Pressure Ulcer Prevention Program Research Articles

Setting up a pressure-ulcer prevention programme

Bridget Günnewicht advises on how to develop a strategy, and gives practical advice on recognizing skin damage, selecting equipment and accessing information.

Implementing Pressure Ulcer Prevention and Treatment Programs: Using AMDA Clinical Practice Guidelines

The American Medical Directors Association (AMDA) Clinical Practice Guidelines (CPG) project was undertaken to develop tools that long-term care (LTC) practitioners can use to improve the delivery of quality care. Each guideline was developed by an interdisciplinary work group of LTC professionals using a process that combined evidence-based and consensus-based thinking. The CPG is a tool to guide the care delivery in a specific area and can help the care team in developing programs and care processes. A CPG detailing the implementation of other CPGs was developed as well. The Pressure Ulcers CPG was one of the initial CPGs developed by AMDA in 1996, and it was followed by a Pressure Ulcer Therapy Companion CPG in 1999. In developing both Pressure Ulcers CPGs, the workgroups were assisted by the previously developed Agency for Health Care Policy and Research (AHCPR) CPGs on the prevention and treatment of pressure ulcers. The workgroup attempted to apply the AHCPR recommendations to the specific practice environment in LTC facilities. This article reviews key points of AMDA’s Pressure Ulcer Therapy Companion CPG supplemented by information from the AHCPR. To assist facilities in implementation, important points in the AMDA Guideline Implementation CPG are discussed as they relate to implementation of the Pressure Ulcer CPG. The goal of this review is to assist medical directors, physicians and all other members of the care team in LTC facilities to understand, develop and implement pressure ulcer prevention and treatment programs.

Implementing Pressure Ulcer Prevention and Treatment Programs: Using AMDA Clinical Practice Guidelines

The American Medical Directors Association (AMDA) Clinical Practice Guidelines (CPG) project was undertaken to develop tools that long-term care (LTC) practitioners can use to improve the delivery of quality care. Each guideline was developed by an interdisciplinary work group of LTC professionals using a process that combined evidence-based and consensus-based thinking. The CPG is a tool to guide the care delivery in a specific area and can help the care team in developing programs and care processes. A CPG detailing the implementation of other CPGs was developed as well. 1 American Medical Directors Association. Guideline Implementation Clinical Practice Guideline. Columbia, MD, 1998. Google Scholar The Pressure Ulcers CPG 2 American Medical Directors Association. Pressure Ulcers Clinical Practice Guideline. Columbia, MD, 1996. Google Scholar was one of the initial CPGs developed by AMDA in 1996, and it was followed by a Pressure Ulcer Therapy Companion CPG 3 American Medical Directors Association. Pressure Ulcers Therapy Companion Clinical Practice Guideline. Columbia, MD, 1999. Google Scholar in 1999. In developing both Pressure Ulcers CPGs, the workgroups were assisted by the previously developed Agency for Health Care Policy and Research (AHCPR) CPGs on the prevention and treatment of pressure ulcers. 4 Agency for Health Care Policy and Research Pressure Ulcers in Adults: Prediction and Prevention. US Department of Health and Human Services, Public Health Service, Rockville, MD1992 Google Scholar , 5 Agency for Health Care Policy, and Research Treatment of Pressure Ulcers. US Department of Health and Human Services, Public Health Service, Rockville, MD1994 Google Scholar The workgroup attempted to apply the AHCPR recommendations to the specific practice environment in LTC facilities. This article reviews key points of AMDA's Pressure Ulcer Therapy Companion CPG supplemented by information from the AHCPR. To assist facilities in implementation, important points in the AMDA Guideline Implementation CPG are discussed as they relate to implementation of the Pressure Ulcer CPG. The goal of this review is to assist medical directors, physicians and all other members of the care team in LTC facilities to understand, develop and implement pressure ulcer prevention and treatment programs.

