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Pressure Ulcers
Pressure ulcers or decubitus ulcer focal ischemic necrosis of skin and underlying tissues at sites of constant pressure or recurring friction in persons confined to bed or immobilized by illness; malnutrition worsens the prognosis.
Intraoperatively Acquired Pressure Ulcers: Are There Common Risk Factors?
Surgery puts patients at risk for developing pressure ulcers. Studies examining factors most likely associated with intraoperatively acquired pressure ulcers have not resulted in the development of a risk assessment tool specific to the surgical patient population. To ascertain the current national rate and potential risk factors of intraoperatively acquired pressure ulcers, a survey method was used to obtain data from a 1-day descriptive study. Between May and August 2003, Wound Ostomy Continence Nurses in 37 participating facilities in 21 states completed 281 individual patient surveys. Nine patients (3.5%) developed pressure ulcers related to a surgical event. Most (six patients, 66.7%) had at least one comorbidity and were managed with a warming device and 89% received three or more anesthetic agents. The median operative time for patients developing a pressure ulcer was 4.48 hours. While the external validity of these findings is limited by the current study sample size, the observations confirm previously reported trends and the need for research to improve risk factor identification of surgical patients to improve pressure ulcer prevention efforts. KEYWORDS: pressure ulcer, intraoperative, surgery, risk factors, risk assessment
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A Prospective, Descriptive Pressure Ulcer Risk Factor and Prevalence Study at a University Hospital in Turkey
Valid and reliable patient records regarding pressure ulcers and standard procedures to promote pressure ulcer prevention are not generally available in Turkish hospitals. Consequently, information about pressure ulcer prevalence and risk factors is limited and cannot be obtained retrospectively. A prospective, 1-day, cross-sectional descriptive study was conducted among all eligible, hospitalized patients in the adult medical, surgical, and intensive care units of a university hospital in Turkey. The purpose of the study was to ascertain the prevalence and characteristics of patients with or at risk for developing pressure ulcers. A patient history and demographic and length of stay variables were obtained and skin integrity and Braden scale score variables were assessed for all eligible patients (n = 344 patients admitted more than 24 hours before the study). Forty (40) patients had at least one pressure ulcer (prevalence rate 11.6%) and 111 (32.3%) were found to be at risk for pressure ulcer development. Patients with a low albumin level and other diseases or medical problems as well as those who were comatose or had surgery had a higher rate of pressure ulcers. Patients at risk for pressure ulcer development were found to be male, older, unconscious, and post surgery; additionally, they had a low body mass index and serum albumin as well as other health problems known to be associated with pressure ulcer formation. A significant, negative correlation between hospital length of stay and Braden scale score also was observed. These findings confirm prevalence and risk factor data from studies conducted in other countries and suggest that assessment and prevention efforts in Turkish hospitals must improve in order to decrease the burden of pressure ulcers. KEYWORDS: prospective study, pressure ulcer prevalence, risk factors, Braden Scale, hospitalized patients
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Pressure Ulcers in Nursing Homes: Does Negligence Litigation Exceed Available Evidence?
Nursing homes today face an increasing amount of oversight as they comply with regulations from federal, state, and local governments and agencies. The trend of judicial oversight, particularly in cases involving pressure ulcers, presents a unique set of challenges to the nursing home industry. The standards of care that are increasingly applied to establish the incidence of negligence in relevant cases are dependent on an under-researched area of the clinical phenomenon of skin breakdown within a frail elderly population. As the nursing home population continues to grow and resources are further strained, finding ways to best utilize resources becomes imperative. Consideration must be given to the growing body of evidence indicating that some patients are incapable of mounting a "normal" response to the physical forces responsible for the damage observed with pressure ulcers. Pressure ulcers have evolved to the status of being a synonym for neglect and/or abuse. Clinicians must focus on establishing a realistic and far more nuanced body of knowledge regarding pressure ulcers among the frail elderly.
