Pressure ulcers are a serious problem in current healthcare. Khalik (2014), the patients will need to stay longer in the hospital and increasing the cost. A report analysis in Singapore showed that the rise of pressure ulcers per patient will cost S$5456 (unspecified), MOH. With the rising cause, the normal intervention of two-hourly turning, an air mattress, routine diaper changes, skincare, and prophylactic dressing are basic preventative measures for pressure ulcers. However, as per the current hospital at KTPH pressure ulcer is high and the needs indicate high rates of hospitalized high-risk patients suffering from them. Sustained pressure including pressure associated with shear, resulting in localized damage to the skin and/or underlying tissue usually over a bony prominence causes pressure ulcers. Adult patients in the intensive care setting are especially vulnerable to the development of pressures based on their acuity diagnosis requiring extensive treatments, procedures, and the use of multiple medical devices (MOH 2001).“Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit” (Kalowes et al., 2016)was a chosen paper to critique using JBI format (Aromataris& Munn, 2020).

This assignment is a prospective, Randomized Control Trial (RCT) from admission until discharge from the intensive care unit (ICU). The purpose of this study is to access the efficacy of standard/usual pressure ulcer management in the ICU by employing a 5-layered soft silicone foam dressing to prevent pressure ulcers in ICU settings. The author also investigated the economic savings associated with reducing pressure ulcers by investigating risk variables. Sinceulcer prevention is complicated, the severity of the condition is high, and preventative methods may be contraindicated or restricted.

The researcher used the permuted randomization approach, a computerized study randomizer, picking blocks of 2, 4, or 6 patients which were then separated into treatment and control groups. A person is assigned to a treatment group randomly with each “block” numbered randomly assigned treatment assignments. These are actual randomization cases (Kim et al., 2018). The rigorous technique enables the research to receive equal treatment group sizes (National library of medicine (NLM),” 2021) while eliminating any possible bias in the treatment group selection process. The conditions for genuine randomization are met where every person was assigned to a group successfully. Hence, internal validity is not jeopardized. In this study, the use of sequential allocation functions as concealment since the researcher would not be able to assign individuals to control or treatment groups selectively (Lee, 2010). However, limited information in the paper makes the behavior of concealing uncertain. If researchers know the permuted block size, they may predict the treatment needed later in the allocation. Hence, permuted block allocation cannot be considered concealed (Berger et al. 2015). To tackle this the block size is masked from the executer and employs randomly mixed block sizes which were not provided in the study and no information was given on any concealment procedures (such as central randomization or sequentially numbered, opaque, or sealed envelopes) to ensure the allocation was disguised.

In a total of 569 beds-level II trauma, Magnet hospital, the treatment groups were identified from the beginning as the chief investigator or research nurse followed suitability screening when patients were admitted to the cardiac, medical, surgical, and trauma ICUs. The patient selection, eligibility, 18 years old and above, have intact sacral skin, sex, level of consciousness, days of mechanical ventilation, sedation, medications, the daily Braden score of 13 or less, therapeutic procedures such as dialysis, mortality risk (APACHE IV score), APACHE III score, physiological variables, medical conditions, and death were gathered(Bouch& Thompson, 2018). The severity of the disease is also a risk factor for the development of PU which is accounted for Acute Physiology, Age, Chronic Health Evaluation (APACHE) III score. To generate the APACHE III projected mortality score, the worst values of 12 physiological variables within the first 24 hours after ICU admission, and an appraisal of the patient’s chronic health and admission diagnosis was used. The model is well validated and in demand in ICUs to classify sickness severity and predict hospital mortality. Higher APACHE III scores indicate a greater risk of mortality. Furthermore, diagnosis of sepsis, Acinetobacterbaumannii (Ab), or Pseudomonas aeruginosa (Pa) are regarded as significant inherent risk factors in the ICU. Thus, the researcher favored employing APACHE for more accurate investigations(Zuo&Meng, 2015). Despite its possibility, blinded outcome assessment is recommended to reduce bias for open-label trials. Therefore, identifying alternative methods for reducing bias is essential. Kahan et al.(2014), suggested that those not directly involved in the care and unaware of the treatment allocation could be used as blinded assessors to determine if the patient should undergo further intervention. However, this option was unacceptable, as the number might lack knowledge and not be trained(Siepmann et al., 2016). Evidently, the participants, treatment providers, and outcome assessors were all non-blinded and were aware of what was acceptable. Both the control and treatment groups received standard care (SKIN bundle), with the former getting an additional 5-layered soft silicone foam dressing applied to the sacrum (Mepilex Border Sacrum, Mölnlycke Health Care AB) within 24 hours of ICU admission. With the advantage given, no placebo was given to the control group.