Under pressure case study

They are used in the selection of leader and in the determination of issue.

Under pressure case study

An updated Cochrane review gives us the current state of the evidence.

Under pressure case study

Any new reddening of the skin was like a mark of shame for the nurse looking after the bearer of it. Back then, it was the Norton Scale, whilst now, for hospital patients in the UK at least, the Waterlow Scale prevails, though around forty different tools are currently in use.

The tools list factors believed to contribute to the development of pressure ulcers and award them a numerical value. Assessors choose an option from each parameter relating to mobility, continence and so on and calculate a final score.

Structured pressure ulcer risk assessment tools are recommended in many international guidelines and completing the Waterlow score is a requirement Under pressure case study nurses in NHS hospitals on admitting a patient. But do they actually reduce the number of patients who develop pressure ulcers, compared with no structured risk assessment or clinical judgement alone?

Under pressure case study

A small RCT conducted in in a military hospital compared use of the Braden Scale and training, unstructured pressure ulcer risk assessment and training, and unstructured risk assessment only.

The trial had methodological problems and is at high risk of bias. There was no difference in pressure ulcer incidence between groups A large RCT in an Australian teaching hospital internal medicine or cancer wards compared the Waterlow and Ramstadius assessment tools and clinical judgement alone.

This was a high quality trial at low risk of bias.

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There was no difference in pressure ulcer incidence between groups No reliable evidence to suggest that the use of structured, systematic pressure ulcer risk assessment tools reduces the incidence of pressure ulcers A workman may only be as good as his tools, but nurses are better than theirs!

Eileen Shepherd eileenshepherdClinical Editor of the Nursing Times, tweeted the point that a tool is there to support clinical judgement and is only as good as the person using it, and certainly the importance of clinical judgement should not be underestimated.

On the other hand, as Tissue Viability Nurse Joy Bell points out in her article for Wounds UKsuch tools may be really helpful for new practitioners who lack extensive clinical judgement skills, as long as they as all staff are trained to use them properly. I asked nurses on Twitter what are the most important things they do to prevent their patients developing pressure ulcers and they told me education themselves, patients, carersprioritising continence and nutrition and, of course, repositioning the jury is out, I think, on intentional rounding.

No-one mentioned risk assessment actually! Drawing by Virginia Powell, ca. Joy Bell concludes that structured risk assessment tools do have the potential to enhance patient care whilst acknowledging the lack of robust research.

This review highlights that resources are currently being allocated to a practice for which there is no high quality evidence of benefit, in terms of preventing pressure ulcers.

But more, excellent, research is needed to determine whether or not it is of value and for which patients or clinical settings. You can follow us on Twitter ukcochranecentr.

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I discovered an impressive community of nurses on Twitter, who certainly had plenty to say! You can catch up with it here. And then something else happened….

On 11th November we had another lively tweet chat on this topic, which WeNurses invited me to guest host. Since the last chat, and the original publication of this blog, a new NICE Guideline on pressure ulcers has been issued.

What did nurses think about this?

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Find out here Links: Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic ReviewsIssue 2.

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Nurses under pressure: do risk assessment tools help prevent pressure ulcers? - Evidently Cochrane