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Long-Term Outcomes of Full-Thickness Pressure Ulcers: Healing and Mortality
A non-experimental, retrospective analysis of pressure ulcer quality-assurance data was conducted from October 1997 to October 2002 to ascertain the relationship between the occurrence of nosocomial full-thickness pressure ulcers, healing, and mortality. The records of 74 patients (one woman, 73 men) who developed full-thickness pressure ulcers as inpatients at a regional Veterans Affairs medical center with acute, intensive, and long-term care units were assessed. Start day was the day that the ulcer was determined to have occurred and end day was the date the patient was pronounced dead. Major diagnoses for all patients, 70.7% for whom end-of-life planning was in effect, were cerebrovascular accident, diabetes, and cancer. The majority of ulcers were located in the sacral/coccygeal area (66.2%) and heel (16.2%). None of the ulcers healed in patients who died within 180 days of ulcer onset. A 180-day mortality rate of 68.9% was noted in people who developed nosocomial full-thickness pressure ulcers, with an average of 47.0 days from ulcer onset to death. No deaths were related to the presence of the pressure ulcer. In this data set of people with a heavy disease burden who were approaching the end of life, the development of full-thickness pressure ulcers appeared to be a comorbid pathologic process. Collecting and analyzing long-term pressure ulcer healing and mortality outcomes is a missing component of pressure ulcer quality-assurance data.
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Skin Assessment and Pressure Ulcer Care in Hospital-based Skilled Nursing Facilities
The Minimum Data Set, a comprehensive assessment tool for nursing home residents, is used for clinical decision-making, research, quality improvement, and Medicare and Medicaid reimbursement. Within the Minimum Data Set, pressure ulcers and skin condition are evaluated. Because information about pressure ulcer prevalence and care in hospital-based skilled nursing facilities is sparse, a study was conducted to: a) determine pressure ulcer prevalence upon admission to hospital-based skilled nursing facilities in the state of Missouri, and b) ascertain methods of assessment, treatment, and documentation of skin and pressure ulcer care in these facilities. Prevalence data were obtained from analysis of the Minimum Data Set data, and a survey was conducted to obtain skin care practices. The vast majority of residents (96%) were admitted from acute care facilities, and pressure ulcer prevalence on admission was 18.4% +/- 8.0%. Seventy-seven percent (77%) of the 88 surveys mailed were returned. The Braden or Norton Scale for risk assessment is reportedly used by 55% of facilities; whereas, 35% use a facility-developed tool. Commonly reported pressure ulcer prevention/treatment interventions used include: dietitian referral, use of barrier ointments, and a written repositioning schedule. Incontinence management and minimizing the head of bed elevation were infrequently used. Nearly one-half (47%) of facilities reported daily reassessment and documentation of wound status, suggesting less-than-optimal, time-consuming wound care practices. Despite the limitations inherent in survey designs and the use of databases such as the Minimum Data Set, the results of this study suggest that pressure ulcers are a common problem in acute care and hospital-based skilled nursing facilities and research-based risk assessment, prevention, and wound assessment strategies have not been widely implemented. The results of this study provide a basis for developing educational programs and a guide for future research.
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Knowledge of Pressure Ulcers by Undergraduate Nursing Students in Brazil
The purpose of this study was to examine Brazilian nursing students' knowledge of pressure ulcers. Third- and fourth-year undergraduate baccalaureate students at a public university in Brazil (N = 83) were asked to provide demographic information, identify extracurricular activities (eg, reading journals and articles and using the Internet to enhance comprehension of pressure ulcer care), and complete the Pressure Ulcer Knowledge Test. Students correctly answered 67.7% of the Pressure Ulcer Knowledge Test items. Students who participated in extracurricular activities and used the Internet had significantly higher Knowledge Test scores than those who did not. Readings did not significantly impact the Knowledge Test score. Generally, the students were found to have low pressure ulcer knowledge, but that educational programs and the Internet have the potential to positively impact nursing students' knowledge of pressure ulcers.
