Monica Waidley, Nikki Taylor, Leah L Shever-Doletzky
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引用次数: 0
Abstract
Purpose: The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.
Participants and setting: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.
Approach: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.
Outcomes: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.
Implications for practice: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.
目的:本质量改进项目的目的是利用增强型皮肤评估(黑皮肤皮肤评估,SADS)和卤素灯照明来识别肤色较深患者的第一阶段压力损伤(PI):该质量改进项目在密歇根州东南部一所大型大学教学医院的 3 个病房开展。该项目的最初设计是为了让床旁护士识别出参与项目的患者有足够的黑色素,以便在常规照明下掩盖手部/前臂的肤色褪色,但这一目标并未实现。数据分析基于自我认同为非裔美国人或黑人、夏威夷原住民或太平洋岛民、亚裔、美国印第安人和阿拉斯加原住民的患者。参与该项目的床边护士还被要求填写一份调查问卷,描述他们对该项目的了解和经验,以及对肤色较深患者早期 PI 的评估:方法:爱荷华循证实践模式被用来指导这项质量改进计划。在一次触发事件后,我们查阅了相关文献,并开发了一种用于评估肤色较深患者的增强型技术,其中包括使用卤素灯(SADS)和记录评估结果。我们选择了本机构的一些科室,教护士们应用 SADS 方法。我们利用电子病历中的数据和对参与护士的调查,对项目实施前后的结果进行了比较。比较基于描述性数据分析:结果:实施增强型体格评估后,参与单位在实施期间的设施获得性 PI 总数下降了 6%:实践启示:增强型体格评估与卤素灯照明相结合,可提高对深色皮肤者第一阶段 PI 的识别率。该评估方法易教、易学,可在床边进行,作为例行皮肤检查的轮班评估的一部分。
期刊介绍:
The Journal of Wound, Ostomy and Continence Nursing (JWOCN), the official journal of the Wound, Ostomy and Continence Nurses Society™ (WOCN®), is the premier publication for wound, ostomy and continence practice and research. The Journal’s mission is to publish current best evidence and original research to guide the delivery of expert health care.
The WOCN Society is a professional nursing society which supports its members by promoting educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies and continence care needs.