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Biophysical detection of skin changes to cue pressure injury prevention in nursing homes

Award Number: R01NR020487
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/19/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2026

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Biophysical detection of skin changes to cue pressure injury prevention in nursing homes - Abstract Pressure injuries (PrIs), commonly located over bony prominences, are local areas of damage to the skin and underlying soft tissue caused by pressure and shear forces. These painful, dangerous, costly, and preventable injuries in nursing home (NH) residents are associated with reduced quality of life and mortality. This embedded pragmatic stepped wedge cluster clinical trial, using a mixed-methods approach for all residents in 8 NHs, will examine use of subepidermal moisture (SEM) assessment results as a cue for nursing staff to initiate PrI prevention. SEM assessment, a biophysical measure that senses changes in skin characteristics, detects early pressure damage by identifying subclinical signs of PrI. SEM use is an innovative addition to current PrI prevention care that is currently initiated upon a positive risk assessment and/or a visual inspection of skin discoloration. Significant damage exists by the time erythema or purple skin is observed. Lag time between pressure-induced tissue damage and visual detection of skin discoloration delays nursing actions to prevent PrIs. Discoloration is more difficult to discern in persons with dark skin tones, making skin damage detection more challenging for residents from minority or under-represented racial/ethnic groups than those with lighter skin tones; thus, producing a health disparity. The study will incorporate SEM assessment into PrI prevention standard-of-care and conduct the intervention over a 9-month period. The study aims are to: 1) determine if early pressure damage detected by SEM assessment at time of visual skin observation of NH resident sacral and heel areas is effective in cueing initiation of NH standard PrI prevention; 2) examine the association between NH standard PrI prevention and SEM assessment and NH residents’ characteristics (age, gender, risk, skin tone, race, ethnicity, BMI, cognitive status) and their interactions on individual NH residents with regard to initiation of NH standard PrI prevention and PrI occurrence; and, 3) explore if SEM usability, NH, and nursing staff characteristics influence the adoption and assimilation of early PrI detection and subsequent PrI prevention practices. Current NH PrI prevention protocols and periodic safety and care checks will be performed. Sample will be comprised of all residents at intervention start and those newly admitted during the 9-month intervention period. An intention to treat approach will be used for quantitative analyses with resident data accrued throughout the intervention period included in analyses. Cueing effectiveness will be determined by evaluating the initiation of PrI prevention strategies in relation to SEM values and the development of PrI during the intervention. Mixed effects regression models for clustered/repeated measures will use electronic health record data and SEM assessment values modeled to predict initiation of PrI prevention actions. Qualitative analyses will be applied to focus group data with comparison to cueing effectiveness findings. Study results will advance knowledge about clinically assessed PrI risk-level and contribute to future redesign of preventive nursing practices and refinement of PrI prevention guidelines.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $782,106 )
2025	2025	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Nursing Research	000	4	7/1/2025	NON-COMPETING CONTINUATION	$782,106
														Subtotal = $782,106

Issue Date FY: 2024 ( Subtotal = $735,138 )
2024	2024	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Nursing Research	000	3	7/11/2024	NON-COMPETING CONTINUATION	$735,138
														Subtotal = $735,138

Issue Date FY: 2023 ( Subtotal = $756,812 )
2023	2023	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Nursing Research	001	2	6/20/2023	NON-COMPETING CONTINUATION	$756,812
2023	2022	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Nursing Research	000	1	12/23/2022	NEW	$0
														Subtotal = $756,812

Issue Date FY: 2022 ( Subtotal = $808,318 )
2022	2022	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Nursing Research	000	1	9/19/2022	NEW	$808,318
														Subtotal = $808,318

Grand Total All Awards = $3,082,374

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Biophysical detection of skin changes to cue pressure injury prevention in nursing homes

Award Number: R01NR020487

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/19/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2026

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