Are patients with or at risk of pressure ulcers allocated appropriate prevention measures?
ABSTRACT The aims of the study were to investigate the risk for and prevalence of pressure ulcers in different medical care groups, to discover if patients at risk for or with pressure ulcers are allocated appropriate pressure ulcer preventions and to investigate which variables are associated with appropriate pressure ulcer preventions. A cross-sectional survey design was used and followed the methodology developed by the European Pressure Ulcer Advisory Panel. A total of 612 patients participated in the study. The prevalence of pressure ulcers was greatest in geriatric care, followed by intensive care, acute care and neurological care. The majority of patients at risk for or with pressure ulcers did not receive appropriate preventative measures, either while they were in bed or in a chair. Significant variables associated with appropriate preventions in bed were intensive care, geriatric care, a low Braden score, a low score in the subscale activity and a long hospital stay.
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ABSTRACT: To enhance the learner's competence with information geared toward improving processes to capture present-on-admission pressure ulcers. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Analyze the research study presented and its effects regarding identification of present-on-admission pressure ulcers (PrUs) and reduction of healthcare-acquired conditions.2. Identify implications of proper admission skin assessment and documentation on reimbursement by the Centers for Medicare & Medicaid Services.3. Implement recommendations from the research study for ways to improve PrU documentation on admission assessment. OBJECTIVE:This study was designed to determine if a process could be built to accurately capture present-on-admission (POA) pressure ulcers (PrUs). Will a formalized electronic process designed to identify, communicate, and document assessment findings of POA PrUs from clinical nurses to admitting physicians reduce missed identification of POA PrUs, improve communication processes, improve physicians' documentation, and improve reimbursement for the hospital?DESIGN: A before-and-after study design in a single site over a 4-month period compared with the same period during the previous 2 years.SETTING: An acute-care, 333-bed hospital in the Midwestern United States.Nurses were the primary study population.INTERVENTION: The wound assessment screen in the electronic medical record (EMR) was revised to include a new prompt for POA documentation and communication to the admitting physician of the assessment findings.MAIN OUTCOME MEASURES: An increase in POA PrU reporting and reduction in hospital-acquired condition (HAC) reported PrUs.RESULTS: A statistically significant change (2010: P < .01, z = 2.507; 2011: P < .01, z = 2.632) was found for POA; HAC also had a statistically significant change (2010: P = .02, z = 2.411; 2011: P < .01, z = 2.781).CONCLUSIONS: The implementation of the electronic prompt did not contribute to the improvement in the POA and HAC rates because the reduction occurred before the EMR prompt intervention. Changing processes such as EMR upgrades, shared governance, Magnet journey, participation in the National Database of Nursing Quality Indicators, and unit-based nursing councils and skin care champions may have exerted positive forces and contributed to improvement in the communication process between the admitting physicians and the clinical nurses.Advances in skin & wound care 12/2013; 26(12):566-572.
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ABSTRACT: Aims and Objectives To explore nurses' views of the barriers and facilitators to the use of a newly devised patient-centred pressure ulcer prevention care bundle.Background Given pressure ulcer prevention strategies are not implemented consistently, the use of a pressure ulcer care bundle may improve implementation given bundles generally assist in standardising care.DesignA quality improvement project was undertaken after a pressure ulcer prevention care bundle was developed and pilot-tested.Methods Short, conversational interviews with nurse explored their views of a patient-centred pressure ulcer care bundle. Interviews were audio-taped and transcribed. Inductive content analysis was used to analyse the transcripts.ResultsA total of 20 nurses were interviewed. Five categories with corresponding subcategories emerged from the analysis. They were increasing awareness of pressure ulcer prevention, prompting pressure ulcer prevention activities, promoting active patient participation, barriers to using a pressure ulcer prevention care bundle and enabling integration of the pressure ulcer prevention care bundle into routine practice.Conclusions Benefits of using a patient-centred pressure ulcer prevention care bundle may include prompting patients and staff to implement prevention strategies and promote active patient participation in care. The success of the care bundle relied on both patients' willingness to participate and nurses' willingness to incorporate it into their routine work.Relevance to Clinical PracticeA patient-centred pressure ulcer prevention care bundle may facilitate more consistent implementation of pressure ulcer prevention strategies and active patient participation in care.Journal of Clinical Nursing 03/2014; · 1.23 Impact Factor
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ABSTRACT: Pressure ulcer (also known as pressure sore, bedsore, ischemia, decubitus ulcer) is a global challenge for today’s healthcare society. Found in several locations in the human body such as the sacrum, heel, back of the head, shoulder, knee caps, it occurs when soft tissues are under continuous loading and a subject’s mobility is restricted (bedbound/chair bound). Blood flow in soft tissues becomes insufficient leading to tissue necrosis (cell death) and pressure ulcer. The subject’s physiological parameters (age, body mass index) and types of body support surface materials (mattress) are also factors in the formation of pressure ulcer. The economic impacts of these are huge, and the subject’s quality of life is reduced in many ways. There are several methods of detecting and preventing ulceration in human body. Detection depends on assessing local pressure on tissue and prevention on scales of risk used to assess a subject prior to admission. There are also various types of mattresses (air cushioned/liquid filled/foam) available to prevent ulceration. But, despite this work, pressure ulcers remain common.This article reviews the aetiology, cost, detection and prevention of these ulcers.International Journal of Engineering Sciences & Research Technology. 09/2014; 3(9):419-428.