Hospital‐acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review

Abstract

Aim(s)

To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.

Design

Exploratory.

Methods

Scoping review.

Data Sources

Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).

Results

Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).

Conclusion

Quality of evidence was low for the interventional studies and best practice recommendations.

Implications for the Profession and/or Patient Care

Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.

Impact Statement

This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.

Reporting Method

We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.

Patient or Public Contribution

No patient or public contribution.

What Does this Paper Contribute to the Wider Global Clinical Community?

Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.

Protocol Registration

Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).