Abstract
BackgroundHazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain.MethodsExisting data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden.ResultsA total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47–64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay.Discussion and ConclusionsIn the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.Trial registration ISRCTN85296908.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0326-0) contains supplementary material, which is available to authorized users.
Highlights
Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied
Heel pressure ulcer across the entire care delivery chain Skin inspections were performed at different time points across the care delivery chain for the majority of the included patients (ED n = 169 (92 %); ward day 1 n = 168 (92 %); ward day 3 n = 100 (87 %) and; ward day 7 n = 49 (100 %))
Findings from the present study revealed that several of the included patients were assessed as being at risk for developing pressure ulcer, and that heel pressure ulcer develops across the care delivery chain (i.e pre-hospital and emergency care level, and further at the hospital ward)
Summary
For example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Healthcare economy and effectiveness are highlighted in many healthcare systems around the world, leading to more focus on the health professionals and on how to maximize their work efficiency and increase their use of best evidence practice in patient care [1, 2] To achieve these goals, a great deal of focus is placed on the prevention of adverse events and how to use resources most effectively [2,3,4]. More focus is needed on preventing adverse events and identifying what preventive actions can be taken during the care delivery chain (i.e prehospital and emergency care level, and further at the hospital ward)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
