Incidence Of Hospital-acquired Pressure Ulcers Research Articles

Hospital-acquired pressure ulcer prevention: a burn surgeon's team approach.

Hospital-acquired pressure ulcers (HAPUs) are a problem that has been under increased scrutiny in recent years. To help reduce the incidence of HAPUs and to improve their management, a burn unit-centered wound care team was established. The team decided to pursue two goals: to identify opportunities for improvement that may help prevent HAPUs and to evaluate all available support surfaces to identify those that might best help with pressure redistribution. To identify opportunities for improvement, the team studied each new case of HAPUs throughout our hospital with a forensic chart review for a 3-year period. To identify the best support surfaces to help reduce the incidence of pressure ulcers, we evaluated all support surfaces available at our institution by pressure mapping in healthy volunteers. From 3 years of collecting and reporting data for quality improvement, we identified 23 patients with HAPUs and obtained more than 800 data sets from pressure mapping in healthy volunteers. Most (23/24; 96%) patients with HAPUs identified in this series had undergone a surgical procedure. The results of the quality improvement studies are presented. We conclude that prevention planning of HAPUs needs to be improved in patients undergoing surgery, in particular. No single support surface can prevent pressure ulcers, but use of overlays may help reduce peak pressures over bony prominences.

US Medicare data show incidence of hospital-acquired pressure ulcers is 4.5%, and they are associated with longer hospital stay and higher risk of death

Commentary on: Lyder CH, Wang Y, Metersky M, et al . Hospital-acquired pressure ulcers: results from the national Medicare patient safety monitoring system study. J Am Geriatr Soc 2012;60:268–8.[OpenUrl][1] Development...

Financial Implications of Starting a Mobility Protocol in a Surgical Intensive Care Unit

A review of the literature revealed that there was a dearth of information regarding the financial impact of implementing a mobility program in an intensive care unit. The purpose of this article was to identify and quantify costs and cost-benefit from implementing a mobility protocol. Factors to be considered when implementing a mobility program in an intensive care unit are identified and discussed. The increased acuity and lengths of stay associated with this population and the unavoidable increase in the incidence of hospital-acquired pressure ulcers make it difficult to extrapolate the economic benefits of the mobility program at this time.

Investigation of prediction and prevention status for pressure ulcers in comprehensive hospitals

Objective To analyze the status of prediction and prevention for pressure ulcers in comprehensive hospitals in order to get suggestions for pressure ulcers.Methods Using consensus investigating times,tools,ways and procedure flows and judgment criteria,and organizing 457 nurses who trained and passed examination to do a cross-sectional investigation for condition of prediction and prevention for pressure ulcers in 12 comprehensive acute care hospitals.Data were calculated by SPSS 16.0 statistic software.Results Totals of 39 952 cases run into the database,the prevalence of pressure ulcers was 1.579％ and the incidence of hospital-acquired pressure ulcers was 0.628 ％ (251/39 952).Out of patients with Braden scale ≤ 16 points totally 4 710 cases,the first assessment rate was 50.235％ and reassessment rate was 56.645％.The first assessment rate of 380 patients found out pressure ulcers on admission was 87.38％ and reassessment rate was 90.842％.The reassessment rate of 251 patients with hospital-acquired pressure ulcers was 95.219％.The first assessment rate of 1 094 critical care patients on admission was 94％ and reassessment rate was 69.104％.The application rate of support surfaces or devices on beds and chairs for 4 710 patients with risk of pressure ulcers was 61.805％and 3.652％,respectively.The regular changing position rate on beds and chairs for 4 710 patients with risk of pressure ulcers was 75.138％ and 7.834％ respectively.The difference of Braden scores by clinical nurses and trained wound care team nurses was significant [(14.01 ± 3.54) vs (3.29 ± 3.54) ;t =3.221,P ＜ 0.01].Pressure ulcer risk patients use decompression pad status and timing change positions comparative differences were statistically significant (P ＜ 0.01).Conclusions The results of prediction and prevention for pressure ulcers in twelve comprehensive hospitals did not meet the guidelines' aim.It is important to set up the organized frame and train different professional nurses for preventing pressure ulcers,and enhance clinical nurses' recognition to prevent pressure ulcers,check and guide them regularly. Key words: Pressure ulcers ; A cross-sectional survey; Data collection; Prevention

