Review of Literature- Application of an Interdisciplinary Approach and SSKIN Bundle as Interventions to Address Pressure Injuries

Review of Literature- Application of an Interdisciplinary Approach and SSKIN Bundle as Interventions to Address Pressure Injuries

Pressure injuries (PIs), especially among patients in long-term bed care and prolonged bed stays with limited mobility, remain an issue of concern in nursing homes. The recurrence of PIs and the association of PIs to deteriorating health conditions significantly contribute to longer lengths of stay and higher costs of care in patients in long-term care settings. A study by  Padula and Delarmente (2019) estimated that the national cost of hospital-acquired pressure injuries (HAPIs) was at a high of $26.8 billion in the United States alone. These costs and risks of recurrence of PIs raise arguments on the feasibility of treating and preventing PIs. Singh et al. (2022), in a review of the literature on the costs of healing and preventing PIs drawn from multiple countries and settings, noted that caring for 206 patients with HAPIs had an accumulated cost of $2,204,200 throughout the treatment period. In the United States, the cost of treating a single patient with stage PI per patient in a year was estimated to be $31,485 between 2019 and 2020, while the cost of preventing a PI per patient per day was $21 while in Netherlands compared costs for preventing PIs were €0.50 per patient per day, while the cost of treating a stage 3 PI was €77.36 per patient per day within a similar period and care settings (Singh et al., 2022). This evidence suggests that focusing on PI prevention rather than treating PIs is a more cost-effective strategy for addressing PIs by reducing the overall burden of PIs on patients.

Various strategies for addressing PIs exist. However, the effectiveness and costs of implementation vary. This paper explores the effectiveness of the application of an interdisciplinary approach and SSKIN bundle as interventions to address pressure injuries. It also identifies factors that favor the application of each intervention in addressing PIs. The proposed PICO(T) question to guide the literature search is, “In patients at a high risk of pressure injuries (P), does an interdisciplinary approach and SSKIN bundle (I), compared to usual care and treatment (C), effectively reduce the incidence of pressure injuries (O) over a period of 6 months periods (T)?”

Synthesis of Literature

An electronic literature search utilizing “interdisciplinary approach in PI prevention,” “SSKIN bundle in PI prevention,” and “PI prevention and treatment costs” as main search phrases returned multiple related search results. A total of ten scholarly peer-reviewed articles that directly related to the interdisciplinary approach and SSKIN bundle in PI prevention and the feasible PI prevention interventions were selected and reviewed. Themes related to the interdisciplinary approach included interdisciplinary communication, provider demographics, and integrated wound care teams (IWCT). Themes related to the SSKIN bundle include skin assessment, sub-epidermal moisture (SEM) measurement, nutrition, patient repositioning, and the support surface.

Interdisciplinary Approach

Interdisciplinary collaboration is essential to pressure injury (PI) care and prevention. Care for high-risk patient populations is usually segmented based on population and varied population needs. In all cases, multiple healthcare teams from various disciplines and professions must work together in most long-term care settings for patients. As the risk of developing PIs is high in such settings, various aspects of interdisciplinary teams, such as communication, evidence-based decision-making, and integrating various care perspectives, are essential for effective care for high-risk patients.

Interdisciplinary Communication

Effective communication is a vital element in all care settings. The possession of good communication skills is the driving force of all interdisciplinary approaches in patient care and for positive patient- and provider-related experiences and outcomes. Evidence has linked interdisciplinary roles to the development of communication skills as well as interdisciplinary communication, leading to significant and desirable outcomes in the care management and prevention of PIs in long-term care settings. A quality improvement project conducted by Al-Mansour et al. (2020) involving creating an interdisciplinary healthcare team for managing patients with stage 3, stage 4, and unstageable pressure injuries (PIs) led to improving communication between the interdisciplinary team members. Additionally, the improved communication improved the care of patients with PIs due to a better understanding of PI care management and adherence to care plans (Al-Mansour et al., 2020). The overall outcome of the improved interdisciplinary communication was a notable reduction in the rate of new HAPI cases. A study by Heerschap et al. (2019) focused on the decision-making processes within interprofessional teams and identified effective communication between team members as a factor that improved the decision-making processes.

