Risk Of Developing Pressure Injuries Research Articles

Secondary Analysis on Ventilator-Associated Pneumonia and Pressure Injury

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

Mandated Quality of Care Metrics for Medicare Patients: Examining New or Worsened Pressure Ulcers and Rehabilitation Outcomes in United States Inpatient Rehabilitation Facilities

ObjectiveTo examine the association between the Medicare pressure ulcer quality indicator (the development of new or worsened pressure ulcers) and rehabilitation outcomes among Medicare patients seen in an inpatient rehabilitation facility (IRF). DesignRetrospective descriptive study. SettingIRFs subscribed to the Uniform Data System for Medical Rehabilitation. ParticipantsNearly 500,000 IRF Medicare patients who were discharged between January 2013 and September 2014 were examined. InterventionsNot applicable. Main Outcome MeasuresFunctional independence, functional change (gain), and discharge destination. ResultsThe pressure ulcer quality indicator was associated with poorer rehabilitation outcomes; patients were less likely to achieve functional independence (odds ratio [OR], .47; 95% confidence interval [CI], .44–.51), were less likely to be discharged to a community setting (OR, .88; 95% CI, .82–.95), and made less functional gain during their IRF stay (a difference of 6 FIM points). ConclusionsThese results support that the pressure ulcer quality indicator is associated with lower quality of rehabilitation outcomes; however, given that those patients with a new or worsened pressure injury still made functional gains and most were discharged to the community, the risk of pressure injury development should not preclude the admission of these cases to an IRF.

Dramatic Reduction in Hospital-Acquired Pressure Injuries Using a Pink Paper Reminder System.

The goal of this quality improvement project was to reduce the number of hospital-acquired pressure injuries (HAPIs) by flagging extremely high-risk patients with a pink paper reminder system and implementing a pressure injury prevention order set. The pink paper reminder system is an innovative, cost-neutral, simple approach to identify patients at highest risk of pressure injury development who meet specific criteria. There are 2 steps to this intervention. First, study authors developed a new risk assessment tool, the pink paper criteria. When a patient met the specified criteria, a pink piece of paper titled "SKIN AT RISK" in a large font was hung at the head of his/her bed to reinforce preventive strategies. Next, a set of pressure injury preventive measures was ordered. This quality improvement project included all adult hospitalized patients of all specialties based in 2 Kaiser Permanente hospitals. There was a 67% reduction in HAPI incidences following the initiation of the pink paper reminder system, from a mean rate of 1.2 to 0.4 incidence of HAPIs per 1000 patient-days measured over 4 years. Identifying and flagging patients who are at extremely high risk of pressure injuries and implementing an order set of pressure injury preventive measures dramatically reduced the rate of HAPIs per 1000 patient-days.

Blepharoplasty incorporating epicanthoplasty using the scar-hiding procedure

Introduction: Hospitalized patients after stroke stay more time bedridden, what increases the risk of developing Pressure Ulcer (PU). Objective: To verify which nutritional and morbidity parameters are more associated to the risk of pressure injury development in hospitalization of patients after stroke. Methodology: Cross-sectional descriptive study, with sample composed by 52 old adults hospitalized after stroke. The patients were submitted to nutritional evaluation in until 72 hours after the date of hospitalization, which was composed by anthropometric as weight, height, BMI, circumference and skinfold; biochemistry (albumin, hemogram, urea, creatinine, C-reactive protein) and dietetic. As parameters of morbidity were evaluated number and type of stroke, presence of deglutition disorders and anemia. Braden scale was applied to evaluate the risk of PU development. It was applied One-way ANOVA followed of Tukey to comparisons of average of categorizations. Results: Patients who did not presented deglutition disorders (27%, n=14) had less risk of developing PU in relation to patients with deglutition disorders (73%, n=38, p=0.0002). Patients with moderate risk of developing PU had serum albumin and hemoglobin levels statistically lower when compared to low risk patients (p=00.49, p=0.012, respectively). Analyzing these patients anemia type, it was suggested anemia for nutritional deficit, since that the Red Cell Distribution Width (RDW) was elevated and the mean corpuscular volume was normal. Conclusion: According to the results, it was observed an important association of biochemistry and dietetic parameters with the risk of PU development. It was not observed any association of anthropometric parameters with the risk of PU. The presence of anemia and deglutition disorders should be monitored, because they have a relation with PU development. The hospitalized patient nutritional monitoring is necessary in order to decrease the presence of medical complications and readmissions of patients after stroke.

Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients

Journal of Wound, Ostomy and Continence Nursing 44(5):p E1-E2, September/October 2017. | DOI: 10.1097/WON.0000000000000368

Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients.

The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients. Retrospective review of electronic medical records. The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013. Analysis is based on data from 6377 patients. Retrospective chart review was used to determine Braden Scale total and subscale scores, age, and incidence of pressure injury development. We used survival analysis to determine the hazards of developing a pressure injury associated with each subscale of the Braden Scale, with the lowest-risk category as a reference. In addition, we used time-dependent Cox regression with natural cubic splines to model the interaction between age and Braden Scale scores and subscale scores in pressure injury risk. Of the 6377 ICU patients, 214 (4%) developed a pressure injury (stages 2-4, deep tissue injury, or unstageable) and 516 (8%) developed a hospital-acquired pressure injury of any stage. With the exception of the friction and shear subscales, regardless of age, individuals with scores in the intermediate-risk levels had the highest likelihood of developing pressure injury. The relationship between age, Braden Scale subscale scores, and pressure injury development varied among subscales. Maximal preventive efforts should be extended to include individuals with intermediate Braden Scale subscale scores, and age should be considered along with the subscale scores as a factor in care planning.

Skin Tears: Finally Recognized

Skin Tears: Finally Recognized