Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE)

Journal article

Coyer, Fiona, Gardner, Anne, Doubrovsky, Anna, Cole, Rae, Ryan, Frances Mary, Allen, Craig and McNamara, Greg. (2015). Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). American Journal of Critical Care. 24(3), pp. 199-209. https://doi.org/10.4037/ajcc2015930
AuthorsCoyer, Fiona, Gardner, Anne, Doubrovsky, Anna, Cole, Rae, Ryan, Frances Mary, Allen, Craig and McNamara, Greg
Abstract

Purpose
To test an interventional patient skin integrity bundle, the InSPiRE protocol, for reducing pressure injuries in critically ill patients in an Australian adult intensive care unit.

Methods
Before and after design: patients receiving the intervention (InSPiRE protocol) were compared with a similar control group who received standard care. Data collected included demographic and clinical variables, skin assessment, presence and stage of pressure injuries, and score on the Sequential Organ Failure Assessment (SOFA).

Results
Overall, 207 patients were enrolled, 105 in the intervention group and 102 in the control group. Most patients were men (mean age, 55 years). The groups were similar on major demographic variables (age, SOFA scores, intensive care unit stay). Cumulative incidence of pressure injuries was significantly lower in the intervention group (18.1%) than in the control group (30.4%) for skin injuries (⁠χ21=4.3⁠, P = .04) and mucous injuries (t = 3.27, P≤ .001). Significantly fewer pressure injuries developed over time in the intervention group (log rank = 11.842, df = 1, P≤ .001) and intervention patients had fewer skin injuries (> 3 pressure injuries/patient = 1/105) than did control patients (> 3 pressure injuries/patient = 10/102; P = .02).

Conclusion
The intervention group, receiving the InSPiRE protocol, had a lower cumulative incidence of pressure injuries, and fewer and less severe pressure injuries that developed over time. Systematic and ongoing assessment of the patient’s skin and risk for pressure injuries as well as implementation of tailored prevention measures are central to preventing pressure injuries.

