Development of Pressure Injury Prevention Guidelines for Elderly Intubated Patients in Internal Medicine Ward 2, Female Geriatric Unit, Loei Hospital
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Abstract
Pressure injuries (PIs) are a critical patient safety concern among older adults in intermediate care units. Intubated patients face a 2.5–3.5-fold higher risk than general ward patients. Ward-level surveillance data (2023) revealed a PI incidence of 3.67% (15/409 admissions), exceeding the Healthcare Accreditation Institute (HA) benchmark (≤2.0%), with 26.7% incidence among high-risk eligible patients. This study aimed to develop and evaluate an evidence-based PI prevention guideline for elderly intubated patients. Methods A participatory action research (PAR) design guided by Kemmis and McTaggart's (2005) framework was employed, with four iterative cycles from October 2023 to July 2024 in a 33 bed intermediate care unit, Loei Hospital, Thailand. Participants included 20 registered nurses and 42 unique elderly female intubated patients (15 at baseline; 27 post-intervention unique patients, yielding 59 patient-cycle observations). Ethics approval was obtained from the Human Research Ethics Committee, Loei Hospital (No. [xxx/2566]). Seven instruments were validated (CVI ≥ 0.83; Cronbach's alpha = 0.92; inter-rater agreement = 92.6%). Data were analyzed using descriptive statistics, Fisher's Exact Test (α = 0.05), and qualitative content analysis.
The finalized guideline comprised seven core components. PI incidence decreased significantly from 26.7% (4/15; 95% CI: 7.8–55.1%) at baseline to 0% in cycles 3–4 (0/37; 95% CI: 0–9.5%) (p = 0.005). Guideline adherence reached 93.5–98.4% in cycle 4. Nurses reported the highest satisfaction (mean = 4.68/5.0, SD = 0.32; 100% response rate). Qualitative analysis identified four key learning themes — documentation burden, repositioning technique, nutrition coordination, and MDRPI awareness — that guided iterative guideline refinement.
PAR enabled development of a contextually appropriate, evidence-based guideline achieving zero PI incidence in high-risk patients. The guideline demonstrates transferability to similar intermediate care contexts with appropriate local adaptation.
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