Provider Demographics

Provider demographics significantly impact care, including care delivery, disease prevention, and care outcomes. The care provider demographics greatly influence how the provider communicates within interdisciplinary teams, engages with patients, and practices care. This also applies to the management of PI care. Evidence shows that demographic factors, especially the level of knowledge and age of a provider, significantly influence how they understand and adhere to PI prevention guidelines (Haavisto et al., 2022). Haavisto et al. (2022) further add that knowledge levels influence how providers employ evidence in PI prevention as well as the frequency of the employed PI prevention practices.

Integrated Wound Care Teams (IWCT)

As earlier identified, interprofessional teams within healthcare settings significantly contribute to providing high-quality patient care in the context of PI care management. Arguably, the effectiveness of the interprofessional approach in PI care is related to the use of multiple professional perspectives in the care decision-making processes (Heerschap et al., 2019). The application of integrated systems in PI injury care as an aspect of interdisciplinary approaches in PI prevention is linked to improved outcomes. A five-year retrospective observational study reviewing evidence of the preventive effectiveness of novel integrated wound care team (IWCT) as a team approach in PI management showed that IWCT significantly reduced stage 3 and 4 PIs by an estimated 4%, increased healing rate by 10%, and reduced the period of treatment by 6 days (Kim et al., 2023). However, the IWCT increased the risk of stage 1 PIs by 19.4%

SSKIN Bundle

The SSKIN bundle provides guided approaches to patient assessment and the planning of care for patients with a high risk of developing PIs. Some major aspects of the SSKIN bundle include skin assessment, sub-epidermal moisture (SEM) measurement, nutrition, patient repositioning, and the support surface.

Skin Assessment

Skin assessment is the continuous inspection of the patient’s skin surface for any changes in color or appearance of markings or any skin damage that can indicate a pressure injury. Skin assessment is the major strategy for the prevention of PI in long-term care facilities (Haavisto et al., 2022). Consistency of skin assessment as a preventive strategy for PI allows for continued skin maintenance as well as early detection of PI. Early detection helps with the deployment of appropriate skin and wound care measures, which can prevent further deterioration and risk of complications.

Sub Epidermal Moisture (SEM) Measurement

Although SEM measurement is majorly focused on monitoring the sub-epidermal moisture, it also relates to the skin’s cleanliness and moisture both on the surface and within the sub-epidermal layer. SEM is a biophysical marker that occurs on the skin as a result of plasma leakage following an inflammation, which indicates increased permeability of the local vasculature (Byrne et al., 2023). Although usual topical skin moisture monitoring and skin assessment can help determine changes in skin moisture, such observations are inconclusive or indicative of a developing PI as the skin is affected by the immediate environment. However, SEM scores can be used to monitor damaged tissue as conditions within the environment never influence SEM. A study by Byrne et al. (2023) comparing SEM measurement scores using targeted SSKIN bundle interventions such as an SEM Scanner for skin assessment with scores from usual care on high-risk patients showed that SEM measurements reduced the risk of developing PIs by 100%, while the control group under usual care had a 1.41% risk of developing PIs. Continued SEM measurement can also help with diet planning to ensure the patient has the right nutrition and fluids to ensure skin health.

Patient Repositioning and Support Surface

The surface of support for the patient as well as the time spent in one position, determines the risk of developing PIs. Evidence shows that frequent patient repositioning or moving and having the right support surface for the patient can effectively prevent PIs or reduce the risk of developing PIs. For instance, a 140-day study by Stone (2020) found that a low-profile alternating pressure (AP) support surface had a 100% effectiveness rate in preventing PI in participants within the period of study. Additionally, Stone notes that the mean time on the alternating pressure overlay can significantly reduce the stay within the facility, which can impact related costs of care. Similarly, Haavisto et al. (2022) identify patient repositioning as a common strategy acceptable in PI prevention practices that significantly impacts reducing the risk of occurrence of PIs. However, Regardless of the SSKIN bundle employed in the prevention of PIs, Haavisto et al. (2022) further argue that the preventive effectiveness of each method applied is linked to the consistency of the care delivered and adherence to the provided evidence-based care guidelines.