Keywordslength of stay; intensive care; pressure ulcer; middle-aged; patient care bundles
Year2015
JournalAmerican Journal of Critical Care
Journal citation24 (3), pp. 199-209
PublisherAmerican Association of Critical Care Nurses
ISSN1062-3264
Digital Object Identifier (DOI)https://doi.org/10.4037/ajcc2015930
Scopus EID2-s2.0-84930017314
Page range199-209
FunderRoyal Brisbane and Women’s Hospital Foundation
Queensland University of Technology (QUT)
Research GroupSchool of Nursing, Midwifery and Paramedicine
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Irritability :an underappreciated side effect of interferon treatment for chronic hepatitis C?
Blacklaws, Helen, Gardner, Anne and Usher, Kim. (2011). Irritability :an underappreciated side effect of interferon treatment for chronic hepatitis C? Journal of Clinical Nursing. 20, pp. 1215 - 1224. https://doi.org/10.1111/j.1365-2702.2010.03494.x
A prospective pilot study evaluating the 'cardiac decompensation score' in the setting of intraaortic balloon counterpulsation
Lewis, Peter, Bartlett, Harry, Townsend, Shane, Courtney, Mary Denise, Mullany, Daniel and Coyer, Fiona. (2011). A prospective pilot study evaluating the 'cardiac decompensation score' in the setting of intraaortic balloon counterpulsation. Intensive and Critical Care Nursing. 27(1), pp. 31 - 36. https://doi.org/10.1016/j.iccn.2010.10.001
Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients
Hughes, K., Gardner, Anne and McArdle, J.. (2011). Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients. Renal Society of Australasia Journal. 7(3), pp. 108 - 114.
The status of Australian nurse practitioners: The second national census
Middleton, Sandy, Gardner, Anne, Gardner, G. and Della, P R.. (2011). The status of Australian nurse practitioners: The second national census. Australian Health Review. 35(4), pp. 448 - 454. https://doi.org/10.1071/AH10987
A snapshot of Australian nurse practitioners' extended practice activities
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Della, Phillip and Doubrovsky, Anna. (2010). A snapshot of Australian nurse practitioners' extended practice activities. The Nurse Practitioner Series. 3(1), pp. 8-15.
A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia
Mitchell, Brett, Gardner, Anne, Collignon, Peter, Stewart, Lee and Cruickshank, Marilyn. (2010). A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia. Healthcare Infection. 15(4), pp. 105 - 113. https://doi.org/10.1071/HI10030
The work of nurse practitioners
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Della, Phillip, Kain, Victoria and Doubrovsky, Anna. (2010). The work of nurse practitioners. Journal of Advanced Nursing. 66(10), pp. 2160-2169. https://doi.org/10.1111/j.1365-2648.2010.05379.x
Diarrhoea risk factors in enterally tube fed critically ill patients : A retrospective audit
Jack, Leanne, Coyer, Fiona, Courtney, Mary Denise and Venkatesh, Bala. (2010). Diarrhoea risk factors in enterally tube fed critically ill patients : A retrospective audit. Intensive and Critical Care Nursing. 26(6), pp. 327 - 334. https://doi.org/10.1016/j.iccn.2010.08.001
The first Australian nurse practitioner census : A protocol to guide standardized collection of information about an emergent professional group
Middleton, Sandy, Gardner, Glenn, Gardner, Anne, Della, Phillip, Gibb, Michelle and Millar, Lynne. (2010). The first Australian nurse practitioner census : A protocol to guide standardized collection of information about an emergent professional group. International Journal of Nursing Practice. 16(5), pp. 517-524. https://doi.org/10.1111/j.1440-172X.2010.01877.x
Probiotics and diarrhoea management in enterally tube fed critically ill patients-What is the evidence?
Jack, Leanne, Coyer, Fiona, Courtney, Mary Denise and Venkatesh, Bala. (2010). Probiotics and diarrhoea management in enterally tube fed critically ill patients-What is the evidence? Intensive and Critical Care Nursing. 26(6), pp. 314 - 326. https://doi.org/10.1016/j.iccn.2010.07.001
Development and validation of a novel approach to work sampling : A study of work practitioner work patterns
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Gibb, Michelle, Della, Phillip and Duffield, Christine. (2010). Development and validation of a novel approach to work sampling : A study of work practitioner work patterns. Australian Journal of Advanced Nursing. 27(4), pp. 4-12.
Clients' understanding of the role of nurse practitioners
Susan, Allnutt,, Allnutt, Nissa, McMaster, Rose, O'Connell, Jane, Middleton, Sandy, Hillege, Sharon, Della, Phillip R., Gardner, Glenn E. and Gardner, Anne. (2010). Clients' understanding of the role of nurse practitioners. Australian Health Review. 34(1), pp. 59-65. https://doi.org/10.1071/AH09688
The status of Australian nurse practitioners : The first national census
Gardner, Anne, Della, Phillip R., Middleton, Sandy and Gardner, Glenn. (2009). The status of Australian nurse practitioners : The first national census. Australian Health Review. 33(4), pp. 679-689. https://doi.org/10.1071/AH090679
