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

Chaboyer, Wendy, Bucknall, Tracey, Webster, Joan, McInnes, Elizabeth, Gillespie, Brigid M., Banks, Merrilyn, Whitty, Jennifer A., Thalib, Lukman, Roberts, Shelley, Tallott, Mandy, Cullum, Nicky and Wallis, Marianne 2016, The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): a cluster randomised trial, International journal of nursing studies, vol. 64, pp. 63-71, doi: 10.1016/j.ijnurstu.2016.09.015.

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Title The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): a cluster randomised trial
Author(s) Chaboyer, Wendy
Bucknall, TraceyORCID iD for Bucknall, Tracey orcid.org/0000-0001-9089-3583
Webster, Joan
McInnes, Elizabeth
Gillespie, Brigid M.
Banks, Merrilyn
Whitty, Jennifer A.
Thalib, Lukman
Roberts, Shelley
Tallott, Mandy
Cullum, Nicky
Wallis, Marianne
Journal name International journal of nursing studies
Volume number 64
Start page 63
End page 71
Total pages 9
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-12
ISSN 0020-7489
1873-491X
Keyword(s) care bundle
cluster randomised trial
nursing
nursing interventions
patient indicators
patient outcomes
pressure ulcer
pressure ulcer prevention
outcomes potentially sensitive to nursing
Summary 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 ≥48h 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.
Language eng
DOI 10.1016/j.ijnurstu.2016.09.015
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
1110 Nursing
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution Non-Commercial No-Derivatives licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089023

Document type: Journal Article
Collections: School of Nursing and Midwifery
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.