RESUMEN
BACKGROUND: Pressure ulcers are a complex healthcare issue. Hospital-acquired pressure ulcers are used as proxy measurements for the quality and safety of nursing care. Medical device-related pressure ulcers are mostly facility acquired, but their reporting has only recently been widely adopted. Consequently, we do not yet know what factors impact their reporting by registered nurses. OBJECTIVES: To identify and systematically report determinants of the practice of medical device-related pressure ulcers reporting using the Tailored Implementation for Chronic Diseases checklist. DESIGN: Descriptive, explorative design using semi-structured interviews to explore barriers and facilitators to reporting medical device-related pressure ulcers. SETTING: We undertook online, telephone, and face-to-face interviews with participants from 11 different countries. PARTICIPANTS: We interviewed 17 participants who represented acute care (Adult, Paediatrics), academia, and industry. Eleven participants were healthcare professionals with more than 10â¯years' experience in wound care. METHODS: The interview recordings were transcribed and coded by the lead researcher. Data were analysed thematically using the codebook approach, and themes were developed inductively and deductively. RESULTS: Participants identified determinants of practice which clustered around four domains of the Tailored Implementation for Chronic Diseases checklist i) individual health professional factors, ii) professional interactions, iii) incentives and resources, and iv) capacity for organisational change. Knowledge, attitudes, workload, time, staffing, and perception of consequences, including financial, were identified as the main barriers to reporting. Factors supporting the practice were education, openness, and teamwork. Device procurement could take on characteristics of a barrier or facilitator depending on the organisation. CONCLUSIONS: Reporting medical device-related pressure ulcers has been adopted in healthcare institutions worldwide. Understanding what drives the reporting practice enables improvements in incident reporting, which consequently can lead to improvements in the quality of nursing care and patient safety.
Asunto(s)
Úlcera por Presión , Adulto , Niño , Personal de Salud , Humanos , Seguridad del Paciente , Úlcera por Presión/etiología , Investigación Cualitativa , Gestión de RiesgosRESUMEN
Pressure ulcers (PUs) occur in a range of care settings, resulting in reduced quality of life for the individual. There has been a growing awareness that medical devices can cause PUs, although reporting has been limited. There is a need to evaluate PU reporting practice and identify whether standards exist for medical device-related pressure ulcers (MDRPUs). AIM: To synthesize academic and grey literature relevant to reporting of PUs and MDRPUs in healthcare settings. METHODS: A systematic search of multiple scientific and grey literature databases was undertaken. Key search terms and Boolean operators were used to identify relevant literature. All sources of evidence discussing reporting practices were included in a synthesis. Primary topics are discussed in the corresponding analysis. RESULTS: Thirty-one evidence sources met the inclusion criteria, including 16 journal articles and 15 policy and guidance documents. The results revealed a variation in reporting practices. MDRPUs were often not identified as a separate category in local and national systems. Policies for related patient safety reporting varied across all organisational levels, with more serious categories of PUs reported more consistently. Reporting to medical device regulatory bodies was not mandatory. CONCLUSION: This narrative review identified inconsistencies in local and national reporting of PUs and MDRPUs, prohibiting meaningful comparisons and improvements in patient safety. Lack of specific medical device data and low levels of voluntary reporting to regulatory bodies is likely to result in an under-reporting, with little evidence of specific devices which may be a patient safety concern.