Using the research article of Hospital-Acquired Pressure Injuries in Adults with Prone Positioning Using Manual Method Versus Specialty Bed

Using the research article of Hospital-Acquired Pressure Injuries in Adults with Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study, identify three key questions you will ask and answer when reading the research study and why these questions are important. When responding to peers, provide other questions and answers that could be considered in relation to the peers’ studies.

The actual article:

Hospital-Acquired Pressure Injuries in Adults with Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study is the title of the research study chosen for this topic. The authors of this work are Teri M. Kozik, Harbir Bhattacharyya, Mouchumi Pacitto, Jacqueline M. DeMellow, and Jacqueline M. Dhillon.Linked ORCID page for the author: Kozik, Teri M., and it was printed in the May/June 2023, Volume 50(3), p 197-202 of the Journal of Wound, Ostomy & Continence Nursing. This study compared the prevalence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) who were manually or mechanically positioned in a prone position and used a specific bed made to support prone placement. Comparing these groups’ death rates was a secondary goal. Retrospective analysis of electronic medical records is being done.

160 ARDS patients who were handled by prone positioning made up the sample used by the researchers. 58% (n = 96) of them were men, and their mean age was 61.08 years (SD = 12.73). In Stockton, California, a 355-bed community hospital served as the study’s location. Data was gathered between July 2019 and January 2021, and data from electronic medical records were retrospectively checked for the occurrence of COVID-19 infections, the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the development of pressure injuries.

The mortality rate for ARDS, which results in lung inflammation and hypoxia, is 48%. Mechanical breathing, limiting tidal volume to 6 mL/kg of ideal body weight, and plateau pressure less than 30 cm H2O are all treatments for ARDS. Patients with moderate to severe ARDS (Pao2/Fio2 ratio 150 mm Hg) ought to lie on their backs for more than 12 hours per day. Long-term prone positioning improves blood oxygen levels and ventral lung perfusion. In the ICU, about 28% of COVID-19 patients are treated while lying on their backs. In ARDS patients, prone positioning decreased mortality but increased endotracheal tube obstruction and hospital-acquired pressure injuries (HAPIs), according to a recent meta-analysis. Pressure injuries affected about 57% of patients who were lying on their backs. In contrast to other HAPIs, these pressure injuries happen on the face, thorax, and trochanter. It takes time and requires careful planning to safely prone a patient without dislodging lines and tubes or causing HAPIs. The patient can be turned prone by a customized bed frame, or several caregivers can move the patient physically. Both methods may be required due to the shortage of specialist beds and the need for prone positioning for ICU patients affected by the pandemic. On HAPI development, manual versus specialized bed-assisted prone positioning is unknown. Before the pandemic, our facility only used Rotoprone (ArjoHuntleigh Inc., San Antonio, Texas) beds. We had to manually reposition patients during the COVID-9 pandemic. In this study, HAPI rates were examined between patients who were manually placed in a prone position and those who were using a specialty bed. We compared the death rates of the two cohorts. The target population included adults who were admitted to one of our adult ICUs between July 1, 2019, and January 31, 2021, and who had codes for ARDS and COVID-19 on the International Classification of Diseases, Tenth Revision, Clinical Modification. With the exception of manual vs bed-assisted prone posture, our ARDS regimen treated all patients the same way. Study procedures were evaluated by the Dignity Health Institutional Review Board (IRB #CANV DHIRB-2020-568).

For each variable, descriptive statistics were computed. Possible causes linked to a higher risk of getting a HAPI were found using univariate analysis.

Limitation

The majority of the problems of this study are caused by its retrospective design. In particular, data gathering was limited to the EHR’s clinical data. For instance, just the wound care nurse’s notes were used to identify HAPIs. They were unable to gather enough information to examine the impact of additional factors on HAPI development, such as dietary components or vasopressor use.

Conclusion

Retrospective results from a sample of clinically sick ARDS patients who required prone positioning revealed no differences in HAPI incidences according to prone positioning strategy. To verify their findings and compare the costs of manually prone posture versus using a specialist bed, more research is required. To find effective preventive interventions for this susceptible population, more study is also required.

Reference

DeMellow, J., Dhillon, H., Bhattacharyya, M., Pacitto, D. & Kozik, T. (2023). Hospital-Acquired Pressure Injuries in Adults with Prone Positioning Using Manual Method Versus Specialty Bed. J Wound Ostomy Continence Nurs., 50 (3), 197-202. https:// doi.org/ 10.1097/WON.0000000000000976.