Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation

Aim and objective. The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. Background. Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of pressure ulcers on length of hospital stay after cardiothoracic surgery is yet undetermined. Design. Prospective follow‐up study. Methods. Two hundred and four patients admitted for elective cardiothoracic surgery and with an intensive care unit stay of >48 hours were included in a prospective cohort study. The course of the skin condition in relation to pressure ulcers was monitored during their stay in a teaching hospital. Length of hospital stay was compared between the group with and without pressure ulcers. Results. Hospital stay for cardiothoracic patients with and without pressure ulcers did not differ significantly (p = 0·23). Patients that developed pressure ulcers had a median hospital stay of 13 days (interquartile range: 9–19) vs. 12 days (interquartile range: 7–15) for patients without pressure ulcers. However, we observed that length of stay in the intensive care unit was significantly (p = 0·005) longer for patients with pressure ulcers. This was not associated with the occurrence of complications. However, the occurrence of pressure ulcers was significantly correlated with length of intensive care support in postoperative care. Conclusion. Non‐complicated pressure ulcers in postsurgery patients do not significantly increase the length of total hospital stay. Relevance to clinical practice. Health professionals need to recognise that patients who have undergone major surgery (such as cardiothoracic surgery) are prone to develop pressure ulcers. Despite the fact that pressure ulcers do not necessarily extend hospital stay, monitoring the skin condition remains of crucial importance for prevention and early detection as well as treatment of pressure ulcers and to minimise patient discomfort. Moreover, as pressure ulcers often originate in the operating room, prevention in the operating room should receive more attention.     

Skin problems: epidemiology of pressure ulcers in a skilled care facility.

The majority of nursing home residents have conditions that place them at risk for the development of pressure ulcers. Reported pressure ulcer prevalence rates range from 16% to 35%. Pressure ulcers are multifactorial in origin and necessitate ongoing vigilance by the entire health-care team. Associated risk factors include impairments of circulation, sensation, physical condition, nutrition, mobility, and activity. Stage I pressure ulcers frequently go unrecognized, yet their recognition is essential to prevent further damage. Comprehensive initial assessments of the skin and risk factors of pressure ulcer development at admission will allow for easier reassessment and comparison.     

全程信息化管理在压疮高危患者护理中的应用

目的：探讨全程信息化管理体系在压疮高危患者护理中的应用,评价其对压疮高危风险预防管理效果的影响。方法设立压疮管理核心组对全院压疮高危患者的护理实行专科技术指导;构建信息化管理模块,完善压疮高危风险报告表,增设压疮高危风险统计分析表,并实行智能化记录和自动统计;完善并实施压疮高危患者的护理管理流程,加强护理管理者对压疮预防措施落实情况的督查,压疮高危患者从上报到转归的全过程均通过信息系统进行动态实时管理。结果全程信息化管理体系实施后,全院压疮高危患者的压疮发生率为18．98％,较实施前的32．64％显著降低,差异有统计学意义（χ2＝10．032,P＜0．01）;压疮高危患者上报资料正确率为98．15％,与实施前的91．71％相比显著提高,差异有统计学意义（χ2＝9．084,P＜0．01）;护理部进行季度压疮高危风险统计所需时间由6 h 降至20 min。结论应用全程信息化管理体系,可降低压疮高危患者的压疮发生率,提高压疮高危风险上报资料的正确率,提高压疮高危风险统计分析的工作效率,有助于完善压疮预防和控制工作。     

压疮监控小组在压疮防治中的作用

目的探讨压疮监控小组在压疮防治中的作用。方法回顾2012年1月~2013年12月在我院住院并上报护理部的压疮高危患者378例,其中发生院内外压疮患者135例为研究组,通过压疮监控小组同一规范的管理,规范压疮监控制度和流程,定期对压疮患者进行追踪、指导、督促。并与2010年1月~2011年12月在我院住院并上报护理部的压疮高危患者153例,其中发生院内外压疮患者88例为对照组,并对两组疗效及发生院内难免压疮情况进行比较。结果两组疗效及发生院内难免压疮情况比较有显著性差异（P〈0.01,P〈0.05）。结论压疮监控小组对压疮患者进行同一规范的管理,提高了护理人员对预防和治疗压疮患者的管理技能,提高了护理质量。     

