Loading...
The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial
Chaboyer, Wendy Bucknall, Tracey Webster, Joan McInnes, Elizabeth Catherine Gillespie, Brigid M. Banks, Merrilyn Whitty, Jennifer A. Thalib, Lukman Roberts, Shelley Tallott, Mandy
Chaboyer, Wendy
Bucknall, Tracey
Webster, Joan
McInnes, Elizabeth Catherine
Gillespie, Brigid M.
Banks, Merrilyn
Whitty, Jennifer A.
Thalib, Lukman
Roberts, Shelley
Tallott, Mandy
Abstract
Background Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. Objective To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. Design Pragmatic cluster randomised trial. Setting Eight tertiary referral hospitals with > 200 beds each in three Australian states. Participants 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure ulcer because of limited mobility; expected to stay in hospital ≥48 h and able to read English. Methods Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients’ participation in pressure ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. Results Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure ulcers developed (pressure ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33; p = 0.198). No adverse events or harms were reported. Conclusions Although the pressure ulcer prevention care bundle was associated with a large reduction in the hazard of ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure ulcer prevention care bundle was effective but the sample size too small to detect this.
Keywords
Care bundle, Cluster randomised trial, Nursing, Nursing interventions, Patient indicators, Patient outcomes, Pressure ulcer, Pressure ulcer prevention, Outcomes potentially sensitive to nursing
Date
2016
Type
Journal article
Journal
International Journal of Nursing Studies
Book
Volume
64
Issue
Page Range
63-71
Article Number
ACU Department
Nursing Research Institute
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled