Hospital-acquired Pressure Ulcers Research Articles

The benefits of using a first generation SEM scanner versus an equipment selection pathway in preventing HAPUs.

Several studies have demonstrated improved clinical outcomes in pressure ulcer prevention using the SEM scanner, but none have compared it with other methods. In one of Scotland's health boards, 'hot spot' wards had been unable to reduce the number of hospital-acquired pressure ulcers (HAPUs) after several years of focused improvement work. In addition, other wards showed high use of dynamic therapy systems with associated costs. This review compares the use of a first generation SEM scanner versus a mattress and equipment selection pathway over a 6-week period. The findings show that the SEM scanner wards had zero HAPU while the equipment pathway wards developed a total of 4 HAPU. The two SEM scanner wards showed a 11% and 33% reduction in dynamic therapy use, while the pathway wards showed an average 40% increase. Consideration should be given to using SEM scanners to support staff decision-making to reduce HAPU development and dynamic therapy usage.

The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review

Background:Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.Objective:The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.Methods:This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.Results:The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.Conclusion:Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.

Heel pressure ulceration: the perennial clinical and financial problem?

The heel of the foot is particularly susceptible to pressure, friction and shear forces. In consequence, heel pressure ulcers account for approximately 18% of all hospital-acquired pressure ulcers in England. To ameliorate the effects of friction and shear forces, the use of heel protectors made from silk-like fabric is recommended. This article outlines how one such product, the Parafricta bootee (APA Parafricta), has facilitated a reduction in heel pressure ulcer development, resulting in both time and cost savings in an acute NHS trust over the course of 8 years and thousands of patients. A cost-analysis will also be detailed to show that if the products and processes pioneered by this trust were used throughout NHS England, over £300 million in resource savings could be achieved each year.

The retention effect of staff education programme: Sustaining a decrease in hospital-acquired pressure ulcers via culture of care integration.

Hospital‐acquired pressure ulcers (HAPUs) negatively affect patients during hospitalisation, putting patients at risk for further complications. HAPUs are one of the hospital quality key performance indicators (KPIs) that necessitate quality initiatives and/or programmes to minimise its occurrence and consequences. When quality initiatives are put into place and proven effective, the next important focus is sustainability of the effects. The original Saudi Arabian study based on data collected from 50 441 patients, showed that implementation of the pressure ulcer prevention programme (PUPP) was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The aim of this follow‐up check of the original study was to assess if the PUPP's effectiveness success was retained. Also, to try and determine why the implemented quality improvement programme to prevent HAPUs was so successfully retained. Designed and conducted as a systemic review, it tracked the outcomes of pressure ulcer rates during and post PUPP implementation that mostly focused on evidence‐based staff education, concentrating on years 2016 to 2018. Statistically significant reductions were captured by data that have been presented through Pearson Chi squares. HAPU decline was notable between year 2017 and 2018. This was followed by a further reduction in year 2018. The results determine retention effect sustainability of the initial positive results achieved. By doing so, the study was further able to establish that the PUPP had been integrated into the hospital system's care culture as evidenced by the reduction of HAPUs despite a large inpatient growth. Consideration of what contributing factors led to this successful integration of new knowledge into the care culture are also examined. KPIs can be used as indicators to help reinforce staff education. Culture of care (support of values and interventions taught during the PUPP) offer hope that these may be duplicated in future improvement projects. The supportive nature of a given culture of care may in fact be just as important as the practical education provided to staff members.

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic.

Objectives:To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019.Design:This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group).Setting:High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri.PATIENTS:All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded.Interventions:None.Measurements and Main Results:We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001).Conclusions:Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.

Impact of a Swiss pressure ulcer prevention breakthrough collaborative.