Implementing a Continuous Quality Improvement Program for Reducing Pressure Prevalence in a Teaching Hospital in China

The purpose of this study was to determine whether a continuous quality improvement program would reduce pressure ulcer prevalence. The study sample comprised 2913 patients who were used as a baseline comparison group and 3019 patients who acted as the intervention group. The research setting was a 3000-bed teaching hospital with 61 nursing units located in Wuhan, China. This prospective study compared pressure ulcer prevalence of patients admitted to hospital before and after implementation of a continuous quality improvement program designed to reduce the incidence of hospital-acquired pressure ulcers. The program was implemented after baseline data were collected in April and the comparison prevalence survey was completed in October of the same year. Pressure ulcer prevalence data were collected on a single day. The overall pressure ulcer prevalence (combining ulcers that were hospital acquired and present on admission) was 1.8% at baseline as compared to 1.4% following implementation of the quality improvement program. The prevalence of hospital-acquired pressure ulcers was 1.5% at baseline; it was 1.1% following the intervention. Excluding stage 1 pressure ulcers, the prevalence was 0.8% and 0.6%, respectively. No stage 4 pressure ulcers were identified when prevalence was measured after initiation of the prevention project. Pressure ulcer prevalence, which was low at baseline measurement, did not statistically significantly decrease, despite a comprehensive quality improvement program.

Retrospective Review of the Reduction of Oral Pressure Ulcers in Mechanically Ventilated Patients

Hospital-acquired pressure ulcers (HAPU) are a growing concern in patient care. Mucosal pressure ulcers (PUs) on the lips, mouth, gums, and tongue caused by oral intubation and their securement devices can be difficult to identify and prevent. In an effort to address this problem and reduce mucosal PU, implementation of an alternative securement device, the Hollister ETAD endotracheal (ET) tube securing device, in conjunction with the B&B Medical Universal Bite Block, was introduced at our institution, a level 1 trauma and burn center, in July 2007. The ETAD was later replaced by the Hollister AnchorFast ET tube securing device in December 2007. By April 2009, they became the standard devices and method used to secure oral ET tubes. We hypothesized the use of the new securement devices and bite block would lead to a decrease of HAPUs on the lips, mouth, gums, and tongue of orally intubated critical care patients because these allow for better oral assessment and ET tube manipulation to redistribute pressure. Using data collected from our electronic medical record and our HAPU incidence tracking system, we analyzed the number of PUs on the lips, mouth, gums, and tongue of orally intubated patients in our preintervention (phase 1) group compared with the data from our postintervention (phases 2 and 3) groups. A clinically significant decrease in the reported incidence of HAPUs on the lips, mouth, gums, and tongue was noted in our phases 2 and 3 groups following introduction of the ETAD, AnchorFast, and Universal Bite Block in our institution.

Building information for systematic improvement of the prevention of hospital-acquired pressure ulcers with statistical process control charts and regression

ObjectivesTo demonstrate complementary results of regression and statistical process control (SPC) chart analyses for hospital-acquired pressure ulcers (HAPUs), and identify possible links between changes and opportunities for improvement between hospital...

Care‐Related Risk Factors for Hospital‐Acquired Pressure Ulcers in Elderly Adults with Hip Fracture

To identify care-related factors associated with hospital-acquired pressure ulcers (HAPUs). Prospective cohort study. Nine hospitals in Baltimore Hip Studies network. Six hundred fifty-eight individuals aged 65 and older who underwent surgery for hip fracture. Skin examinations at baseline and on alternating days until hospital discharge. Participants were deemed to have a HAPU if they developed one or more new Stage 2 or higher pressure ulcers (PUs) during the hospital stay. Longer emergency department stays were associated with lower HAPU incidence (>4-6hours: adjusted incidence rate ratio (aIRR) = 0.68, 95% confidence interval (CI) = 0.48-0.96; >6hours: aIRR = 0.68, 95% CI=0.46-0.99, both vs≤4hours). Participants with 24hours or longer between admission and surgery had a higher postsurgery HAPU rate than those with less than 24hours (aIRR = 1.62, 95% CI=1.24-2.11). Surgery with general anesthesia had a lower postsurgery HAPU rate than surgery with other types of anesthesia (aIRR = 0.66, 95% CI=0.49-0.88). There was no significant association between HAPU incidence and timing of transport to the hospital, type of transport to the hospital, or surgery duration. Most of the factors hypothesized to be associated with higher PU incidence were associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice.

