585 Preventing Occipital Pressure Injuries in Patients Admitted to the Burn ICU

Abstract Introduction Occipital pressure injuries (OPI) are categorized as pressure injuries on the occipital bone caused by pressure, shearing, or friction. Patients with significant burns are at a greater risk of developing these types of injuries due to increased fluid volume from resuscitation, decreased tissue perfusion, immobility, edema and length of stay. The rate of OPI in the BICU was 4.3 in 2016; this led to a comprehensive program to reduce/eliminate these injuries. Methods Early identification of at-risk patients and implementation of prevention strategies was conducted. Best practices were reviewed and the following interventions were put into place: on admission, all patients with facial burns, (intubated or not), were given a small size fluidized positioner pillow. The pillow was to be positioned with a defined divot in the center and not flattened (which is the way they were currently being utilized). The fluidized pillow must go into the hydrotherapy room with the patient and the patient’s head turned and repositioned every 2 hours. The use of a moisture-wicking fabric was utilized over the fluidized positioner pillow to prevent maceration. Nursing staff and burn technicians were educated as to practice changes; wound care nurses were available for educational support. In addition, in 2017, the Burn ICU instituted a 2 RN skin check daily for all patients in the hydrotherapy room once all dressings were removed. This tank room “time out” was instituted for early identification of areas of potential skin breakdown. Results Implementation of these protocols has significantly decreased the occurrence of OPI in the BICU. Since implementation, the rate of OPI in 2017, 2018 and Q1 and Q2 of 2019 has been 0%. The application of the fluidized positioner pillow, tank room “time-out” and staff education has greatly decreased the occurrence of OPI in the BICU. Conclusions Patients sustaining large surface area burns and/or full-thickness burns to the head and neck are susceptible to the development of OPI. The utilization of a fluidized positioner pillow in conjunction with improved assessment and identification using a 2 RN “time out” skin assessment daily, has led to a decrease in OPI in our BICU. Applicability of Research to Practice The utilization of the fluidized positioner pillow in conjunction with the described interventions can lead to a decrease in occipital HAPI and improve patient outcomes.

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Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

British Journal of Nursing ◽

10.12968/bjon.2021.30.sup20.s34 ◽

2021 ◽

Vol 30 (Sup20) ◽

pp. S34-S40

Author(s):

Jenni MacDonald

Keyword(s):

Patient Outcomes ◽

Wound Care ◽

Cost Effective ◽

Theory Of Knowledge ◽

Care Needs ◽

Profound Knowledge ◽

The Cost ◽

Improve Patient ◽

Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

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Multidisciplinary Approach to PAD: Who's on Your Team?

Seminars in Interventional Radiology ◽

10.1055/s-0038-1676094 ◽

2018 ◽

Vol 35 (05) ◽

pp. 378-383

Author(s):

Sabeen Dhand

Keyword(s):

Patient Outcomes ◽

Orthopedic Surgery ◽

Multidisciplinary Approach ◽

Wound Care ◽

Arterial Disease ◽

Team Approach ◽

Peripheral Arterial ◽

Treat All ◽

Improve Patient ◽

Care Nursing

AbstractThe complexity of peripheral arterial disease (PAD) and its multiorgan involvement requires the utilization of a multispecialty team approach. Members of this team include a vascular specialty (interventional radiology, cardiology, and vascular surgery), podiatry, orthopedic surgery, primary care, infectious disease, endocrinology, plastic surgery, wound care nursing, and dietetics. A team approach has been proven to significantly improve patient outcomes as well as decreasing amputation rates. In order to promote collaboration and avoid duplication of care, the team can be broken down into three main pillars: medical management, wound care, and revascularization. A complete team approach is vital for this population, with an overall goal to treat all manifestations of the disease and prevent further progression and risk of major sequelae of the disease.

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Diagnosis and treatment impacts on wound care efficiency drivers: real-world analysis

Journal of Wound Care ◽

10.12968/jowc.2021.30.7.534 ◽

2021 ◽

Vol 30 (7) ◽

pp. 534-542

Author(s):

Christina Lindholm ◽

Tim J Styche ◽

Helen E Horton

Keyword(s):

