A pressure ulcer audit and feedback project across multi-hospital settings in the Netherlands.

OBJECTIVE: To examine whether participating in a pressure ulcer prevalence survey and receiving feedback results in an improvement in quality of care. DESIGN: Cross-sectional studies from 1998 to 2002 were compared over time. SETTING: Sixty-two acute care hospitals in the Netherlands. STUDY PARTICIPANTS: Patients hospitalized at the moment of the surveys. INTERVENTIONS: Each hospital was given hospital-specific performance data and national aggregate data, and peer comparisons to improve the quality of care. MAIN OUTCOME MEASURES: The case-mix-adjusted prevalence of pressure ulcers of grade >or=2, the percentage of high-risk patients receiving adequate prevention, and the total number of enabling conditions present were compared between successive surveys using multi-level analysis, in order to estimate a linear trend model and trend differences for each hospital. RESULTS: The case-mix-adjusted prevalence of pressure ulcers decreased over the 5-year period, while the percentage of patients receiving adequate prevention and the total number of enabling conditions present increased. The total number of enabling conditions had a significant effect on the decrease in case-mix-adjusted prevalence: more enabling conditions led to a lower case-mix-adjusted prevalence (chi(2) = 125; degrees of freedom = 1; P < 0.00). The percentage of patients receiving adequate prevention also had an effect on the change in case-mix-adjusted prevalence, with a higher percentage leading to a lower case-mix-adjusted prevalence. This effect, however, was not significant. CONCLUSIONS: Monitoring prevalence and giving feedback results in an improvement in quality of care in terms of pressure ulcer prevention. It is very important to continue conducting surveys to avoid attention moving away from this topic, which may in turn lead to a deterioration in the quality of pressure ulcer care. Further research to find the most effective feedback approach is needed.     

Quality improvement for pressure ulcer care in the nursing home setting: the Northeast Pressure Ulcer Project

OBJECTIVES: The objectives of this study were to evaluate the impact of a collaborative model of quality improvement in nursing homes on processes of care for the prevention and treatment of pressure ulcers. STUDY DESIGN: The study design was experimental. SETTING: We studied 29 nursing homes in New Jersey, Pennsylvania, and Rhode Island. PARTICIPANTS: Participants consisted of pressure ulcer quality improvement teams in 29 nursing homes. INTERVENTION: Quality improvement teams attended a series of workshops to review clinical guidelines and quality improvement principles and to share best practices, and worked one-on-one with mentors to implement quality improvement techniques and to collect data independently. MEASUREMENTS: We calculated process measures based on the Agency for Healthcare Research and Quality (AHRQ) guidelines. Process measures addressed each facility's processes of care for the prevention and treatment of pressure ulcers at baseline and after 12 months of intervention. Prevention measures focused on recent admissions and high-risk residents; treatment measures focused on patients newly diagnosed with pressure ulcers and all patients with pressure ulcers. RESULTS: Overall, 6 of 8 prevention process measures improved significantly, with percent difference between baseline and follow up ranging from 11.6% to 24.5%. Three of 4 treatment process measures improved significantly, with 5.0%, 8.9%, and 25.9% difference between baseline and follow up. For each process measure, between 5 and 12 facilities demonstrated significant improvement between baseline and follow up, and only 2 or fewer declined for each process measure. CONCLUSION: Improvement in processes of care after the use of a structured collaborative quality improvement approach is possible in the nursing home setting.     

康惠尔透明贴应用于压疮预防及Ⅰ～Ⅱ期压疮治疗的效果分析

目的观察康惠尔透明贴应用于压疮预防以及Ⅰ～Ⅱ期压疮治疗的效果。方法 2008年2月～2010年2月期间我院老年科患者89例,其中Ⅰ～Ⅱ期压疮发生患者47例,随机分为对照组(23例31处)和实验组(24例35处),实验组应用康惠尔透明贴治疗压疮,对照组采用传统压疮护理方法;另外未发生压疮患者42例,亦随机分为对照组和实验组,每组各21例,实验组除常规护理方法外,根据受压情况给予预防性使用康惠尔透明贴,对照组按常规方法预防护理。4周后观察比较两组的压疮治疗情况及预防情况。结果实验组总有效率显著高于对照组(91.7%vs73.9%,P<0.05);实验组平均愈合时间显著短于对照组(7.6±2.3dvs11.4±2.9d,P<0.05);未发生压疮患者中,实验组压疮发生率显著低于对照组(28.6%vs61.9%,P<0.05)。结论康惠尔透明贴能显著预防压疮的发生,并能促进Ⅰ～Ⅱ期压疮的愈合,效果显著,值得临床推广应用。     