The link between absorbent pads and pressure management products

Very little is known about the relationship between pressure management products (also known as pressure-relieving devices or pressure-redistributing devices) and absorbent continence products. However, a new project will focus on this little investigated yet important area of nursing research. The project is being carried out as part of a new award scheme that aims to enhance nursing research capacity by funding nurses to carry out doctoral level research (Box 1). A strong association between poor mobility and continence problems has been identified (Sgadari et al, 1997; Jirovec and Wells, 1990; McGrother et al, 1990; Ouslander et al, 1987) and reduced mobility is considered to be one of the intrinsic risk factors for the development of pressure ulcers (RCN, 2001). However, the relationship between incontinence and the development of pressure ulcers is not fully understood.     

自制糜子垫在预防压疮中的应用

目的探讨自制糜子垫在预防压疮中的效果。方法将60例具有压疮风险病人按入院次序分为对照组和实验组,每组各30例。对照组采用气垫床防压疮护理,实验组采用自制糜子垫防压疮护理。比较两组病人的不舒适感和压疮发生情况。结果实验组与对照组均无发生压疮;实验组患者不舒适感低于对照组,两组比较,P<0.05,差异具有统计学意义。结论采用自制糜子垫可有效保护受压皮肤,达到预防压疮的效果,同时提高病人的舒适度。     

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact

OBJECTIVE: To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation. PARTICIPANTS: Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. RESULTS: Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. CONCLUSIONS: Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.     

A short history of progression of research into seating and postural support

Numerous solutions for cushioning the contact area between product and user have been designed during the past centuries, but only in recent decades has systematic research been conducted on the underlying mechanical principles and the consequences of mechanical load imposed on the human skin and muscular skeletal system. In this paper a short history and future perspectives on the research in pressure ulcers is discussed and innovations in the field in the perspective of the history of the innovations are presented. Research in the past century on pressure ulcers has not (yet) led to the eradication of the problem. What can be observed is that the oxygen supply and blood flow to the cells has been studied in many different ways and reported throughout the last century. After the internal capillary pressure was measured in the famous study of Landis, external interface pressures on the tissue was the object of many studies. In these studies different devices that could measure interface pressure were used, but they mainly introduced more sophisticated and innovative means to measured blood flow and oxygenation. After decades of pressure measurements, devices were designed that could measure the missing component of the mechanical load, namely shear. Recently, commercially available shear sensors have been designed, and will, with no doubt, lead to many studies on the combined mechanical load on the tissue. However, although they are interrelated, still a large gap exists between measurements on external mechanical load and the study on the etiology of pressure ulcers.     

压疮高危患者居家护理相关因素的调查分析

目的：调查压疮高危患者居家主要照顾者对压疮预防知识、态度及行为的现状,分析家庭护理不当的相关因素。方法采用问卷调查法对抽取的108例压疮高危患者主要照顾者进行调查（一般资料调查、采用自行设计的压疮知信行评估问卷进行测评）。结果压疮高危患者居家主要照顾者对压疮的相关知识的认知程度不高,且缺乏正规的学习渠道。在压疮相关知识认知方面：大专及以上者优于大专以下者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。在防护压疮的态度和行为方面：大专以下主要照顾者优于大专及以上者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。结论压疮高危患者居家主要照顾者预防压疮的意识薄弱,应加强压疮防护知识的健康教育,广泛开展多种形式的健康宣教,降低压疮高危患者压疮的发生率,提高其生活质量。     

Clinical Use of Interface Pressure to Predict Pressure Ulcer Development: A Systematic Review

