Shelley Roberts

Using technology to engage hospitalised patients in their care: a realist review

BackgroundPatient participation in health care is associated with improved outcomes for patients and hospitals. New technologies are creating vast potential for patients to participate in care at the bedside. Several studies have explored patient use, satisfaction and perceptions of health information technology (HIT) interventions in hospital. Understanding what works for whom, under what conditions, is important when considering interventions successfully engaging patients in care. This realist review aimed to determine key features of interventions using bedside technology to engage hospital patients in their care and analyse these in terms of context, mechanisms and outcomes.MethodsA realist review was chosen to explain how and why complex HIT interventions work or fail within certain contexts. The review was guided by Pawson’s realist review methodology, involving: clarifying review scope; searching for evidence; data extraction and evidence appraisal; synthesising evidence and drawing conclusions. Author experience and an initial literature scope provided insight and review questions and theories (propositions) around why interventions worked were developed and iteratively refined. A purposive search was conducted to find evidence to support, refute or identify further propositions, which formed an explanatory model. Each study was ‘mined’ for evidence to further develop the propositions and model.ResultsInteractive learning was the overarching theme of studies using technology to engage patients in their care. Several propositions underpinned this, which were labelled: information sharing; self-assessment and feedback; tailored education; user-centred design; and support in use of HIT. As studies were mostly feasibility or usability studies, they reported patient-centred outcomes including patient acceptability, satisfaction and actual use of HIT interventions. For each proposition, outcomes were proposed to come about by mechanisms including improved communication, shared decision-making, empowerment and self-efficacy; which acted as facilitators to patient participation in care. Overall, there was a stronger representation of health than IT disciplines in studies reviewed, with a lack of IT input in terms of theoretical underpinning, methodological design and reporting of outcomes.ConclusionHIT interventions have great potential for engaging hospitalised patients in their care. However, stronger interdisciplinary collaboration between health and IT researchers is needed for effective design and evaluation of HIT interventions.

Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

Purpose To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs). Materials and methods An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI. Results and discussion In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention. Conclusion Patient-centered interventions aimed at increasing patient participation in SSI prevention and evaluating the contributions of allied health professionals in team-based SSI prevention requires future research.

Nutritional intakes of patients at risk of pressure ulcers in the clinical setting

OBJECTIVE Malnutrition is a risk factor for pressure ulcers. The aim of this study was to describe the energy and protein intakes of hospitalized patients at risk for pressure ulcers and to identify predictors of eating inadequately. METHODS An observational study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients with restricted mobility were observed for 24 h, and information such as oral intake and observed nutritional practices was collected. A chart audit gathered other demographic characteristics, clinical, anthropometric, and dietary information. t Tests or one-way analysis of variances were used to identify differences in total energy and protein intakes. Univariate and multivariate regression analyses were conducted to determine predictors of eating inadequately (i.e., intake of <75% of estimated energy and protein requirements). RESULTS Mean energy and protein intakes of the 184 patients were 5917 ± 2956 kJ and 54 ± 28 g, respectively. Estimated energy and protein requirements were calculated for 93 patients. Only 45% (n = 42) and 53% (n = 49) met ≥ 75% of estimated energy and protein requirements, respectively. In multivariate analysis, patients on the renal ward were 4.1 and 4.6 times more likely to be eating inadequately for energy and protein, respectively (P < 0.05). Patients who consumed any amount of oral nutrition support were 5.1 and 15.5 times more likely be eating adequately for energy and protein, respectively (P < 0.05). CONCLUSIONS Renal patients are more likely to be eating inadequately, although any consumption of oral nutrition support seems to increase likelihood of eating adequately.

Feasibility of a patient‐centred nutrition intervention to improve oral intakes of patients at risk of pressure ulcer: a pilot randomised control trial

AIM Nutrition is important for pressure ulcer prevention. This randomised control pilot study assessed the feasibility of conducting a larger trial to test the effectiveness of a patient-centred intervention for improving the dietary intakes of patients at risk of pressure ulcer in hospital. METHODS A 3-day intervention targeting patients at risk of pressure ulcer was developed, based on three main foundations: patient education, patient participation and guided goal setting. The intervention was piloted in three wards in a metropolitan hospital in Queensland, Australia. Participants were randomised into control or intervention groups and had their oral intakes monitored. A subset of intervention patients was interviewed on their perceptions of the intervention. Feasibility was tested against three criteria: ≥75% recruitment; ≥80% retention; and ≥80% intervention fidelity. Secondary outcomes related to effects on energy and protein intakes. RESULTS Eighty patients participated in the study and 66 were included in final analysis. The recruitment rate was 82%, retention rate was 88%, and 100% of intervention patients received the intervention. Patients viewed the intervention as motivating and met significantly more of their estimated energy and protein requirements over time. CONCLUSION This pilot study indicates that the intervention is feasible and acceptable by patients at risk of pressure ulcer. A larger trial is needed to confirm the effectiveness of the intervention in the clinical setting.

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial

BACKGROUND Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. OBJECTIVES To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. DESIGN Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. SETTINGS Eight tertiary hospitals in Australia. PARTICIPANTS Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). METHODS Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU

Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study

(2015). RESULTS The care bundle cost AU

Does participating in a clinical trial affect subsequent nursing management? Post-trial care for participants recruited to the INTACT pressure ulcer prevention trial: A follow-up study.

144.91 (95%CI:

Accuracy and adequacy of food supplied in therapeutic diets to hospitalised patients: An observational study

74.96 to

Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients

246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional

Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review

3296 (95%CI: dominant to