Article

Pressure ulcer preventive device use among elderly patients early in the hospital stay.

Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD 21201, USA.
Nursing research (Impact Factor: 1.5). 01/2009; 58(2):95-104. DOI: 10.1097/NNR.0b013e31818fce8e
Source: PubMed

ABSTRACT Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies.
The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record.
This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction.
Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score < or =14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination.
Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.

Download full-text

Full-text

Available from: David Joel Margolis, Apr 01, 2014
0 Followers
 · 
124 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Documentation of a new or worsened pressure ulcer is a new, required quality indicator for all inpatient rehabilitation facilities (IRFs) in the United States; however, there is little research regarding risk factors for pressure ulcers among patients seen in IRFs.
    PM&R 01/2015; DOI:10.1016/j.pmrj.2015.01.007 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Electronic health information systems can increase the ability of health-care organizations to investigate the effects of clinical interventions. The authors present an organizing framework that integrates outcomes and informatics research paradigms to guide knowledge discovery in electronic clinical databases. They illustrate its application using the example of hospital acquired pressure ulcers (HAPU). The Knowledge Discovery through Informatics for Comparative Effectiveness Research (KDI-CER) framework was conceived as a heuristic to conceptualize study designs and address potential methodological limitations imposed by using a single research perspective. Advances in informatics research can play a complementary role in advancing the field of outcomes research including CER. The KDI-CER framework can be used to facilitate knowledge discovery from routinely collected electronic clinical data. French Les systèmes d'information électroniques sur la santé peuvent accroître la capacité des organismes de soins de santé à étudier les effets des interventions cliniques. Le présent article propose un cadre organisationnel qui intègre les paradigmes de la recherche en informatique et de la recherche sur les résultats afin de faciliter la création de connaissances à l'aide de bases de données cliniques. Afin d'illustrer le cadre proposé, les auteurs l'appliquent à l'exemple des plaies de pression. Ce cadre de création de connaissances à l'aide de l'informatique aux fins de la recherche comparative sur l'efficacité des traitements (CCI-RCET) a été conçu dans le but de servir d'outil heuristique pour la conceptualisation des modèles d'étude et de surmonter les contraintes méthodologiques que peut éventuellement imposer toute perspective de recherche unique. Les percées de la recherche en informatique appliquée peuvent jouer un rôle complémentaire dans le développement du champ de la recherche sur les résultats, y compris de la recherche comparative sur l'efficacité des traitements. Le cadre de CCI-RCET peut être utilisé afin de favoriser la production de connaissances à partir des données cliniques électroniques qui sont recueillies de façon systématique.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 03/2013; 45(1).
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To provide the wound care practitioner with information about the Centers for Medicare and Medicaid Services (CMS) pressure ulcer present-on-admission (POA) indicators. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Describe the history and rationale for the CMS financial incentives for pressure ulcer (PrU) prevention. 2. Identify the CMS Pressure Ulcer POA indicators and 2009 ICD-9 coding for PrU staging. 3. Discuss the implications of the new CMS reimbursement for PrUs on healthcare organization practices with examples of successful interventions for PrU reduction.
    Advances in skin & wound care 10/2009; 22(10):476-84. DOI:10.1097/01.ASW.0000361385.97489.51 · 1.63 Impact Factor