ABSTRACT

Pressure ulcers are a large problem in subjects who use a wheelchair for their mobility. These ulcers originate beneath the bony prominences of the pelvis and progress outward as a consequence of prolonged pressure. Interface pressure is used clinically to predict and prevent pressure ulcers. However, the relation between interface pressure and the development of pressure ulcers is not clear. A systematic review was performed to address the research question of whether interface pressure can be used to predict the development of pressure ulcers or to determine the prognosis of an ulcer once developed. Seven studies were identified that measured interface pressure and used the development or healing of pressure ulcers as an outcome measure. There appears to be a weak qualitative relation between interface pressure and the development of pressure ulcers. However, no conclusive clinical threshold for the interface pressure can be given. This, combined with the influence of individual characteristics, the low internal validity of interface pressure measurement for the prediction of pressure ulcers, and an incongruent relation between pressure magnitude and duration, results in the fact that no quantification of the predictive or prognostic value of interface pressure can be given.     

Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital

Aims and objectives.  This study aimed to describe and identify risk factors associated with hospital‐acquired pressure ulcers among adults in an acute care hospital compared with patients with pre‐existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. Background.  Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital‐acquired pressure ulcers compared with patients with pre‐existing pressure ulcers. Design.  A point prevalence study with a cross‐sectional survey design was conducted at a Swedish university hospital. Method.  Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. Results.  The prevalence of pressure ulcers was 27% (95% confidence interval, 23–31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital‐acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. Conclusion.  The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development. Relevance to clinical practice.  Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.     

康复新液湿润疗法在溃疡期压疮中的应用效果观察

目的:探讨康复新液湿润疗法在溃疡期压疮中的应用效果。方法:将我院2007年1月～2009年4月内科系统收治的32例溃疡期压疮病人作为对照组,将2009年8月～2011年12月内科系统收治的32例溃疡期压疮病人作为观察组。观察组用生理盐水清洗创面及周围皮肤后再用康复新液湿性换药,对照组用碘伏消毒创面及周围皮肤,再用TDP灯照射20～30 min,然后用康复新液换药。结果:两组总有效率及压疮治愈时间比较差异有统计学意义(P=0.003)。结论:用康复新液湿润疗法效果显著,可提高压疮治愈好转率及缩短压疮愈合时间,节省护理人力资源,因此,在溃疡期压疮病人中可优先选用。     

预警管理在压疮管理中的效能分析

目的运用风险预警管理理念,提升护理人员压疮管理意识,降低压疮发生率。方法选取2009年1月-2011年12月通过护理软件上报的压疮高危患者及压疮患者数据进行分析,对存在的薄弱点及时指导并积极制定整改措施,优化压疮管理流程。结果护理人员预防压疮的意识提高,上报压疮高危患者数逐年上升,2009年-2011年极危及高危上报例数占全院出院人数的比率分别为0．76％、1．01％、1．13％;2009年-2011年院内难免压疮发生率分别为0．06％、0．06％、0．02％。结论以伤口小组管理压疮为依托,培养护理人员风险预警管理理念,赋予相应的职责及管理目标有助于压疮的规范管理及学科水平的不断提高。     

麦卢卡蜂蜜治疗Ⅱ～Ⅲ期压疮效果及护理材料成本-效果分析

目的探讨麦卢卡蜂蜜与美皮康敷料治疗Ⅱ~Ⅲ期压疮的效果,并进行护理材料成本-效果分析。方法按照入选标准,选取某市3家三级甲等医院压疮患者38例62处Ⅱ~Ⅲ期压疮,按照随机数字表法,将62处压疮分为两组,即麦卢卡蜂蜜敷料组(蜂蜜组)32处、美皮康敷料组(美皮康组)30处,比较两种方法治疗效果及进行护理材料成本-效果分析。结果两种方法的治疗效果及压疮好转率差异无统计学意义;两种治疗方法的护理材料成本-效果分析,蜂蜜组费用相对低,且结果经敏感度分析具有稳定性。结论麦卢卡蜂蜜与美皮康敷料治疗Ⅱ~Ⅲ期压疮效果基本相同,但麦卢卡蜂蜜敷料的治疗费用相对较低。     

Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset

OBJECTIVES: To identify risk and protective factors associated with a history of recurrent pressure ulcers among participants with spinal cord injury (SCI). DESIGN: A mail survey was used to identify factors associated with the presence or absence of recurrent pressure ulcers. SETTING: A large specialty hospital in the southeastern United States. PARTICIPANTS: All participants had traumatic SCI, were nonambulatory, 18 years or older, and had been injured at least 5 years. A total of 826 subjects participated, 633 of whom reported a pressure ulcer history that could be classified as to whether they did or did not have a history of recurrent pressure ulcers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: History of pressure ulcers was measured by a single item that required participants to classify their history into 1 of 5 options, ranging from never having any pressure ulcers to having almost continuous pressure ulcers, often requiring hospitalization. Those who either never had a pressure ulcer or had them mostly for a short period after SCI onset were classified as nonrecurrent, whereas those who reported at least 1 per year were classified as recurrent. RESULTS: Seventy percent of the participants failed to report recurrent pressure ulcers (never had any or had them only immediately after SCI onset), whereas 13% reported a clear pattern of recurring pressure ulcers of 1 or more per year. Logistic regression analyses suggested several general behaviors were protective for recurrent pressure ulcers, including lifestyle, exercise, and diet. Yet none of the behaviors generally recommended during inpatient rehabilitation specifically to prevent pressure ulcers (eg, skin checks weight shifts) were associated with pressure ulcer history. Only 2 risk behaviors were identified (number of cigarettes smoked, use of medication for sleep), although several proxy variables were related to pressure ulcer history. CONCLUSIONS: Pressure ulcer history is a more viable measure of pressure ulcer outcomes than measures taken at a single point in time (current), over a brief period (eg, 1y), or those relying on critical events occurring at any time since SCI onset (ie, surgeries to repair pressure ulcers). A healthy lifestyle appears to be strongly associated with avoiding pressure ulcers, whereas the efficacy of specific prevention behaviors was not demonstrated. Problem solving and coping strategies should be targets for further research.     

Cognitive function and pressure ulcers in hip fracture patients

The primary aim of this study was to analyse the documented frequency of pressure ulcers in relation to the patients' cognitive status during the acute care after a hip fracture. The secondary aim was to investigate to what extent the information about pressure ulcers is passed on to the next caregiver. The patient population consisted of 356 patients being admitted to hospital because of a hip fracture. The patients' cognitive function was assessed with the Short Portable Mental Status Questionnaire. The outcome for patients with severe cognitive dysfunction was compared with the outcome for those without severe cognitive dysfunction. The overall incidence of pressure ulcers was 16%. Twenty-three percent of the patients with severe cognitive dysfunction developed a pressure ulcer during hospitalization compared with 14% of patients without severe cognitive dysfunction (p < 0.05). Although patients with severe cognitive dysfunction had an increased risk of developing pressure ulcers, the severity and the localization of their ulcers were comparable to those without severe cognitive dysfunction. Information regarding the presence of the pressure ulcers in the nurses' report to the next caregiver was lacking for 42% of the patients with ulcers regardless of the cognitive function status. In summary, the incidence of pressure ulcers was increased in hip fracture patients with severe cognitive dysfunction. In the acute setting in routine health care, the caregiver needs a validated and feasible instrument for assessing the patient's cognitive function as well as robust criteria for identifying patients at risk for developing pressure ulcers.     

Predicting pressure ulcers: cases missed using a new clinical prediction rule

AIM: The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'. BACKGROUND: Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified. METHODS: Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission. RESULTS: Patients who developed pressure ulcers experienced more problems with 'friction and shear' and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions. CONCLUSION: We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule from patients who were correctly classified as 'not at risk'. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.