Effect analysis of improved guideline-based bundled care plan on prevention and treatment of secondary pressure injuries in elderly patients with pneumonia
Objective To observe and analyze the effect of improved guideline-based bundled care plan on prevention and treatment of secondary pressure injuries(PI)in elderly patients with pneumonia,and to provide basis for effective prevention and care of pressure injury in such patients.Methods In view of the characteristics and nursing difficulties of the elderly pneumonia patients with hypoxemia,hyperglycemia,malnutrition and gastrointestinal dysfunction leading to high incidence of incontinence,the SKIN bun-dled care plan based on guidelines,including the use of support surface(S),keep moving(K),incontinence care(I)and nutrition care(N)was modified as the ASSKIN bundled care plan based on update guidelines,including assessing risk(A),skin inspection(S),the use of support surface(S),keep moving(K),incontinence care(I)and nutrition care(N).The overall prevention of ASSKIN was carried out for 35 elderly patients with pneumonia,and the AS-SKIN+staging treatment scheme was carried out for patients with PI.For patients with stage 1-2 PI,the nurse team carried out ASSKIN+lo-cal cleaning,then covered the foam dressing,and replaced it 2-3 times a week.For patients with stage 3-4 PI,the nurse team carried out the ASSKIN scheme,and at the same time,jointly treated PI with the doctors three times a week.The Braden scale was used to eval-uate the daily risk score results,the incidence of hospital-acquired pressure injuries(HAPI),and length of hospital stay as prevention effectiveness indicators.The healing rate and days of pressure injuries were used to evaluate treatment effectiveness indicators.Re-sults The Braden scoring monitoring results showed that patients with pressure injuries scored lower than those without pressure inju-ries(10.5±2.0 points vs.16.6±3.3 points),indicating that the former had a greater risk of developing pressure injuries than the latter.The prevention results showed that 2 cases(5.7％)had HAPI,33 cases did not have new pressure injuries,11 cases brought in by fami-ly and 2 cases acquired in hospital had an average length of stay of 36.0(18.0,47.5)days,and 22 cases without pressure injuries had an average length of stay of 18.0(14.0,21.0)days.The difference was statistically significant(Z=2.650,P=0.008).Treatment results showed that 6 patients with stage 1 to 3 pressure injuries were cured non-surgically,3 patients with stage 4 stress injuries were cured surgically,2 patients with stage 4 pressure injuries were treated in the outpatient department until healing after discharge,and 2 pa-tients with stage 4 pressure injuries did not heal due to multiple organ failure,with a total healing rate of 84.6％(11/13).The healing time was 30.0(8.0,47.5)d.Conclusion The improved guideline-based bundled care plan effectively prevents secondary PI in el-derly pneumonia patients,promotes the healing of PI and shorten the length of hospital stay.
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