High Risk For Pressure Ulcers Research Articles

The design and application of forecast report chart for pressure ul-cer

Objective To elevate the prevention rate and reduce the incidence of pressure ulcer inhospi-tal. Methods Design a forecast report chart to assess patients who were in hospital from Jan. 2007 to Dec. 2008 by putting this chart in application, from which screen out 1881 patients who were susceptible to high risk of pressure ulcer (patients risk scale was below 14) . Those patients were regarded as investigation group, and their shin con-difions was observed, and taken effective nursing measures. Using historical contrast, the patients picked out by Braden chart in Jan. 2005-Dec. 2006 were considered as control group. The differences in gender, age, history, and the number of patients between two groups were insignificant (P>0.05) . The high - risk prediction accura-cy rate of pressure ulcer, inevitable pressure ulcer rate, the amount of inevitable pressure ulcer in different depth, and the amount of evitable pressure ulcer were analyzed. Results The high - risk prediction accuracy rote of pres-sure ulcer, inevitable pressure ulcer rate, the amount of inevitable pressure ulcer in Ⅱ depth, and the amount of evitable pressure ulcer inhospital of investigation group were significantly better than those of control group (P < 0.05) . Conclusions The forecast report chart is a more effective in pressure ulcer risk prediction. Predictive nuring , management and supervision for patients with pressure ulcer high risk factors are conducive to the im-provement of the basic nursing quality and thus lower the incidence of pressure ulcer among high risk patients. Key words: Pressure ulcer risk; Forecast report chart; Design; Application

Repositioning Guidelines Often Not Followed

Repositioning Guidelines Often Not Followed

Pressure Ulcer Preventive Device Use Among Elderly Patients Early in the Hospital Stay

Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies. The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record. This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction. Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score < or =14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination. Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.

Aiming for Star Performance: The Relationship Between Setting Targets and Improved Nursing Home Quality of Care

To evaluate relative improvement among nursing homes that set targets using the Nursing Home Setting Targets-Achieving Results (STAR) Site for 2 quality measures: (1) the proportion of long-stay residents who are physically restrained daily; and (2) the proportion of high-risk long-stay residents who have pressure ulcers. This analysis focuses on the 7091 Medicare- and/or Medicaid-certified nursing homes whose staff set STAR targets in 2005 for at least 1 of the 2 quality measures included in this analysis. In 2005, the Centers for Medicare & Medicaid Services (CMS) launched STAR to help nursing homes select annual performance goals, or targets, for 4 outcomes that CMS publicly reports quarterly on Nursing Home Compare. Volunteer nursing homes used STAR to evaluate current clinical performance, identify targets, and then track their achievement of those targets. To assess improvement, the project team calculated 4-quarter averages for baseline (ending the quarter when the target was set) and remeasurement (ending the quarter when the target expired) time periods. The team also estimated the number of lives impacted by improvements associated with setting STAR targets. When compared to nursing homes that did not set physical restraint or pressure ulcer targets, nursing homes that set a target had significantly greater relative improvement for the associated quality measure. In particular, nursing homes that set physical restraint targets improved nearly twice as much on the physical restraint quality measure. These trends persisted regardless of nursing home characteristics (eg, facility size or membership in a multifacility corporation) or nursing homes' intensive participation in work with their state's Quality Improvement Organization (QIO). During the 1-year observation period, target setting was associated with 2576 fewer residents at risk for pressure ulcers developing a pressure ulcer and 4321 fewer residents being physically restrained. These analyses demonstrate consistently greater relative improvement among nursing homes that set STAR targets for the daily physical restraint or high-risk pressure ulcer quality measures than among nursing homes that did not set these targets. Although the absolute improvement is relatively small-less than 1% for each quality measure-the number of residents affected is substantial. If STAR targets were routinely incorporated into practice and this level of improvement realized by all nursing homes nationwide, an estimated 45,000 residents would experience better pressure ulcer and physical restraint outcomes at the end of 1 year.

Intensive Care Nurses’ Knowledge of Pressure Ulcers: Development of an Assessment Tool and Effect of an Educational Program

Critically ill patients are at high risk for pressure ulcers. Successful prevention of pressure ulcers requires that caregivers have adequate knowledge of this complication. To assess intensive care nurses' knowledge of pressure ulcers and the impact of an educational program on knowledge levels. A knowledge assessment test was developed. A cohort of registered nurses in a tertiary referral hospital in New Zealand had knowledge assessed 3 times: before an educational program, within 2 weeks after the program, and 20 weeks later. Multivariate analysis was performed to determine if attributes such as length of time since qualifying or level of intensive care unit experience were associated with test scores. The content and results of the assessment test were evaluated. Completion of the educational program resulted in improved levels of knowledge. Mean scores on the assessment test were 84% at baseline and 89% following the educational program. The mean baseline score did not differ significantly from the mean 20-week follow-up score of 85%. No association was detected between demographic data and test scores. Content validity and standard setting were verified by using a variety of methods. Levels of knowledge to prevent and manage pressure ulcers were good initially and improved with an educational program, but soon returned to baseline.