Pressure ulcers may have severe impacts on the quality of life of patients, including pain, low mood and restrictions in performing daily life and social life activities. In Switzerland, 4% of patients develop hospital-acquired pressure ulcers. Six hospitals teamed up with the Vaud Hospital Federation (Switzerland) in a Breakthrough Collaborative, with the goal of reducing hospital-acquired pressure ulcers by 50%. The aim of this study was to assess the actual reduction. A multimodal set of interventions was deployed in all wards except obstetrics and gynaecology, over 18 months starting in October 2016, including systematic risk assessment, use of a prevention bundle, education through e-learning, measurement and feedback, patient engagement and promotion of a safety culture. All six hospitals monitored compliance with the use of the risk assessment, bundle application and patient involvement aspects. A safety calendar was implemented in all wards, for recording and visually displaying the numbers of new patients with pressure ulcers, as well as the presence of such ulcers upon admission and their category. Compliance with performing Braden risk assessments rose from 39% at baseline to 61% by the end of the collaborative (P < .001), prevention bundle compliance from 2% to 30% (P < .001%) and documented patient engagement from 2% to 21% (P < .001%). The percentage of days where one or more patient was reported as having developed one or more pressure ulcers in the ward decreased from 8.21% to 4.18%, a 49% reduction (P < .001) which amounts to preventing 1124 new patients from developing one or more pressure ulcers during the collaborative. The Breakthrough Collaborative using a multimodal improvement approach combined with measurement and feedback was associated with a statistically and clinically significant improvement in compliance to best practice and with a reduction of hospital-acquired pressure ulcers by half.

Characteristics of Hospital Acquired Pressure Ulcer and Factors Affecting Its Development: A Retrospective Study.

BackgroundWorldwide, pressure ulcers (PUs) have been implicated in costing billions annually, with 60,000 deaths out of 2.5 million hospitalized patients resulting from complications related to PU. The prevention of PU reduces the incidence of other illnesses, decreases the financial costs, and improves the quality of life for patients. We aimed to identify the most influential factors that increased the risk of developing PUs among hospitalized patients at a university hospital according to the Waterlow scale.MethodsData were collected retrospectively from patients who developed PUs between January 2016 and December 2018 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were evaluated using the Waterlow PU risk assessment tool. The analysis was performed using the Statistical Package for Social Science (SPSS), version 23.0 (IBM, Armonk, NY).ResultsA total of 272 cases were included in this study. The highest number of cases (n = 83, 30.5%) belonged to the age group of 50 to 64 years. The majority of patients had stage 2 PUs (165, 60.7%). The most frequent location of PU was the “back” (97, 35.7%). A history of undergoing major surgery was significantly associated with a higher stage of PU (p = 0.040). The mean Waterlow PU score for all cases was 27.19 ± 13.143. There was a moderate positive correlation between the neurological deficit score and the Waterlow PU score (correlation coefficient: 0.447, p < 0.001). Multinomial logistic regression analysis revealed that increasing age is a significant predictive factor for developing higher stages of PUs (p = 0.046).ConclusionMajor surgery, neurological deficit, low hemoglobin level, and increasing age were strong predictors for developing higher stages of PU. Therefore, healthcare contributors should consider these risks when applying a comprehensive PU management plan.

Identification of increased risk of pressure damage with a sub-epidermal moisture scanner: clinical outcomes and cost-effectiveness

Hospital-acquired pressure ulcers and subsequent interventions are a substantial burden to patients. This article reviews the use of a sub-epidermal moisture (SEM) scanning device as an early and robust method of identifying the increased risk of pressure damage before it is visible on the surface of the skin. This could allow the implementation of early interventions and potentially decrease the frequency of hospital-acquired pressure ulcers.

Hospital adverse outcomes of the elderly in a tertiary referral hospital: A prospective cohort study of 9,586 admissions