Pressure injury prevalence in a private health service: Risks and recommendations
Gardner, Anne, Millar, Lynne, Legg, Sandra, Gomez, Yvette, McGillion, Tony and Mulcahy, Aidan. (2009). Pressure injury prevalence in a private health service: Risks and recommendations. Wound Practice & Research. 17(3), pp. 134 - 145.
Absolutely fabulous - but are we? Carers' perspectives on satisfaction with a palliative homecare service
O'Connor, Lera, Gardner, Anne, Millar, Lynne and Bennett, Peter. (2009). Absolutely fabulous - but are we? Carers' perspectives on satisfaction with a palliative homecare service. Collegian. 16(4), pp. 201 - 209. https://doi.org/10.1016/j.colegn.2009.04.005
Implementing a journal club in a palliative care setting: A link in the chain of evidence-based practice
O'Connor, Lera, Bennett, Peter, Gardner, Anne, Hawkins, Mary and Wellman, David. (2009). Implementing a journal club in a palliative care setting: A link in the chain of evidence-based practice. Collegian. 16(3), pp. 147 - 152. https://doi.org/10.1016/j.colegn.2008.12.006
A literature review of central venous catheter dressings: Implications for haemodialysis in the tropics
McArdle, Joleen and Gardner, Anne. (2009). A literature review of central venous catheter dressings: Implications for haemodialysis in the tropics. Infection, Disease and Health. 14(4), pp. 139 - 146. https://doi.org/10.1071/HI09014
Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia
McCann, Leanne, Groot, Patrick, Charnley, Chris and Gardner, Anne. (2009). Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia. Australian Journal of Rural Health. 17(5), pp. 273 - 278. https://doi.org/10.1111/j.1440-1584.2009.01098.x
Writing ourselves into a web of obedience: A nursing policy analysis
Bail, Kasia, Cook, Robert, Gardner, Anne and Grealish, Laurie. (2009). Writing ourselves into a web of obedience: A nursing policy analysis. International Journal of Nursing Studies. 46(11), pp. 1457 - 1466. https://doi.org/10.1016/j.ijnurstu.2009.04.005
Potential scope and impact of a transboundary model of nurse practitioners in aged care
Bail, Kasia, Arbon, Paul, Eggert, Marlene, Gardner, Anne, Hogan, Sonia, Phillips, Christine, van Dieman, Nicole and Waddington, Gordon. (2009). Potential scope and impact of a transboundary model of nurse practitioners in aged care. Australian Journal of Primary Health. 15(3), pp. 232 - 237. https://doi.org/10.1071/PY09009
Patients' and nurses' perspectives on oxygen therapy: A qualitative study
Eastwood, Glenn, O'Connell, Beverley, Gardner, Anne and Considine, Julie. (2009). Patients' and nurses' perspectives on oxygen therapy: A qualitative study. Journal of Advanced Nursing. 65(3), pp. 634 - 641. https://doi.org/10.1111/j.1365-2648.2008.04933.x
Reporting a research project on the potential of aged care nurse practitioners in the Australian capital territory
Arbon, Paul, Bail, Kasia, Eggert, Marlene, Gardner, Anne, Hogan, Sonia, Phillips, Christine, van Dieman, Nicole and Waddington, Gordon. (2009). Reporting a research project on the potential of aged care nurse practitioners in the Australian capital territory. Journal of Clinical Nursing. 18(2), pp. 255 - 262. https://doi.org/10.1111/j.1365-2702.2008.02452.x
Selecting the right integration of research into practice strategy
Eastwood, Glenn, O'Connell, Beverley and Gardner, Anne. (2008). Selecting the right integration of research into practice strategy. Journal of Nursing Care Quality. 23(3), pp. 258 - 264. https://doi.org/10.1097/01.NCQ.0000324591.76590.e9
From competence to capability: A study of nurse practitioners in clinical practice
Gardner, Anne, Hase, Stewart, Gardner, Glenn, Dunn, Sandra and Carryer, Jenny. (2008). From competence to capability: A study of nurse practitioners in clinical practice. Journal of Clinical Nursing. 17(2), pp. 250 - 258. https://doi.org/10.1111/j.1365-2702.2006.01880.x
Evaluation of nasopharyngeal oxygen, nasal prongs and facemask oxygen therapy devices in adult patients: A randomised crossover trial
Eastwood, Glenn, O'Connell, Beverley, Gardner, Anne and Considine, Julie. (2008). Evaluation of nasopharyngeal oxygen, nasal prongs and facemask oxygen therapy devices in adult patients: A randomised crossover trial. Anaesthesia and Intensive Care. 36(5), pp. 691 - 694.
The core role of the nurse practitioner: practice, professionalism and clinical leadership
Carryer, Jenny, Gardner, Glenn, Dunn, Sandra and Gardner, Anne. (2007). The core role of the nurse practitioner: practice, professionalism and clinical leadership. Journal of Clinical Nursing. 16(10), pp. 1818 - 1825. https://doi.org/10.1111/j.1365-2702.2007.01823.x
Living with chronic illness
Gardner, Glenn and Gardner, Anne. (2007). Living with chronic illness. In In McAllister, Margaret (Ed.). Solution focused nursing : Rethinking practice pp. 143-153 Palgrave Macmillan.
Dealing with data: optimising data consistency to demonstrate the value of nurse practitioner service