Patient Outcomes ◽

Real World ◽

Economic Burden ◽

Wound Care ◽

Diagnosis And Treatment ◽

Wound Management ◽

Care Pathways ◽

Care Providers ◽

Dressing Change ◽

Improve Patient

Objective: The prevalence and economic burden of wounds are growing. Any wound has the potential to become hard-to-heal and require frequent care. Clinicians need to find ways to absorb demand on services without compromising outcomes. Drivers of wound care efficiency—time-to-heal, frequency of dressing change and the incidence of complications—can be evaluated to shape future wound management. A survey of wound care was conducted by clinicians from five centres in Sweden over a one-week period, during which clinicians documented every wound once. At the time of surveying, 49% of wounds were considered to be improving, infection incidence was 11.7% and dressings were changed a mean of 2.2 times per week, with highly exuding wounds changed 6.9 times per week. The data highlighted the importance of diagnosing patient and wound characteristics in selecting treatments and organising care. Recognised gaps in diagnoses potentially identify opportunities to influence healing, complication incidence and intensity of nursing, thus reducing demand on resources. In conclusion, this survey highlights opportunities to reduce the burdens these drivers present. Through improved diagnosis and alignment to recognised care pathways, there is potential to improve patient outcomes and alleviate the strains placed upon wound care providers.

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Achieving effective patient outcomes with PolyMem® Silicone Border

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.10.498 ◽

2021 ◽

Vol 26 (10) ◽

pp. 498-509

Author(s):

Linda Rafter ◽

Mark Rafter

Keyword(s):

Patient Outcomes ◽

Chronic Wounds ◽

Wound Care ◽

Evidence Based ◽

Evidence Based Treatment ◽

Healing Environment ◽

Good Patient ◽

Community Staff ◽

The Right ◽

Improve Patient

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.

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Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician–Patient Agreement, and Patient Experience

Journal of Patient Experience ◽

10.1177/23743735211008303 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110083

Author(s):

John T Ratelle ◽

Michelle Herberts ◽

Donna Miller ◽

Ashok Kumbamu ◽

Donna Lawson ◽

...

Keyword(s):

Patient Outcomes ◽

Patient Experience ◽

Hospital Medicine ◽

Main Concern ◽

Discharge Location ◽

Ward Rounds ◽

Research Assistants ◽

Improve Patient ◽

Room Time ◽

Medication Changes

Hospital medicine ward rounds are often conducted away from patients’ bedsides, but it is unknown if more time-at-bedside is associated with improved patient outcomes. Our objective is to measure the association between “time-at-bedside,” patient experience, and patient–clinician care agreement during ward rounds. Research assistants directly observed medicine services to quantify the amount of time spent discussing each patient’s care inside versus outside the patient’s room. “Time-at-bedside” was defined as the proportion of time spent discussing a patient’s care in his or her room. Patient experience and patient–clinician care agreement both were measured immediately after ward rounds. Results demonstrated that the majority of patient and physicians completely agreement on planned tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and discharge location (66.9%), but had no agreement on the patient’s main concern (74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care agreement or patient experience ( P > .05 for all comparisons). This study demonstrates that spending more time at the bedside during ward rounds, alone, is insufficient to improve patient experience.

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T.I.M.E to improve patient outcomes: optimising wound care through a clinical decision support tool

British Journal of Nursing ◽

10.12968/bjon.2019.28.6.s17 ◽

2019 ◽

Vol 28 (6) ◽

pp. S17-S21

Author(s):

Caroline Dowsett ◽

Yvonne Hall

Keyword(s):

Decision Support ◽

Patient Outcomes ◽

Clinical Decision Support ◽

Wound Care ◽

Decision Support Tool ◽

Clinical Decision ◽

Support Tool ◽

Clinical Decision Support Tool ◽

Improve Patient

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State of the Art in Artificial Intelligence and Radiomics in Hepatocellular Carcinoma

Diagnostics ◽

10.3390/diagnostics11071194 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1194

Author(s):

Anna Castaldo ◽

Davide Raffaele De Lucia ◽

Giuseppe Pontillo ◽

Marco Gatti ◽

Sirio Cocozza ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Patient Outcomes ◽

State Of The Art ◽

Effective Management ◽

Lesion Segmentation ◽

Liver Malignancy ◽

Modeling And Prediction ◽

Imaging Characteristics ◽

Risk Patients ◽

Improve Patient

The most common liver malignancy is hepatocellular carcinoma (HCC), which is also associated with high mortality. Often HCC develops in a chronic liver disease setting, and early diagnosis as well as accurate screening of high-risk patients is crucial for appropriate and effective management of these patients. While imaging characteristics of HCC are well-defined in the diagnostic phase, challenging cases still occur, and current prognostic and predictive models are limited in their accuracy. Radiomics and machine learning (ML) offer new tools to address these issues and may lead to scientific breakthroughs with the potential to impact clinical practice and improve patient outcomes. In this review, we will present an overview of these technologies in the setting of HCC imaging across different modalities and a range of applications. These include lesion segmentation, diagnosis, prognostic modeling and prediction of treatment response. Finally, limitations preventing clinical application of radiomics and ML at the present time are discussed, together with necessary future developments to bring the field forward and outside of a purely academic endeavor.

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