'Decubitus' guideline of the Dutch College of Family Practitioners: response from internal medicine

The guideline on pressure ulcers by the Dutch College of General Practitioners is good in the aspects of simplicity and giving very practical advice. It can be used as a guideline for prevention as well as treatment of pressure ulcers. Some aspects, however, are insufficiently dealt with. There is no summing up of the differences in anti-pressure ulcer devices such as mattresses and cushions. Use is made of the international classification of pressure ulcers in 4 stages, but also of a kind of rating in three colours (red-yellow-black), of which it is known that it underestimates the severity of pressure ulcers. There is an advice to use the knowledge of surgeons, dermatologists and nursing home doctors in difficult cases in the home care, where training and deployment of nurses specialised in this specific field might be preferable. Nevertheless, the guideline is well documented and useful in general practice.     

Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale

To derive a brief bedside pressure ulcer prediction tool for patients admitted to acute care hospitals, we conducted a prospective study of first pressure ulcer incidence among 1,190 consecutive patients hospitalized in selected wards of a Swiss teaching hospital. Baseline predictors included patient age and items from the Norton and Braden ulcer prediction scales. During follow-up, 170 patients developed new pressure ulcers. The predictive ability of baseline assessments decayed over time. Occurrence of first pressure ulcer in the 5 days after admission (129 events) was best predicted by patient age (5 levels), mobility (3 levels), mental status (3 levels), and friction/shear (3 levels). The Fragmment score (sum of friction, age, mobility, mental status) was linearly related to pressure ulcer risk, and its area under the receiver operating characteristic curve (0.80) was higher than for the Norton (0.74; P = 0.006) and Braden (0.74; P = 0.004) scores. This brief pressure ulcer prediction scale performed well in an acute care setting. Use of this scale may facilitate the implementation of pressure ulcer prevention interventions.     

伤口专科护理小组在压疮护理管理中的作用

目的观察开展伤口专科小组对压疮护理记录的影响效果。方法选择2009年1月至2009年12月成立伤口专科小组前的50例护理记录为实施前组,选择2012年1月至2012年12月成立伤口专科小组运作1年后的56例护理记录为实施后组．通过回顾调查实施前后两组病历中与压疮预防、治疗、处理等有关的护理记录内容进行对比分析效果。结果压疮大小、减压措施采用率及压疮风险评估、告知制度落实均明显提高,与实施前比较差异具有统计学意义（P〈0．05）。结论建立伤1：2小组使压疮伤口护理记录更规范．培养护士防治压疮的新理念．减少护理不良事件的发生．     

Using telehealth interventions to prevent pressure ulcers in newly injured spinal cord injury patients post-discharge. Results from a pilot study

OBJECTIVE: To determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge. METHODS: Spinal cord injury patients (n = 12) were recruited for a telehealth intervention after initial injury, and matched cases were recruited for telephone counseling and standard care groups. Patients were monitored for 6-8 months after discharge. RESULTS: The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment. CONCLUSIONS: Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.     

Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy

BACKGROUND: Chronic wounds such as leg ulcers, diabetic foot ulcers and pressure sores are common in both acute and community healthcare settings. The prevention and treatment of these wounds involves many strategies: pressure-relieving beds, mattresses and cushions are universally used as measures for the prevention and treatment of pressure sores; compression therapy in a variety of forms is widely used for venous leg ulcer prevention and treatment; and a whole range of therapies involving laser, ultrasound and electricity is also applied to chronic wounds. This report covers the final three reviews from a series of seven. AIMS: To assess the clinical effectiveness and cost- effectiveness of: (1) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (2) compression therapy for the prevention and treatment of leg ulcers; (3) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were handsearched. An expert panel was also consulted. METHODS - STUDY SELECTION: Randomised controlled trials (RCTs) which evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. RESULTS - BEDS, MATTRESSES AND CUSHIONS FOR PRESSURE SORE PREVENTION AND TREATMENT: A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only two trials evaluated cushions, one evaluated the use of sheepskins, and two looked at turning beds/kinetic therapy. RESULTS - COMPRESSION FOR LEG ULCERS: A total of 24 trials reporting 26 comparisons were included (two of prevention and 24 of treatment strategies). RESULTS - LOW-LEVEL LASER THERAPY, THERAPEUTIC ULTRASOUND, ELECTROTHERAPY AND ELECTROMAGNETIC THERAPY: Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischaemic and diabetic ulcers, and chronic wounds generally) and five of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. CONCLUSIONS (1) Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggests that air-fluidised therapy may increase pressure sore healing rates. (2) Compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence. (3) There is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing.     

奥美拉唑与西咪替丁防治胃溃疡复发100例临床观察

目的对奥美拉唑与西咪替丁防治胃溃疡复发的效果进行临床观察。方法选取胃溃疡患者100例,分为四组,每组各25例,即奥美拉唑治疗组,西咪替丁治疗组,奥美拉唑预防组和西咪替丁预防组。对四组治疗的临床资料进行回顾性分析,比较奥美拉唑与西咪替丁防治胃溃疡复发的效果。结果奥美拉唑组与西咪替丁组在停药6个月和一年后胃溃疡的复发率分别为:6个月:25.3%与54.5%,一年:32.1%与73.4%,p<0.05,差异显著,具有统计学意义;奥美拉唑预防组与西咪替丁预防组在停药6个月和一年后胃溃疡的复发率分别为:6个月:7.2%与24.5%,一年:10.3%与33.6%,p<0.05,差异显著,具有统计学意义。结论相比西咪替丁,奥美拉唑对胃溃疡的治疗与预防均有较好的效果,值得临床推广。     

Preventing pressure ulcers: the goal is zero

BACKGROUND: One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Prevent Pressure Ulcers ... by reliably using science-based guidelines for their prevention." Pressure ulcers cause considerable harm to patients, hindering functional recovery, frequently causing pain, and often serving as vehicles for the development of serious infections. Although the goal for health care facilities to reduce pressure ulcers is admirable, the goal for pressure ulcer incidence should be zero. THE CASE FOR PREVENTION: Pressure ulcer prevention entails two major steps: identifying patients at risk and reliably implementing prevention strategies for all patients identified as at risk. Prevention strategies include six key elements (elements 3-6 address patients at risk): (1) conduct a pressure ulcer admission assessment for all patients, (2) reassess risk for all patients daily, (3) inspect skin daily, (4) manage moisture, (5) optimize nutrition and hydration, and (6) minimize pressure. Facilities may wish to form a multidisciplinary team to develop a pressure ulcer prevention program. CONCLUSION: The development of pressure ulcers is a painful, expensive, and unnecessary harm event that is all too prevalent in American hospitals. The prevention of pressure ulcers is a key intervention that is not new, not expensive, and has the potential to save thousands of patients from unnecessary harm.     

某三甲医院院外带入压疮临床特点的回顾性研究

目的 分析院外压疮发生的临床特点,为预防院外压疮提供参考依据.方法 采用回顾性研究的方法,对2017年1月1日至2019年12月31日期间我院所有科室压疮上报数据进行收集,并对患者的一般资料和压疮的基本信息进行统计分析.结果 带入压疮中家庭带入87.2％,非家庭(养老院、医疗机构)带入12.8％;男性占61.0％,女性...     