How to reduce hospital-acquired pressure ulcers on a neuroscience unit with a skin and wound assessment team

Background:In 2008, the incidence of hospital acquired pressure ulcers (HAPUs) continued to increase on a neuroscience unit that included both neurosurgical and neurological patients in a 14-bed intensive care unit, and in a 18-bed floor unit.Methods:To reduce HAPUs, several changes were instituted in 2008; (1) turning patients every 1–2 h/repositioning, (2) specialty beds, and (3) a “skin and wound assessment team (SWAT)” that included one (or two) “expert” nurses/nursing assistants who made rounds on all the patients in the unit at least once a week. They would examine patients from “head to toe”, document/measure all pressure ulcers, and educate primary nurses/nurse assistants on the plan/products needed for the patients wound care based on their assessments. In 2010, further measures included: (1) adding eight Stryker beds, (2) adding pressure relieving heel protector boots, and (3) requiring that all new hospital orientees work one shift (7.5 h) shadowing the SWAT team.Results:The SWAT team initially decreased HAPUs by 48% in 2009; this reduction was further increased in 2010 (57%), and 2011 (61%). Additionally, in 2010, the SWAT team was required to educate nurses in all other units. By 2011, all nurses had to complete the hospital acquired pressure ulcer prevention tutorial.Conclusions:Since instituting a specialized SWAT team for our neuroscience unit, the incidence of HAPUs (cost estimated for grade IV, US $129,248) was decreased by 48% in 2009, by 57% in 2010, and by 61% in 2011. The SWAT program is now hospital-wide.

Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)

ObjectiveTo evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers.DesignA single blind randomised controlled trial.SettingA large metropolitan tertiary hospital.Participants1231 patients admitted to internal medicine...

Professional Practice-Implementing a Pressure Ulcer Prevention Program

OBJECTIVE: To decrease the overall rate of hospital-acquired pressure ulcers in hospital through education on risk assessment prevention protocols, and collaboration of skin team members, WOCN and nursing staff. DESIGN: Tracking of retrospective documentation of monthly hospital-acquired pressure ulcer rates for the past four fiscal years. SETTING: A 238-bed rural tertiary Level II Trauma Center in Northeastern Penna. PARTICIPANTS: Patients with hospital-acquired pressure ulcers from July 1, 2004–June 30, 2008. INTERVENTIONS: Mentoring and mandatory education of nurses and care partners by skin Team members and WOCN regarding identification of at-risk patients and implementation of prevention measures. Skin care team members attended quarterly team meetings, participated in quarterly prevalence studies, and participated in chart reviews and education. Evidence-based pressure ulcer prevention protocols and treatment protocols were implemented. This allowed nurses to enter the prevention or treatment of pressure ulcers. In January of 2006 a qualitative initiative called “Measurement Monday” was implemented to improve documentation of impaired skin with a designated day of the week for measurements. In January of 2007 a uniform documentation tool for impaired skin was implemented on the nursing units. In March of 2008 computerized epic documentation for electronic record was implemented. Pressure ulcer rates also became part of the nursing managers' report card and yearly goals. Discussion of pressure ulcer rates and measures to decrease rates were ongoing. Our Vice President of Nursing and Chief Nursing Officer provided ongoing support for our prevention strategies and programs. RESULTS: Incidence of hospital-acquired pressure ulcers decreased yearly over the 4 years with an overall decrease of 46% from 2004–2008. CONCLUSION: Reduction in incidence of hospital-acquired pressure ulcers was achieved through pressure ulcer prevention measures, education and the collaborative approach of skin team members, WOCN, nurses, care partners, management and administration (Russo).

