(EBP-006) Implementing evidence-based clinical pathways for improved pressure injury population intervention outcomes.
Co-Author(s):
Martin Burns, MBA – Chief Executive Officer, Bruin Biometrics, LLC; Kate Hancock, RN – Executive VP-Global Marketing, Bruin Biometrics, LLC
Introduction: Preventing pressure injuries (PIs) is a significant challenge in daily PI care practices. The development of stage 3 or 4 PIs could be a potential sentinel event. Localized oedema or sub-epidermal moisture (SEM) is a diagnostic biomarker for the development of early-stage, non-visible PIs.1,2,3 The assessment of SEM is recognised in the international clinical practice guidelines for the prevention of PIs.3 Our objective was to develop and implement repeatable evidence-based clinical pathways using SEM assessment technology* for targeted, early interventions and improved population-level PI outcomes.
Methods: Clinical questions were developed using the Patient Intervention Comparison Outcome (PICO) framework. A comprehensive literature search, with ‘SEM’ and ‘PI’s as primary keywords, was performed using international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Results were categorized into two groups (clinical studies and quality initiatives) and were analyzed for each PICO element. Current PI standard of care protocols from multiple care settings were reviewed to develop an SEM assessment-based clinical pathway. This was then implemented in 28 global sites (12 different care settings). Statistical analysis was performed on the real-world PI outcomes dataset generated from these facilities.
Results: Reviewing SEM literature and existing PI protocols resulted in developing a simple, repeatable, and easily implemented clinical pathway for treating persistent focal oedema and achieving PI prevention. Patient-level analysis (1995 patients, 15,574 SEM assessments) revealed that an SEM assessment prompt i.e., a call for early, anatomy-specific intervention, was reported in 83.9% of assessments (13,071/15,574).4 PI incidence reductions were achieved in all 28 facilities with no new interventions and no new staff. A 100% PI incidence reduction was achieved in 19 facilities. Six (6) sites achieved statistically significant reductions in PI incidence (p< 0.05). Meta-analysis revealed a 3-fold decrease in PI incidence post-implementation of SEM assessment-based clinical pathways (RR=0.38, p< 0.01) .5
Discussion: SEM assessment-based clinical pathways provide early and objective prompts for anatomy-specific interventions for patients at high risk of developing PIs. Facilities should consider integrating SEM-based pathways to modernize clinical workflows and translational quality initiatives to improve PI intervention outcomes at the population level.
Trademarked Items: *Provizio® SEM Scanner
References: 1. Okonkwo, H., Bryant, R., Milne, J., Molyneaux, D., Sanders, J., Cunningham, G., Brangman, S., Eardley, W., Chan, G. K., Mayer, B., Waldo, M. & Ju, B. 2020. A blinded clinical study using a subepidermal moisture biocapacitance measurement device for early detection of pressure injuries. Wound Repair Regen. 2. Chaboyer, W., Coyer, F., Harbeck, E., Thalib, L., Latimer, S., Wan, C. S., Tobiano, G., Griffin, B. R., Campbell, J. L., Walker, R., Carlini, J. J., Lockwood, I., Clark, J. & Gillespie, B. M. 2022. Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis. Int J Nurs Stud, 128, 104189. 3. EPUAP/NPIAP/PPPIA 2019. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA. 4. Ousey, Karen et al. “Sub-epidermal moisture assessment as a prompt for clinical action in treatment of pressure ulcers in at-risk hospital patients.” Journal of wound care vol. 31,4 (2022): 294-303. doi:10.12968/jowc.2022.31.4.294 5. Ousey, K., Stephenson, J. & Blackburn, J. 2022. Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence. Journal of Wound Care, 31, 208-216.
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