Name: RAMON ARAÚJO DOS SANTOS
Publication date: 28/08/2023
Examining board:
Name |
Role |
|---|---|
| CANDIDA CANICALI PRIMO | Coorientador |
| ELIANE DE FATIMA ALMEIDA LIMA | Examinador Interno |
| PAULA DE SOUZA SILVA FREITAS | Presidente |
| PAULO JORGE PEREIRA ALVES | Examinador Externo |
Summary: Introduction: Pressure injuries represent a challenging issue for healthcare institutions and intensive care units, primarily due to being considered a foreseeable adverse event. Despite the increasing evidence production on preventive measures
for pressure injuries in recent years, the implementation and translation of these findings face various limitations for everyday application by healthcare teams. In this
perspective, care bundles or packages represent a set of evidence-based practices
collectively designed to enhance the quality of care. General objective: To implement best practices for improving the quality of care for adult intensive care unit patients
regarding pressure injury prevention. Specific objectives: Conduct a situational diagnosis regarding best practice recommendations for pressure injury prevention; identify barriers and facilitators to improve compliance with recommendations; develop and implement a pressure injury prevention bundle; monitor changes in compliance with recommendations after bundle implementation. Method: Participatory research based on the theoretical framework of implementation science carried out in an Adult Intensive Care Unit of a university hospital in the state of Espírito Santo, Brazil. The research involved a multidisciplinary team composed of nurses, nursing technicians, physiotherapists, nutritionists, and social workers. A multidisciplinary working group was established within the institution to work on pressure injury reduction strategies. The research was conducted in 4 stages using the PDCA cycle. In the 1st stage, a situational diagnosis was performed using management tools. In the 2nd stage, the pilot bundle was developed with content, face evaluation, bundle validation, and implementation through theoretical and practical training. The third stage involved monitoring adherence to bundle recommendations for one month. After one month of implementation, the 4th stage involved evaluating the implementation process, identifying barriers and facilitators using the Consolidated Framework for
Implementation Research (CFIR). Thematic analysis was used for qualitative data, and descriptive analysis for quantitative data. Results: The first pressure injury prevention bundle for the intensive care unit was collectively developed. The acronym ACERT was created to name the bundle, based on five main categories: A: Assessment of skin and pressure injury risk; C: Skin care and moisture management; E: Patient and caregiver involvement; R: Repositioning and support surface; T: Nutritional therapy. Following training, the material was evaluated by the healthcare team as adapted to meet local realities, with quality interventions, low cost, and minimal complexity. Key
facilitators for implementation included training sessions and the availability of prevention materials, while the main barrier was lack of team engagement and commitment. Monitoring showed satisfactory adherence results, except for categories
and recommendations requiring material acquisition and workflow adjustments. Products: Pressure injury prevention bundle, educational graphic material for display
on monitors, bundle indicator data collection form. Conclusion: Implementing a pressure injury prevention bundle has a high impact on care quality. The research products are already integrated into daily work in the unit, yielding positive outcomes
since implementation. The importance of collectively constructing protocols generates
better acceptance and ownership of practices by the team. Thus, monitoring adherence indicators and in-service training support the maintenance of best practices. This research presents a systematic approach, based on the theoretical
framework of implementation science, for implementing best practices, with potential for expansion to other internal hospital sectors and even to different national contexts.