Summary of Literature

Prevention of PIs is more likely to be achieved by interdisciplinary approaches, and PI care bundles are more practicable than PI treatment (Lavallée et al., 2019). An interdisciplinary approach in PI care and prevention is associated with better team communication and improved preventive capacity (Al-Mansour et al., 2020), better wound care management decisions, successful prevention of PI recurrence, and improved patient and provider satisfaction (Heerschap et al., 2019). Additionally, the application of the SSKIN bundle leads to better risk assessment and consistency of care (Haavisto et al., 2022), improved adherence to care guidelines, and reduction of overall length of stay (Byrne et al., 2023), and reduced costs of care, and patient experiences (Lavallée et al., 2019). SSKIN bundle components such as support and positioning techniques, including low-profile alternating pressure overlay, effectively prevent the development of pressure injuries in long-stay settings as well as reduce the length of stay within such facilities (Stone, 2020).

However, the development and progression of PI and the presentation of PI wounds may vary from patient to patient based on race and ethnicity (Bates-Jensen et al., 2021). Therefore, personalized approaches to pressure injury detection, PI management, and PI prevention are required to help reduce the recurrence and incidence rates, as well as the complications and costs related to the management of PIs in long-term care settings. In conclusion, using an interdisciplinary approach and the SSKIN bundle promises to address and prevent both PIs and related expenses more successfully than treating PIs. Therefore, more research and investment should be focused on improving the applicability of the interdisciplinary approach and SSKIN bundle methods as preventative measures to prevent PIs in nursing homes and other long-term care settings.

 References

Al-Mansour, L.A., Dudley-Brown, S., & Al-Shaikhi, A. (2020). Development of an Interdisciplinary Healthcare Team for Pressure Injury Management: A Quality Improvement Project. Journal of Wound, Ostomy, and Continence Nursing, 47(4), 349–352. https://doi.org/10.1097/WON.0000000000000652

Bates-Jensen, B. M., Anber, K., Chen, M. M., Collins, S., Esparza, A. N., Gieschen, K., Haglund, E., Lim, J. Y., Lin, C., Taw, E.-J., Rodriguez, S., Truong, M., Tubillo, P., Xiao, A., & McCreath, H. E. (2021). Natural History of Pressure Injury Among Ethnically/Racially Diverse Nursing Home Residents: The Pressure Ulcer Detection Study. Journal of Gerontological Nursing, 47(3), 37–46. https://doi.org/10.3928/00989134-20210210-03

Byrne, S., Patton, D., Avsar, P., Strapp, H., Budri, A., O’Connor, T., Nugent, L., & Moore, Z. (2023). Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development. International Wound Journal, 20(6), 1987–1999. https://doi.org/10.1111/iwj.14061

Haavisto, E., Kielo-Viljamaa, E., Hjerppe, A., Puukka, P., & Stolt, M. (2022). Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities. Advances in Skin & Wound Care, 35(3), 1–10. https://doi.org/10.1097/01.ASW.0000818576.93870.40Links to an external site.’

Heerschap, C., Nicholas, A., & Whitehead, M. (2019). Wound management: Investigating the interprofessional decision‐making process. International Wound Journal, 16(1), 233–242. https://doi.org/10.1111/iwj.13017

Kim, M. J., Jeong, Y. S., Kim, H. J., Hahn, H. M., Thai, D. Q., & Lee, I. J. (2023). Effect of a Team Approach to Pressure Injury Management over 5 Years in a Tertiary Hospital. Advances in Skin & Wound Care, 36(1), 1–7. https://doi.org/10.1097/01.ASW.0000902488.10296.9b

Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & Social Care in the Community, 27(4), e417–e427. https://doi.org/10.1111/hsc.12742

Padula, W., & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634–640. https://doi.org/10.1111/iwj.13071

Singh, C., Shoqirat, N., & Thorpe, L. (2022). The Cost of Pressure Injury Prevention. Nurse Leader, 20(4), 371–374. https://doi.org/10.1016/j.mnl.2021.11.003

Stone, A. (2020). Preventing Pressure Injuries in Nursing Home Residents Using a Low-Profile Alternating Pressure Overlay: A Point-of-Care Trial. Advances in Skin & Wound Care, 33(10), 533–539. https://doi.org/10.1097/

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This paper must have a research summary table and a synthesis of the literature that is referenced. All references were provided, and the research summary table started.

Review of Literature- Application of an Interdisciplinary Approach and SSKIN Bundle as Interventions to Address Pressure Injuries

The paper must have an introduction that explains its purpose. The PICOT for this paper is centered around using an interdisciplinary approach to address pressure injuries and using the SSKIN bundle to address pressure injuries. A conclusion is needed also. The paper has to be 3-5 pages in length.