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Evaluating the Efficacy of a Uniquely Delivered Skin Protectant and Its Effect on the Formation of Sacral/Buttock Pressure Ulcers
Skin breakdown is a common adverse occurrence in healthcare facilities; effective management of related risk factors is critical for prevention. Measures focusing on the skin care of patients with incontinence are recommended to reduce the incidence of pressure ulcers on the sacrum and ischium. However, little research exists to support these recommendations. A retrospective study was conducted to determine if the use of a skin cleansing/protectant product on residents with incontinence decreased the incidence of nosocomial pressure ulcers in the sacral/buttock area. Chart data from all residents with incontinence of a 57-bed, long-term care, skilled nursing home that employs a comprehensive approach to pressure ulcer prevention were collected for a period of 3 months before use of the new product and for 3 months following introduction of the new product. During the first 3 months, five (14.7%) of the 34 incontinent residents developed superficial pressure ulcers (20% were Stage I, 80% were Stage II). Following the change in skin care, no pressure ulcers occurred in the 30 residents with incontinence. The observed decrease (McNemar's chi-square = 4.786, df = 1, Phi = -.273, P = .015) suggests a significant association between the consistent application of a skin protectant and the prevention of skin breakdown. The results of this study demonstrate that, in this population, and in the presence of a comprehensive pressure ulcer prevention program, use of this skin protectant can significantly reduce the incidence of nosocomial sacral/buttocks pressure ulcers.
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A Historical Overview of Pressure Ulcer Literature of the Past 35 Years
This article discusses a study of publications on pressure ulcers from 1965 to 1999 using the information available in Medline. Results show that .06% of all articles relate to pressure ulcers. Of all the articles about pressure ulcers, 49% were research articles and 51% were clinical articles. When comparing the total percentage of articles on pressure ulcers to the costs of pressure ulcers in healthcare (1.3% of the total Netherland healthcare budget), one can conclude that clinicians and scientists insufficiently appreciate pressure ulcers as a problem. The number and the proportion of pressure ulcer articles are growing, as well as initiatives to urge researchers studying the same topic to start international working groups, but more research is needed. This article offers insight into the current status of pressure ulcer literature and addresses some reasons for the lack of interest in the pressure ulcer problem.
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Prevalence and Incidence Studies of Pressure Ulcers in Two Long-Term Care Facilities in Canada
A study was initiated to determine the prevalence and incidence of pressure ulcers in two long-term care facilities in Canada, one with 95 residents and the other with 92 residents. The prevalence study was conducted at both facilities on a single day. The incidence study was completed after 41 and 42 days, respectively, at each facility. Data were collected on demographics, medical information, and possible contributing factors. Each resident was assessed for the presence of a pressure ulcer. Each ulcer was staged and anatomical location was noted. The prevalence of pressure ulcers in the two long-term care facilities was 36.8% and 53.2%, respectively. The incidence of pressure ulcers in the two long-term care facilities was 11.7% and 11.6%, respectively. In conclusion, the pressure ulcer prevalence is higher than published figures for the long-term care setting. However, a pressure ulcer incidence of less than 12% in each facility suggests an equal and acceptable level of nursing care in both facilities. The disparity of pressure ulcer prevalence between the two facilities may be explained by a difference of case mix.
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Pediatric Pressure Ulcer Prevalence ? One Hospital?s Experience
Pressure ulcers in children are presumed to be relatively uncommon and have not been well studied. To better understand the occurrence of pressure ulcers in the pediatric population, two wound ostomy continence certified nurses at the University of Virginia Children?s Hospital conducted prevalence studies in June 2003 and in June 2004. All five pediatric units (the neonatal intensive care unit, the pediatric intensive care unit, two general acute care units, and the rehabilitation unit) were included in the study. Each hospitalized child present on the unit at the time of the study participated and was examined. The data were tabulated and analyzed using descriptive statistics. In June 2003, two of 77 patients (3%) and a year later three of 79 patients (4%) had a pressure ulcer. These results are comparable to recent multisite study prevalence figures. Priority outcomes of the prevalence studies include implementation of a pediatric pressure ulcer risk assessment tool, education of healthcare professionals, and continuous pressure ulcer prevalence monitoring. KEYWORDS: child, pressure ulcer, prevalence, risk assessment, Braden Q scale
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