澳大利亚重症监护病房的压力伤害预防实践：一项全国横断面调查

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Abstract

Introduction

Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs.

Materials and methods

An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location.

Results

Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026).

Discussion and conclusion

This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs.

摘要翻译（仅供参考）

介绍

压力损伤 (PI) 是重症监护病房(ICU)患者的一个持续问题。本研究的目的是探索澳大利亚成人 ICU 中 PI 预防实践的性质和范围。

材料和方法

一项澳大利亚多中心、横断面研究是通过电话采访使用结构化调查工具进行的，该工具包括六类：工作场所人口统计、患者评估、PI 预防策略、医疗器械、皮肤卫生和其他健康服务策略。接受了重症监护医学学院认可的公共资助的成人重症监护病房接受了调查。数据使用描述性统计和卡方检验进行独立性分析，以根据地理位置探索关联。

结果

在 75 家符合条件的 ICU 中，70 家做出了回应（93% 的回应率）。三分之二 (68%) 的 ICU 都认为 PI 存在问题。常见的 PI 预防策略包括在入院后至少 6 小时内进行的风险评估和视觉皮肤评估（分别为 70% 和 73%）、结构化的重新定位方案（90%）、使用屏障产品保护皮肤（94%） 、骶骨或足跟预防多层硅胶泡沫敷料(88%)、定期 PI 图表审核 (96%) 和 PI质量改进项目 (90%)。37% 的 ICU 使用了 PI 预防安全讨论，31% 进行了 PI 研究。尽管大多数 ICU 都得到了全机构皮肤完整性服务的支持，但在城市 ICU 中比在农村和地区 ICU 中更为常见。p  < 0.001)。相反，在农村或地区 ICU 中，职业治疗师在 PI 预防中的参与程度高于在大城市 ICU 中的参与程度（p  = 0.026）。

讨论与结论

这是第一项对澳大利亚 ICU 中 PI 预防实践进行全面描述的研究。调查结果表明，PI 预防实践虽然在某些地区因地理位置而异，但在 ICU 中以多种不同的方式使用。

原文链接：

https://doi.org/10.1016/j.aucc.2021.11.004

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