Presence of Pressure Ulcer Prevention Methods Used Among Patients Considered at Risk Versus Those Considered Not at Risk

In Brief Purpose This study examined pressure ulcer–prevention strategies available for patients considered at risk versus those considered not at risk. Design The study used a prospective, longitudinal design. Setting and Subjects Six hundred ninety-four patients from units of five acute care hospitals, a rehabilitation facility, and two nurses' home care caseloads participated in the investigation. Instruments Data-collection instruments included the Braden Scale for risk assessment, demographic information, and the Pressure Ulcer–Prevention Strategies tool, which assessed for the presence of 16 pressure ulcer–prevention strategies. Methods All patients admitted to a participating unit during a 2-month period were followed up until discharge. Depending on the site, patients were assessed for the presence of pressure ulcer–prevention strategies one to three times per week. Results Patients in the at-risk group versus those in the not-at-risk group were more likely (p < 0.01) to have the head of the bed in a low position, a pressure-reducing bed surface, pressure ulcer prevention charted, a positioning wedge, incontinence cleanser and ointment, heel protection, a prevention care plan, a trapeze, and a posted turning schedule. The at-risk group had significantly (p < 0.01) more prevention strategies present than did the not-at-risk group. However, the percentage of patients placed on a pressure ulcer–prevention program was low for both groups. Conclusions Pressure ulcer prevention was evident for the at-risk group, but at a low rate. Institutions must continue to explore this critical area affecting patient outcomes. A multisite investigation of the impact of specific pressure ulcer prevention methods on the incidence of pressure ulcers among a large sample of subjects in a variety of health care environments.

Presence of pressure ulcer prevention methods used among patients considered at risk versus those considered not at risk

Purpose: This study examined pressure ulcer-prevention strategies available for patients considered at risk versus those considered not at risk. Design: The study used a prospective, longitudinal design. Setting and Subjects: Six hundred ninety-four patients from units of five acute care hospitals, a rehabilitation facility, and two nurses' home care caseloads participated in the investigation. Instruments: Data-collection instruments included the Braden Scale for risk assessment, demographic information, and the Pressure Ulcer-Prevention Strategies tool, which assessed for the presence of 16 pressure ulcer-prevention strategies. Methods: All patients admitted to a participating unit during a 2-month period were followed up until discharge. Depending on the site, patients were assessed for the presence of pressure ulcer-prevention strategies one to three times per week. Results: Patients in the at-risk group versus those in the not-at-risk group were more likely ( p < 0.01) to have the head of the bed in a low position, a pressure-reducing bed surface, pressure ulcer prevention charted, a positioning wedge, incontinence cleanser and ointment, heel protection, a prevention care plan, a trapeze, and a posted turning schedule. The at-risk group had significantly ( p < 0.01) more prevention strategies present than did the not-at-risk group. However, the percentage of patients placed on a pressure ulcer-prevention program was low for both groups. Conclusions: Pressure ulcer prevention was evident for the at-risk group, but at a low rate. Institutions must continue to explore this critical area affecting patient outcomes.

Computer identification of patients at risk for skin breakdown.

Decreasing the incidence of pressure ulcers in acute care settings is a major healthcare challenge. Compared with other wounds, pressure ulcers are slow healing, are difficult to manage, increase healthcare costs, and lengthen hospitalization. Guidelines for pressure ulcer prediction and prevention from the U.S. Department of Health and Human Services state that most pressure ulcers are preventable when risk is identified and preventive measures individualized. Use of pressure ulcer risk assessment tools and laboratory tests for screening of nutritional status is advocated. Overseeing a pressure ulcer prevention program by traditional methods is difficult because patient acuity status changes daily and lengths of stay are shortened. In this article, a systematic way to identify highest risk patients using the hospital computer is described. When used creatively, the computer can provide a list of high-risk patients using factors that are entered daily in the patient classification system and the laboratory package.

TQM PRESSURE ULCER PREVENTION

An interagency task force has designed and implemented a pressure ulcer prevention program at a county hospital.