Logo image
Back
The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): a cluster randomised trial
Journal article   Open access   Peer reviewed

The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): a cluster randomised trial

Wendy Chaboyer, Tracey Bucknall, Joan Webster, Elizabeth McInnes, Brigid M Gillespie, Merrilyn Banks, Jennifer A Whitty, Lukman Thalib, Shelley Roberts, Mandy Tallott, …
International Journal of Nursing Studies, Vol.64, pp.63-71
2016
DOI: https://doi.org/10.1016/j.ijnurstu.2016.09.015
pdf
PDF - Published Version (Open Access)836.40 kBDownloadView
Published VersionPDF - Published Version (Open Access)CC BY-NC-ND V4.0,  Open Access
url
https://doi.org/10.1016/j.ijnurstu.2016.09.015View
Published Version

Abstract

care bundle cluster randomised trial nursing nursing interventions patient indicators patient outcomes pressure ulcer pressure ulcer prevention outcomes potentially sensitive to nursing
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.

Details

Metrics

65 File views/ downloads
946 Record Views
106 Times Cited - Web of Science

InCites Highlights

These are selected metrics from InCites Benchmarking & Analytics tool, related to this output

Collaboration types
Domestic collaboration
International collaboration
Web Of Science research areas
Nursing

UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

Source: InCites

Logo image