Gardner, Anne, Millar, Lynne and Driscoll, Andrea. (2007). Dealing with data: optimising data consistency to demonstrate the value of nurse practitioner service. The Nurse Practitioner Series. 2(1), pp. 19 - 25.
Intravascular catheter bloodstream infections: An effective and sustained hospital-wide prevention program over 8 years
Collignon, Peter J., eimanis, Dianne E., Beckingham, Wendy D., Roberts, Jan L. and Gardner, Anne. (2007). Intravascular catheter bloodstream infections: An effective and sustained hospital-wide prevention program over 8 years. Medical Journal of Australia. 187(10), pp. 551 - 554.
Establishing an Action Research Group to Explore Family-Focused Nursing in the Intensive Care Unit
Coyer, Fiona, Courtney, Mary and O'Sullivan, Judy. (2007). Establishing an Action Research Group to Explore Family-Focused Nursing in the Intensive Care Unit. International Journal of Nursing Practice. 13(1), pp. 14 - 23. https://doi.org/10.1111/j.1440-172X.2006.00604.x
The capability of nurse practitioners may be diminished by controlling protocols
Carryer, Jenny, Gardner, Glenn, Dunn, Sandra and Gardner, Anne. (2007). The capability of nurse practitioners may be diminished by controlling protocols. Australian Health Review. 31(1), pp. 108 - 115. https://doi.org/10.1071/AH070108
Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings
O'Connell, Beverley, Gardner, Anne, Takase, Miyuki, Hawkins, Mary, Ostaszkiewicz, Joan, Ski, Chantal and Josipovic, Patricia. (2007). Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings. International Journal of Nursing Practice. 13(3), pp. 182 - 192. https://doi.org/10.1111/j.1440-172X.2007.00624.x
Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory
O'Keefe, Elissa, Gardner, Anne, Currie, Marian, Garland, Suzanne, Tabrizi, Sepehr and Bowden, Francis. (2006). Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory. Sexual Health. 3(2), pp. 91 - 94. https://doi.org/10.1071/SH05047
Competency and capability: imperative for nurse practitioner education
Gardner, Glenn, Carryer, Jenny, Dunn, Sandra and Gardner, Anne. (2006). Competency and capability: imperative for nurse practitioner education. Australian Journal of Advanced Nursing. 24(1), pp. 8 - 14.
Using a monitored sip test to assess risk of aspiration in postoperative patients
Osborne, Sonya, Gardner, Glenn, Gardner, Anne, Franklin, Susan, Tuohy, Elizabeth and Fisher, Alex. (2006). Using a monitored sip test to assess risk of aspiration in postoperative patients. AORN Journal. 83(4), pp. 908 - 928. https://doi.org/10.1016/S0001-2092(06)60010-0
Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommendations for practice
Feeley, Kathy and Gardner, Anne. (2006). Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommendations for practice. Australian Critical Care. 19(2), pp. 73 - 77. https://doi.org/10.1016/S1036-7314(06)80012-3
Australasian Trends in Intra-Aortic Balloon Counterpulsation Weaning: Results of a Postal Survey
Lewis, Peter, Mullany, Daniel, Courtney, Mary and Coyer, Fiona. (2006). Australasian Trends in Intra-Aortic Balloon Counterpulsation Weaning: Results of a Postal Survey. Critical Care and Resuscitation. 8(4), pp. 361 - 367.
How ophthalmic day surgery patients convalesce at home: an exploration of the salient issues
Ryan, Fiona, O'Connell, Beverley and Gardner, Anne. (2006). How ophthalmic day surgery patients convalesce at home: an exploration of the salient issues. Day Surgery Australia. 5(3), pp. 11 - 16.
Pressure injury: an exploration of the relationship between risk factors and interface pressure
Gardner, Anne, Dunk, Ann Marie, Eggert, Marlene, Gardner, Glenn and Wellman, David. (2006). Pressure injury: an exploration of the relationship between risk factors and interface pressure. Wound Practice & Research. 14(4), pp. 140 - 149.
Nurse Practitioner competency standards: Findings from collaborative Australian and New Zealand research
Gardner, Glenn, Carryer, Jenny, Gardner, Anne and Dunn, Sandra. (2006). Nurse Practitioner competency standards: Findings from collaborative Australian and New Zealand research. International Journal of Nursing Studies. 43(5), pp. 601 - 610. https://doi.org/10.1016/j.ijnurstu.2005.09.002
A trial of nurse practitioner scope of practice
Gardner, Anne and Gardner, Glenn. (2005). A trial of nurse practitioner scope of practice. Journal of Advanced Nursing. 49(2), pp. 135 - 145. https://doi.org/10.1111/j.1365-2648.2004.03273.x
Best practice in stabilisation of oral endotracheal tubes: a systematic review
Gardner, Anne, Hughes, Dot, Cook, Robert, Henson, Rachael, Osborne, Sonya and Gardner, Glenn. (2005). Best practice in stabilisation of oral endotracheal tubes: a systematic review. Australian Critical Care. 18(4), pp. 158 - 165. https://doi.org/10.1016/S1036-7314(05)80029-3
Parenting a preterm infant: Experiences in a regional neonatal health services programme
Rowe, Jennifer, Gardner, Glenn and Gardner, Anne. (2005). Parenting a preterm infant: Experiences in a regional neonatal health services programme. Neonatal, Paediatric and Child Health Nursing. 8(1), pp. 17 - 23.