Professional Practice-Implementing a Pressure Ulcer Prevention Program

The purpose of this research study was to investigate if the use of a static air mattress overlay and static air seat cushion on all patients admitted to our surgical hospital unit would decrease the incidence of hospital-acquired pressure ulcers. We used cross-sectional data collection using the National Database of Nursing Quality Indicators (NDNQI). The target population was inpatients located on the surgical unit of our hospital and excluded any patient that was not on a static air mattress overlay during their entire inpatient hospital stay. The study compared a one-day snapshot survey of patients with standard ulcer prevention strategies before usage of static air mattress and seat cushion and a one-day snapshot survey after usage of a static air mattress overlay and static air seat cushion, education for the patient, families and nursing staff. We discovered that the percentage of our surgical patients with hospital-acquired pressure ulcers (HPU) for the quarter prior to the research study was 18.18%. The percentage of our surgical patients during the research study was 4.76%. The patients that developed a HPU during our study had been previously excluded from the research study because they were not on a mattress overlay during their entire inpatient stay. We concluded that the use of a static air mattress overlay and static air seat cushion, when used on all patients admitted to our surgical unit along with education for the patient, families and staff resulted in positive patient outcomes as demonstrated by the significant reduction in hospital-acquired pressure ulcers.

Risk Assessment for Pressure Ulcer

To identify patients at risk for developing pressure ulcer among hospitalized patients and the prevalence of pressure ulcer in this group. A prospective study included 100 patients from medical and surgical wards. Data were collected on admission, and subjects were followed up at regular intervals. The Waterlow pressure ulcer risk assessment tool was completed and patients were stratified "as not at risk," "at risk", "high risk", and "very high risk". Subjects were then monitored for 2 weeks and the actual incidence of pressure ulcer formation was analyzed in the various risk groups. Of 100 patients studied, 20% were at risk, 10% were assessed at high risk, and 7% were classified as at very high risk for developing a pressure ulcer. Necessary preventive measures were taken (posture change, specialized beds/mattresses, nursing care, nutritional input, etc) for those patients at risk of development of pressure ulcer. Four of 7 patients (57.1%) who were at very high-risk developed pressure ulcer as compared with 2 of 10 patients (20%) categorized in the high-risk category within a period of 2 weeks. No patient who was classified as not at risk on the Waterlow pressure ulcer risk assessment tool developed a pressure ulcer within the observation period. Pressure ulcers developed in identified risk groups despite adequate available preventive measure being taken to prevent their development. It is of extreme importance to identify patients at risk for the development of pressure ulcers so that preventive measures can be instituted to reduce the incidence of hospital-acquired pressure ulcers.

Pressure Ulcers Among Elderly Patients Early in the Hospital Stay

Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence. A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Service at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified as either preexisting, possibly hospital-acquired, or definitely hospital-acquired. There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.2% (95% confidence interval, 5.4%-7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status. A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person's hospital stay.

Pressure ulcers and lateral rotation beds: A case study

During a 6-month period, the WOC nurses at a 500-bed medical treatment facility noticed the development of nosocomial pressure ulcers on the sacrum, occiput, and heel areas of patients who were placed on lateral rotation specialty beds because they had pulmonary disorders. Measures were taken to address the problem by repositioning the patients and through a staff education program. Repositioning included repositioning the patient's head every 2 hours, thorough skin assessments every 2 hours, and ensuring that the patient's heels were subject to zero pressure. Staff education centered on the importance of using a risk assessment tool (the Braden scale) and understanding the clinical uses for lateral rotation beds. During the subsequent 6 months, the incidence of hospital-acquired pressure ulcers decreased by 52%. Efforts to further decrease the number of pressure ulcers related to the use of lateral rotation beds continue. Issues such as length of stay on the bed and the appropriateness of manufacturer's guidelines still need to be addressed at this facility. This case study highlights the potential issues associated with lateral rotation beds and identifies the need for further research. (J WOCN 2003;30:143-5.)

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.

The effects of ET nursing assessment on the incidence of hospital-acquired pressure ulcers.

The effects of ET nursing assessment on the incidence of hospital-acquired pressure ulcers.