INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

Wendy Chaboyer; Tracey Bucknall; Joan Webster; Elizabeth McInnes; Merrilyn Banks; Marianne Wallis; Brigid M Gillespie; Jennifer A Whitty; Lukman Thalib; Shelley Roberts; Nicky Cullum

doi:10.1016/j.ijnurstu.2015.04.018

INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

Int J Nurs Stud. 2015 Nov;52(11):1659-68. doi: 10.1016/j.ijnurstu.2015.04.018. Epub 2015 May 11.

Authors

Affiliations

¹ NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia; Centre for Health Practice Innovation, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
² Alfred Health, Australia; School of Nursing and Midwifery, Deakin University, Australia.
³ NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia; Royal Brisbane and Women's Hospital, Australia.
⁴ School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia; Nursing Research Institute, St Vincent's Health Australia (Sydney), Australia.
⁵ Royal Brisbane and Women's Hospital, Australia.
⁶ Centre for Health Practice Innovation, Griffith University, Australia; University of the Sunshine Coast, Australia.
⁷ NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; University of Queensland, Australia.
⁸ Faculty of Medicine, University of Kuwait, Kuwait; Griffith University, Australia.
⁹ NHMRC Centre of Research Excellence in Nursing, Griffith University, Australia; Centre for Health Practice Innovation, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia. Electronic address: s.roberts@griffith.edu.au.
¹⁰ University of Manchester, United Kingdom.

PMID: 26003919
DOI: 10.1016/j.ijnurstu.2015.04.018

Abstract

Background: Pressure injuries are a significant clinical and economic issue, affecting both patients and the health care system. Many pressure injuries in hospitals are facility acquired, and are largely preventable. Despite growing evidence and directives for pressure injury prevention, implementation of preventative strategies is suboptimal, and pressure injuries remain a serious problem in hospitals.

Objectives: This study will test the effectiveness and cost-effectiveness of a patient-centred pressure injury prevention care bundle on the development of hospital acquired pressure injury in at-risk patients.

Design: This is a multi-site, parallel group cluster randomised trial. The hospital is the unit of randomisation.

Methods: Adult medical and surgical patients admitted to the study wards of eight hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility), (b) expected to stay in hospital for ≥48h, (c) admitted to hospital in the past 36h; and (d) able to provide informed consent will be eligible to participate. Consenting patients will receive either the pressure injury prevention care bundle or standard care. The care bundle contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a healthy diet. Nurses will receive education about the intervention. Patients will exit the study upon development of a pressure injury, hospital discharge or 28 days, whichever comes first; transfer to another hospital or transfer to critical care and mechanically ventilated. The primary outcome is incidence of hospital acquired pressure injury. Secondary outcomes are pressure injury stage, patient participation in care and health care costs. A health economic sub-study and a process evaluation will be undertaken alongside the trial. Data will be analysed at the cluster (hospital) and patient level. Estimates of hospital acquired pressure injury incidence in each group, group differences and 95% confidence interval and p values will be reported.

Discussion: To our knowledge, this is the first trial of an intervention to incorporate a number of pressure injury prevention strategies into a care bundle focusing on patient participation and nurse-patient partnership. The results of this study will provide important information on the effectiveness and cost-effectiveness of this intervention in preventing pressure injuries in at-risk patients. If the results confirm the utility of the developed care bundle, it could have a significant impact on clinical practice worldwide.

Trial registration: This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001343796.

Keywords: Care bundle; Patient centred care; Patient participation; Pressure injury prevention; Pressure ulcer prevention.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Humans
Outcome and Process Assessment, Health Care
Patient Care Bundles / methods*
Patient Participation
Patient-Centered Care
Pressure Ulcer / economics
Pressure Ulcer / prevention & control*

Associated data

ANZCTR/ACTRN12613001343796