.
Publisher(s): Wiley
File Format(s): application/pdf
Related Link(s): https://epubs.rcsi.ie/smedart/11
First Indexed: 2019-01-03 07:17:23 Last Updated: 2019-01-03 07:17:23