ObjectiveThis study aimed to evaluate the hospital adverse outcomes (HAO) of admitted older adult patients in a large prospective cohort and investigate the demographic, economic, and health-related characteristics at risk of HAO in all older adult patients admitted in the general ward of a tertiary referral hospital. Materials and methodsWe recruited admission episodes of older adult patients aged over 65 years who were admitted at the general ward of Konkuk University Medical Center, which is a tertiary referral hospital, from September 2016 to October 2017. Out of 9,586 admission episodes, 8,263 were included. Modified from the Geriatric Screening for Care-10, six common geriatric health issues, namely, dysphagia, polypharmacy, fecal incontinence, functional mobility, depression, and dementia, were evaluated. Fall, hospital-acquired pressure ulcer (HPU), and mortality were checked daily by experienced nurses during the patients’ hospital stay. A logistic regression model was used, and P < 0.05 was the threshold of significance. ResultsThe incidence rates of fall and HPU were 1.3 % and 4.0 %, respectively. The hospital mortality was 6.1 %. Older adult patients with dysphagia or dementia upon admission were significantly associated with an increased likelihood of falls. Furthermore, age, ER admission, low income, fecal incontinence, or functional immobility increased the HPU incidence. Meanwhile, age, male, ER admission, fecal incontinence, or functional immobility significantly increased the hospital mortality. ConclusionAll demographic, economic, and health-related characteristics, except for polypharmacy and depression, affect the incidence of HAO. Intervention to vulnerable older adult patients with HAO risk could improve the treatment outcome.

The effect of nurse staffing on patient-safety outcomes: A cross-sectional survey.

To analyse the effect of nurse staffing (number of nurses and staff structure) on patient-safety outcomes in hospitals in China. The number of nurses has been shown to have a significant effect on patient-safety outcomes, but the structure of the nursing staff has received little attention. A cross-sectional survey was conducted in 211 units of 13 hospitals. Data on four patient-safety outcomes and numerical and structural indices of nurse staffing were collected from seven types of hospital units. Nurse staffing had inconsistent effects on units' rates of fall and hospital-acquired pressure ulcers. The nurse-to-patient ratio and rate of nurses with work experience ≤5years predicted fall rates, and rate of hospital-acquired pressure ulcers was positively correlated to the level of nurse staffing (low nurse-to-patient ratio and high bed-to-nurse number). The number and structure of nurses are both important to patient safety, and the rate of nurses with work experience ≤5years might be a protective factor against adverse events. Patient outcomes correlated with the number and structure of the nursing staff. Methods to balance the structure of nursing staff might be a topic worthy of examination in future studies.

The risks in nursing interventions offered by nurses with the purpose of preventing hospital-acquired pressure ulcers

Abstract The study was performed in seven medical units in Bucharest with the intention to offer a comprehensive analysis of the nurses’ current prevention practices for hospital-acquired pressure ulcers and also to determine: (1) the main risks that can negatively affect the prevention activities for this type of injury, and (2) if there is a correlation between the nurses’ knowledge and the clinical approach to the current hospital-acquired pressure ulcer prevention practices. The statistical analysis was based on data collected from 713 questionnaires from subjects who met the inclusion criteria of the study. The results showed that nurses considered protocols for hospital-acquired pressure ulcer prevention and its management to be important, but both were not always fully implemented into practice due to the lack of resources, time allocation and staff shortages. The regression analysis method we used was focused to assess the predictive capacity for the combined clinical knowledge and professional approaches to hospital-acquired pressure ulcer prevention and management. The conclusion was that a simultaneous improvement in the clinical approaches and professional knowledge on the topic of pressure-ulcer prevention and management may lead to an improvement of up to 6% of the practices in this field according to the results of the statistical analysis performed.

Evaluating inpatient adverse outcomes under California's Delivery System Reform Incentive Payment Program.