自制尼龙床垫对夏季卧床患者压疮预防研究

目的：探索自制尼龙床垫对夏季卧床患者压疮的预防效果。方法：对2011年8月1日-2013年8月31日住院的60例长期卧床偏瘫、大小便失禁患者进行研究,采用对照研究的方式将其分为对照组和试验组,每组各30例。对照组患者给予常规的压疮预防方法,试验组在常规基础上加用自制尼龙床垫进行预防,对比归纳两组患者的临床效果。结果：两组患者压疮高危率、难免压疮发生率及对护理总满意度比较,差异均具有统计学意义（P〈0.05）。结论：自制尼龙床垫对夏季卧床患者压疮的预防效果确切,可有效降低压疮的发生率,促进疾病转归,减轻患者痛楚,具有较高的临床使用价值。     

116例急诊老年患者压疮治疗和护理情况分析

目的探讨急诊老年患者压疮的有效治疗和护理方法。方法对急诊老年患者中院前带入压疮者,根据不同程度的伤口使用不同的压疮护理用品,采取相应的护理措施,对护理效果进行动态观察。结果 116例老年患者的压疮痊愈106例,好转10例,治愈率91.4%,好转率8.6%。结论预防是压疮管理最主要的环节,在急诊对老年患者的压疮护理措施方法得当,可收到良好的效果。     

Prevalence and treatment of pressure ulcers in northern New South Wales

ABSTRACT: This paper reports on a small, cross-sectional study of 18 hospitals in northern New South Wales. The objectives of this study were to collect baseline data on: (i) the prevalence and type of pressure ulcers in a variety of rural hospitals; and (ii) the range of nursing and medical interventions that are used to prevent/treat pressure ulcers. Using a cross-sectional design, the study found that pressure ulcer prevalence, which was 6%, was within the range found by previous reports (4–15%). Pressure ulcer prevention and treatment practices were varied, ranging from turning of the patient and occlusive dressings, to such creative methods as exposure to sunshine and airing the wound. This study demonstrates that despite years of attention to pressure sore prevention and treatment, the prevalence of ulcers is still a significant problem in northern New South Wales hospitals.     

Revision consensus prevention and treatment decubitus]

The text of the Consensus Meetings Prevention and Treatment of Decubitus (pressure sores; 1985 and 1986 respectively) was adapted to current insights into pathogenesis and treatment. This adaptation was important since the costs of the prevention and treatment of decubitus are enormous and decubitus tends to occur more often since the population is growing older. The so called anti-decubitus devices were grouped in 3 categories: 1. polyether foam mattresses, placed on top of the standard hospital mattresses (merely in prevention and in treatment of patients less than 85 kg), 2. polyether foam mattresses with or without special surface layout or simple alternating pressure air mattresses, replacing the standard hospital mattress (especially in patients greater than 85 kg) and 3. special beds and bed systems as low-air-loss beds and air-fluidized beds (only on strict indications such as thoracic operations and intensive treatments). The clinical manifestations of decubitus were classified in 4 stages: non-blanching erythema (1), blister (2), superficial decubitus (3) and deep decubitus (4). The existence of another form of pressure sores was identified: decubitus originating from operation or angiography tables, on which a deep necrosis develops, extending to form an abscess, erupting through the skin after 7-14 days. These ulcers are characterised by an impressive depth, usually to the underlying bones, but with vivid edges. The development of these sores is prevented in most cases by using a category 1 device on the tables mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)     

Summary of 'Decubitus' guideline of the Dutch College of Family Practitioners

The guideline 'Decubitus' published by the Dutch College of General Practitioners contains guidelines with instructions for prevention, diagnosis and treatment of pressure ulcers in primary care. The classification used for severity is: redness of the skin, superficial damage, superficial ulcer, deep ulcer. This classification follows the one used internationally and the one in the consensus of the Dutch Institute for Health Care Improvement CBO. For each patient who becomes (totally or partly) immobile measures to prevent pressure ulcers are necessary, with emphasis on minimizing pressure and shearing forces acting upon the skin. After a pressure ulcer has developed these measures remain important. Guidelines for treatment are given for each level of severity of the pressure ulcer; the main aim is to keep the ulcer moist, to remove necrosis and exudate and to treat infection.