Study On The Formulation And The Application Of The Preventive Stratagies For Pressure Injury In Patients With Severe Stroke

Objectives1.This paper described the prevalence of hospital acquired pressure injury in hospitalized patients with severe stroke,and investigated the risk factors for the occurrence of pressure injury in patients with severe stroke.2.The multi-criteria decision analysis method was used to optimize the bundle of intervention strategy which was suitable for clinical application,and evaluating its application effect.Methods 1.Case-control study:A total of 292 patients with hospital acquired pressure injury hospitalized in the Department of Neurology,Department of Neurosurgery and ICU of Second Affiliated Hospital of Fujian Medical University from January 2014 to February 2017 were selected as the case group.A total of 292 patients with severe stroke in the same period without hospital acquired pressure injury were selected as control group by random sampling.By consulting the department's report of pressure injury,and consulting the electronic medical records to collect the basic data of the patients and the data of the patients in hospital,Then researchers fill out the clinical data collection form for patients with severe stroke.Single factor and multiple factor Logistic regression analysis was used for analyzing the adverse factors that affected pressure injury for patients with severe stroke.2.Application of multi-criteria decision analysis to optimize cluster intervention strategy.Summarize the measures for the prevention of pressure injury recommended in the guidelines and the measures that can effectively reduce the incidence of pressure injury in previous study,and then the first draft of the bundle of interventions was conducted.The expert consultation questionnaire was designed by the researcher based on the multi-decision analysis method.The corresponding implementation rules and checklist table for bundle of intervention strategy were formulated.3.Perspective study: This study was conducted to select patients with severe stroke who were hospitalized in the Department of Neurology,Second Affiliated Hospital of Fujian Medical University from August 2017 to February 2018.By envelope method,the patients in area A of neurology were classified as the experimental group,and the patients in area B of the department of neurology were the control group.When the patients were admitted to the hospital,the researchers checked the patients to assess whether they met the inclusion criteria.If so,an informed consent form was signed with the patients or their families.In the study,patients were given appropriate intervention programs according to designated groups.Results1.The prevalence rate of pressure injury in severe stroke patients was 24.08% and the hospital acquired pressure injury prevalence rate was 10.30%.The prevalence rate of pressure injury was 11.11% in other stages except stage 1,and the hospital acquired pressure injury prevalence rate was 4.76% in other stages except stage 1.The sacrococcyx was the most common site of pressure injury,followed by buttocks.2.The analysis of risk factors of pressure injury in patients with severe stroke showed that,old age(age above 75 years),high fasting blood glucose,high white blood cell count,long hospital stay,paralysis,fecal and urinal incontinence,indwelling catheter were the independent risk factors affecting the occurrence of pressure injury in patients with severe stroke,while high Braden score,nutritional support,supporting surface and preventive dressing were the protective factors.3.The results of multi-criteria decision analysis showed that there were six items suitable for bundle of intervention strategy,including: risk assessment,preventive dressing,support surface,skin care,posture change and early ambulation and prevention of pressure injury associated with medical devices.4.The optimized bundle of intervention strategy was applied to the patients with severe stroke,the implementation rate of bundle of intervention strategy was 94.12%,the rate of pressure injury was 0% in the experimental group and 11.11% in the control group.The results showed that the cluster intervention strategy could improve the implementation capacity of Nurses and reduce the occurrence risk of pressure injury.Conclusions1.In this study,the prevalence rate and the prevalence rate in other stages except stage 1 of pressure injury in patients with severe stroke was higher than that in general hospitalized patients,and lower than that in bed ridden patients with operation,spinal cord injury,elderly reported in domestic literatures.Stage 1 was the main stage of pressure injury,accounting for 53.77%.Sacrococcyx was the most common site,followed by buttocks.2.The factors affecting the occurrence of pressure injury in patients with severe stroke are multiple and complex.In clinical practice,the implementation capacity of Nurses to various measures to prevent pressure injury is uneven,and the bundle of intervention strategy is optimized by multi-criteria decision method to prevent the occurrence of pressure injury.It will improving the implementation capacity of Nurses and reduce the occurrence risk of pressure injury.