The California Delivery System Reform Incentive Payment Program (DSRIP) provided incentive payments to Designated Public Hospitals (DPHs) to improve quality of care. We assessed the program's impact on reductions in sepsis mortality, central line-associated bloodstream infections (CLABSIs), venous thromboembolisms (VTEs), and hospital-acquired pressure ulcers (HAPUs). We used 2009-2014 discharge data from California hospitals. We used a pre-post study design with a comparison group. We constructed propensity scores and used them to assign inverse probability weights according to their similarity to DPH discharges. Interaction term coefficients of time trends and treatment group provided significance testing. We used Patient Safety Indicators for CLABSI, HAPU, and VTE, and constructed a sepsis mortality measure. Discharges from DPHs and non-DPHs both saw decreases in the four outcomes over the DSRIP period (2010-2014). The difference-in-difference estimator (DD) for sepsis was only significant during two time periods, comparing 2010 with 2012 (DD: -2.90 percent, 95% CI: -5.08, -0.72 percent) and 2010 with 2014 (DD: -5.74, 95% CI: -8.76 percent, -2.72 percent); the DD estimator was not significant comparing 2010 with 2012 (DD: -1.30, 95% CI: -3.18 percent, 0.58 percent) or comparing 2010 with 2013 (DD: -3.05 percent, 95% CI: -6.50 percent, 0.40 percent). For CLABSI, we did not find any meaningful differences between DPHs and non-DPHs across the four time periods. For HAPU and VTE, the only significant DD estimator compared 2014 with 2010. We did not find that DPHs participating in DSRIP outperformed non-DPHs during the DSRIP program. Our results were robust to multiple sensitivity analyses. Given multiple concurrent inpatient safety initiatives, it was challenging to assign improvements over time periods to DSRIP.

Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia.

A tertiary public hospital in Saudi Arabia set out in 2015 to establish a team focused on reducing hospital-acquired pressure ulcers (HAPUs). The pressure ulcer prevention program (PUPP) had a multifaceted approach and data were collected for a period of 5 years. The results showed a definite reduction in the incidences of HAPUs. Many such programs show similar positive results and echo many of the same considerations of risk, prevention strategies, and the need for early intervention. However, none of the other studies either replicate the hospital's PUPP nor the extent of the positive and lasting effect of the program. Eager to determine the contributing factor(s) in order that the project success could be continued and possibly replicated in other quality improvement projects, it was decided that an examination and comparison of other similar programs and their results would be necessary in order to uncover the answer. It was determined that the in-person in-home discharge follow-up portion of the program most likely had the largest effect on the outcomes. Outcomes that were supported by the pre-work completed during the hospital portion of the PUPP towards reducing HAPUs and readmissions.

Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review.

Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.

The impact of bedside handovers on relevant clinical indicators: A matched-controlled multicentre longitudinal study.

To investigate the effects of bedside handover, as contrasted with traditional handovers, on length of hospital stay, unplanned readmission, hospital-acquired pressure ulcers (HAPUs), patient falls, unscheduled intravenous reinfusion and pain. A multicentre matched-controlled longitudinal design. Bedside handover was implemented at five intervention wards in a convenience sample of four hospitals (three surgical/medical wards and two wards for medical rehabilitation). Four control wards continued to use their traditional handover (two surgical-medical wards, one medical rehabilitation ward and one mixed surgical-medical rehabilitation ward; one for each hospital). Patient records, including reports on individual patients in the electronic incident reporting systems, were consulted (N intervention=509; N control=265). The study was carried out between May 2016-February 2018 and data were collected between March 2018-June 2018. The data were analysed using generalized linear mixed-model analysis. No significant differences in length of stay, unplanned readmission, HAPUs, unnecessary intravenous drips, pain or patients falls could be attributed to the use of bedside handovers, whether over time or between the intervention and the control groups. No long-term effects were found on patient safety arising from bedside handover. This lack of significance possibly indicates that: (a) caution is needed when generalizing the results of previous smaller-scale studies; and that (b) bedside handovers do not create hazardous situations for patients. Nurses traditionally perform change-of-shift handovers without the patient. However, the growth in attention paid to reducing adverse events and the demand for more participative and patient-centred approaches in health care both suggest that bedside handovers might be a logical intervention. This study could not confirm the positive results found in the international literature on the impact of bedside handovers on patient safety. Bedside handover should thus be considered as an equally safe, more patient-centred alternative to traditional handover models. ClinicalTrials.gov (NCT02714582).