Chapitre H - Spécificités cliniques du blessé médullaire (escarres, HRA, spasticité)

The management of spinal cord injury patients requires a knowledge of several non-urological aspects associated with a risk of particular complications in these patients: pressure ulcers, spasticity and autonomic hyperreflexia. Spinal cord injury patients present a high risk of pressure ulcer, as almost all patients develop at least one pressure ulcer during their lifetime. During a stay in hospital, the medical team must be particularly attentive to prevent these problems, as, once they develop, they can take several months or even years to heal. Autonomic hyperreflexia and spasticity can be due to a urological cause. These two diseases can cause major discomfort for the patient and, in these patients, must be considered to be equivalent to the pain that they can no longer feel due to sensory disorders. The management of spinal cord injury patients must take into account these three particular risk factors: pressure ulcers, spasticity and autonomic hyperreflexia.

Spinal Cord Injury Medicine. 2. Acute Care Management of Traumatic and Nontraumatic Injury

Wuermser LA, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention. Overall Article Objectives (a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.

Spinal Cord Injury and Pressure Ulcers

The SCI person is at high risk for pressure ulcers; thus, pressure ulcer prevention is a critical component of care. Guidelines exist to promote evidenced-based practice for the prevention and treatment of pressure ulcers in the SCI. There is a discrepancy between what persons with SCI know about pressure ulcer prevention and what they are doing to reduce their risk of developing this serious complication. Objective data demonstrate that adherence to a skin care regimen contributes to the prevention of pressure ulcers. Knowledge about pressure ulcer prevention and treatment must be appropriately focused for the patient, family, and the health care team and must be reinforced over time.

Pressure ulcer risk in hip fracture patients.

Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU were high age and the length of time on the operating table. The risk assessment tool had a low predictive value, however. It is thus hard to predict which patients will develop PU and which will not. Accordingly, we propose maximum preventive measures against PU for all patients presenting with hip fractures.

Risk factors for pressure ulcers among elderly hip fracture patients.

The purpose of this study was to estimate the incidence of hospital-acquired pressure ulcers among elderly patients hospitalized for hip fracture surgery and to identify extrinsic factors that are associated with increased risk. We conducted a secondary analysis of data abstracted from medical records at 20 hospitals in Pennsylvania, Texas, New Jersey, and Virginia. Participants were patients aged 60 years and older admitted with hip fracture to the study hospitals between 1983 and 1993. The incidence of hospital-acquired pressure ulcers was 8.8% (95% confidence interval 8.2%-9.4%). After adjusting for confounding variables, longer wait before surgery, intensive care unit stay, longer surgical procedure, and general anesthesia were significantly associated with higher pressure ulcer risk. Extrinsic factors may be important markers for high pressure ulcer risk in hospitalized hip fracture patients. Although it is not possible to eliminate factors such as requiring an intensive care unit stay or having a long surgical procedure, it may be possible to develop interventions that minimize pressure ulcer risk in patients who experience these factors.

Prevalence and characteristics of pressure ulcers. A one-day patient population in a Finnish city.

This article discusses the prevalence and characteristics of pressure ulcers in a one-day patient population in a Finnish city. The data was collected using two questionnaires. Data analysis was based on percentage distributions; statistical significances were tested with the Chi-square test. The measurement identified 186 patients with a total of 300 pressure ulcers. The majority (90%) of these patients were hospitalized and 10% were in outpatient care. The main causes for the development of pressure ulcers were inadequate turning and positioning and the patient's primary illness. Most of the ulcers were grade II. Only a few patients had ulcers that exposed bone. The preventive effort should extend from the nursing unit level, through the organizational level, to the level of society as a whole. It should consist of the identification of people at high risk for pressure ulcers and the provisions of quality care for these people.

Predicting the risk of pressure ulcers in critically ill patients

Critically ill patients are at high risk for pressure ulcers. To determine the contributions of the Braden subscales in predicting pressure ulcers in critically ill patients and to investigate how often the Braden scale should be completed to assess the risk for pressure ulcers in critically ill patients. The Braden scale was used to assess repeatedly 136 adult patients without pressure ulcers in a medical intensive care unit, a surgical intensive care unit, and a noninvasive respiratory care unit, and the patients' skin was inspected routinely for pressure ulcers. A total of 36 pressure ulcers, most commonly on the sacrum or coccyx and the heels (15 stage 1, 20 stage 2, 1 stage 3), developed in 17 patients (12%). In 14 (82%) of the 17, the ulcers developed within 72 hours of admission to the intensive care unit. The risk for pressure ulcers increased as the mean sensory perception (P = .01) and the mean total Braden (P = .046) scores decreased. The mean sensory perception scores obtained at 12 and 36 hours after admission also had a significant relationship to the risk for pressure ulcers (P = .03). Patients in intensive care units have an increased risk for pressure ulcers. Although waiting until 12 hours after a patient's admission to the intensive care unit to obtain the initial Braden rating may be reasonable (with the second rating obtained 36 hours after admission), additional research is needed before this practice can be recommended.

Decreasing the Prevalence of Pressure Ulcers Using Agency Standards

Home care patients either have or are at high risk for pressure ulcers. This article describes the outcome of a study that examined the effects of pressure ulcer prevention and treatment standards on the prevalence rate of a home healthcare agency's client caseload. Implications for practice and further research also are discussed.