PIH28 MEASURING THE COST OF PRESSURE ULCERS AMONG US HOSPITAL PATIENTS: A CLUSTERING APPROACH

Existing evidence shows that hospital-acquired pressure ulcers lead to poor health outcomes and result in additional costs of up to $70,000 per patient because of high treatment costs and extended hospital stays. However, current studies may not adequately adjust for differences in health and disease status between patients who do and do not develop pressure ulcers during their hospital stay. This study estimated the cost of pressure ulcers while improving controls for patient comorbidities and procedures. The study used data from 21,043 inpatient admissions from 2018 Truven Health Marketscan Commercial Claims and Encounters. A Jaccard dissimilarity score was employed to cluster patients with similar demographics, disease, and treatment status. The incremental cost of pressure ulcers was determined by calculating the difference in average cost of pressure ulcer and non-pressure ulcer patients within each cluster. Examining five different clustering scenarios showed that there is heterogeneity in the impact of pressure ulcers on patients’ costs. The average difference in cost for pressure ulcer and control patients in a cluster varied between $0 and $96,000. In all iterations, the additional total cost of pressure ulcers was positive; the average additional cost per pressure ulcer patient varied from $4,400 to $24,000 depending on the number of clusters into which the data is grouped. Previous research has shown a wide variance in the estimated cost of pressure ulcers. Our results further support this and suggest that the impact of pressure ulcers on costs varies with complex interaction of comorbidities, procedures, and patient characteristics. Further studies are needed to identify the comorbidities, procedures, and patient characteristics for which pressure ulcers have the greatest impact on patient costs and inform effective nutrition interventions to reduce the incidence of pressure ulcers and its economic burden.

Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study.

The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU). A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP). The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU). Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.

Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence

AimTo analyse patient factors and nurse staffing‐related issues involving hospital‐acquired pressure ulcers in patients at two types of hospital.BackgroundHospital‐acquired pressure ulcers are important for the safety of hospitalized patients. Hospital‐acquired pressure ulcers not only cause health problems, but also pose an economic burden to patients. In addition to patient factors such as mobility and skin integrity, hospital factors such as nurse staffing can also affect the management of such patients.MethodsThis study is a retrospective review of patient data and analysis of factors related to hospital‐acquired pressure ulcers using stratified Cox proportional hazards regression.ResultsA total of 53,923 patients were included. The incidence of hospital‐acquired pressure ulcers was 0.98 per 1,000 days. Hospital‐acquired pressure ulcers were affected by gender, age, previous falls, low oxygen levels, positioning and toilet use. When the levels of nurse staffing were determined as one of the hospital factors, the daily hours of patient care was increased thereby contributing to the reduced incidents of hospital‐acquired pressure ulcers.ConclusionStrategies for preventing hospital‐acquired pressure ulcers should be based on the analysis of risk factors.Implications for Nursing ManagementMost individual risk factors for hospital‐acquired pressure ulcers identified cannot be modified easily in a short time. Nurse staffing should be set at adequate levels to prevent hospital‐acquired pressure ulcers.

Analysis of adverse events of pediatric pressure ulcer based on structured method

Objective This study was summarized and analyzed the reporting data of pressure ulcer events in children for nearly 4 years. We expected this study can provide a recommendation for design of the subsequent reporting system, especially the pressure ulcer. Methods A total of 207 children with pressure ulcers from January 2015 to September 2018 were exported from the adverse event reporting system that made a retrospective analysis based on structured method. Results Among the 207 pressure ulcer cases, 173 (83.57%) cases were hospital acquired, 65 (31.40%) were female, 104 (50.24%) were male, and 38 (18.36%) were missing data. The factors that are prone to pressure ulcers in children are in CICU(74/173), the occipital (83/207), and with stage I(112/207). 111(64.16%)cases were delayed reporting, and the median delayed reporting time was 38(143) days. There are many missing records in the description of the event, the medical treatment, the analysis of the possible causes and other items. In univariate analysis, the setting was associated with missing records in system; the occipital and stage I pressure ulcers were associated with a delayed reporting of hospital acquired pressure ulcers. Conclusions For the prevention of pressure ulcers in children, different high-risk populations should have corresponding strategies. The adverse event of pressure ulcers were reported to be missed and delayed that was attributed to the cumbersome process. The reporting process and system should be standardized. Key words: Pressure ulcer; Child; Adverse events; Structured method; Reporting