基于JCI标准的医院压疮现患率和院内压疮发生率调查

目的监测分析我院压疮现患率和院内压疮发生率的基线资料和变化趋势,促进压疮护理质量改进,降低压疮发生率。方法采用JCI（I-NSC-2）和NDNQI中的压疮事件数据收集工具,每季度对住院患者压疮现患率和院内压疮发生率进行横断面调查。结果我院压疮现患率为1．36％～2．63％,院内压疮发生率0．45％～1．13％;监护室的压疮现患率为10．53％～29．41％,院内压疮发生率为5．00％～15．69％,为我院的压疮高发部门。结论监护室的压疮预防应作为医院护理质量改进的重点项目,要重视监护室的质量监控;定期开展医院压疮现患率和院内压疮发生率的调查,可获得压疮护理质量监控的基线数据和变化趋势,为今后评价和研究压疮护理质量提供依据。     

Getting evidence‐based pressure ulcer prevention into practice: a multi‐faceted unit‐tailored intervention in a hospital setting

The aim of the study was to evaluate whether a multi‐faceted, unit‐tailored intervention using evidenced‐based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi‐experimental, clustered pre‐ and post‐test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi‐professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre‐ and post‐test surveys. This multi‐faceted unit‐tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.     

The economics of preventing and treating pressure ulcers: a pilot study

A pilot economic evaluation of a projected pressure ulcer prevention policy was carried out in a 252-bed geriatric unit in Glasgow. The aim was to set up a framework for evaluating and comparing the costs and benefits of current care and a potential prevention programme. Data were collated from prevalence and incidence studies. Prevalence results showed that 41% of the patient population suffered pressure damage to some extent and incidence data showed that 45% of these were potentially preventable. Evaluation of the costs and benefits shows that the prevention programme would be cost-effective. The cost would be between 17,606 Pounds and 28,669 Pounds but the benefits would range from 305,506 Pounds to 342,510 Pounds. The authors conclude that economic appraisal is feasible.     

Critical care nurses' knowledge about pressure ulcer in southeast of Iran

Pressure ulcer prevention needs nurses' awareness of sore classification/onset, its item characteristics, and its prevention. Using Pieper's Pressure Ulcer Knowledge Test, 126 critical care nurses' knowledge about pressure ulcer was examined. The questionnaire was divided into three categories including: (1) sore classification/onset; (2) wound characteristics, and (3) preventive measure. The level of nurse's knowledge was insufficient. The highest rate of correct answers belonged to section 2 - prevention of pressure ulcer. Programs aimed at raising nurses' knowledge accompanied by interventions intended to decrease incidence of pressure ulcer are important parts in educational programs. Continuing education may need to be added to the pressure ulcer care to improve the quality of care at intensive care units.     

EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators.

OBJECTIVE: The aim of this study was to determine the effects of quality improvement programs for pressure ulcer prevention by conducting a follow-up survey in a hospital in Sweden. DESIGN: A cross-sectional survey design with comparison between data collected in 2002 and 2004. SETTING AND SUBJECTS: All inpatient areas were surveyed in the surgical, medical, and geriatric departments in a university hospital. A total of 369 patients were included. INSTRUMENTS: The European Pressure Ulcer Advisory Panel data collection form including some additional questions. METHODS: The 1-day survey was conducted on March 23, 2004. Each patient was visited by 2 registered nurses, who inspected the patient's skin for any pressure ulcer classified according to the EPUAP grading system. RESULTS: There were no significant differences in gender, age, or Braden score between the patients in surgical, medical, or geriatric care in 2002 and 2004. The overall prevalence of pressure ulcers was 33.3% (grade 1 excluded: 10.9%) in 2002 and 28.2% (grade 1 excluded: 14.1%) in 2004. In surgical care, the prevalence was reduced from 26.8% to 17.3% (P = .051). In medical care, the prevalence was 23.6% in 2002 and 26.7% in 2004. Corresponding prevalence figures for geriatric care were 59.3% and 50.0%. A quarter of the patients in surgical care, a third in medical care, and more than half in geriatric care had a pressure ulcer upon arrival at the ward. The use of pressure-reducing mattresses had increased significantly from 16.0% to 42.7% in medical care (P = .000). CONCLUSIONS: The EPUAP methodology has facilitated the introduction of pressure ulcer as a quality indicator at hospital level. Pressure ulcer prevalence surveys with a standardized methodology should be repeated on a regular basis in order to stimulate quality improvement.     

Use of a sacral silicone border foam dressing as one component of a pressure ulcer prevention program in an intensive care unit setting

In 2008, patients in the intensive care unit (ICU) at Danbury Hospital, Danbury, Connecticut, experienced 79 pressure ulcers. As a result, pressure ulcer-prevention interventions were standardized in critical care and medical-surgical units and education was provided to all direct patient care staff about principles of skin care and prevention. Following these efforts, 53 ICU patients developed pressure ulcers in the sacral area in fiscal year 2009, representing a 12.5% incidence for the ICU as compared to a 3.4% overall pressure ulcer incidence for the total hospital. In order to achieve additional reduction in pressure ulcer incidence, we replicated an initiative that called for application of a silicone foam dressing every 3 days to determine its effect on sacral pressure ulcer incidence in the ICU. We found that the use of the dressing further diminished the incidence of sacral pressure ulcers in our patients.     

Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9‐year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual‐care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital‐acquired pressure ulcers decreased following implementation of an evidence‐based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual‐care nurses under‐estimated patients' risk of pressure ulcer development and under‐utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital‐acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.     

Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings

Mucous membrane pressure injury (MMPI) is associated with a history of medical device use at the site of injury. The current international guideline recommends they should be reported in incidence and prevalence studies. The aim of this systematic review was to analyse the incidence and prevalence of hospital‐acquired MMPI in adults admitted to acute hospital settings. Database searches (EBSCO CINAHL Complete, EBSCO Medline Complete, Embase, Scopus and Web of Science) were undertaken between October 2019 and February 2021, using search terms related to hospital‐acquired, mucosal and device‐related pressure injury/ulcer incidence and prevalence. Searches were limited to the English language. Articles published between 2008 and 2020, reporting incidence or prevalence of mucous membrane or medical device‐related pressure injury in non‐interventional samples were selected. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. Twenty‐one studies met inclusion criteria; most provided incidence data. No studies were found that specifically reported MMPI incidence or prevalence. It was possible to calculate incidence or prevalence from four studies; all were in intensive care settings. MMPI incidence of 0.8% and 30.4%, and prevalence of 1.7% and 3.7% were found. One study provided data that enabled calculation of prevalence of 0.1% in a non‐intensive care sample. Only one other study provided specific data about MMPI. It is concluded that there is insufficient evidence available to enable estimation of MMPI incidence or prevalence in either acute hospital or intensive care settings.     

A national study of pressure ulcer prevalence and incidence in acute care hospitals.

OBJECTIVE: This study sought to establish national benchmarks for pressure ulcer prevalence and incidence among acute care health organizations served by Novation LLC. SETTING AND SUBJECTS: One hundred sixteen acute care facilities from 34 states participated; the sample consisted of 17,560 patients in hospital-based medical-surgical or intensive care units. INSTRUMENTS: Standardized education kits were provided to each participating site. The kits included an educational video about pressure ulcer staging, a post-test and answer key, and assessment form for patient data collection. METHODS: Pressure ulcer prevalence was measured during a predetermined 24-hour period at each facility. Incidence was measured over the average length of stay determined for each participating facility. Subjects were assessed by teams consisting of a registered nurse and one other health care professional (e.g. licensed practical nurse, physical therapist). Demographic, wound, and other data were collected for these patients. Data collection forms were audited and submitted to a central site for database entry, analysis, and generation of reports. RESULTS: The average length of stay for the participating facilities was 5 days. Pressure ulcers developed in 7% of the subjects (n = 383); 90% were stage I or II pressure ulcers, and 73% occurred in patients older than 65 years. The most sites based on both prevalence and incidence measurements were the sacrum and coccyx at 26% and 31%, respectively. CONCLUSIONS: Prevalence and incidence studies must be routinely conducted to clearly identify the extent of the pressure ulcer problem to provide guidance for efficient and effective corrective action.     

Pressure ulcers in four Indonesian hospitals: prevalence,patient characteristics,ulcer characteristics,prevention and treatment

The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross‐sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety‐one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I–IV pressure ulcers was 8·0% (95% CI 6·4–9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3–5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline‐impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence‐based international guideline.     

Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as the foundation for future quality improvement

The objectives of the study were to examine the prevalence of pressure ulcers and hospital-acquired pressure ulcers (HAPU) and identify modifiable factors in patients who develop HAPU as the basis for subsequent quality assurance studies and improvement in hospital care. The study was conducted in five hospitals in two Swedish County Councils. A 1-day prevalence study (n = 1192) using the standards of the European Pressure Ulcer Advisory Panel and Collaborative Alliance for Nursing Outcomes was conducted. The prevalence of ulcers was 14·9% and 11·6% were HAPU. Older age, more days of hospitalisation, less activity, problems with shear and friction and reduced sensory perception contributed significantly to HAPU. Pressure ulcer prevention strategies used more often in those with HAPU were risk assessment at admission, provision of a pressure relief mattress, having a turning schedule and using a heel or chair cushion. The prevalence of pressure ulcers continues to be a significant issue in acute care and the prevalence of HAPU is high. There is significant room for quality improvement in pressure ulcer prevention in Swedish hospitals. Future research needs to address both HAPU and community-acquired pressure ulcers and focus on preventive strategies, including when they are initiated and which are effective in mitigating the high HAPU rate.     

Use of a total quality management model to reduce pressure ulcer prevalence in the acute care setting

As the population ages and becomes more frail, pressure ulcer prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. All patients on the adult medical, surgical, and critical care units were examined regularly by the “Rear Admirals,” a team comprising a skin care resource person and a nursing unit representative. The Total Quality Management model, characterized by the phrase “Plan-Do-Check-Act,” was used to address barriers to quality care. Findings during that time prompted changes in policies, products, protocols, work assignments, and documentation tools. The outcomes achieved demonstrate the effectiveness of those strategies. After implementation of the Total Quality Management model at our institution, the prevalence of patients with nosocomial pressure ulcers was reduced by 83%.     

Clinical trial of a prevention and treatment protocol for skin breakdown in two nursing homes.

OBJECTIVE: Our objective was to assess the effectiveness of skin care protocols, including a body wash and skin protectant, on skin breakdown in 2 nursing homes. DESIGN: This was a quasi-experimental pretest/posttest design study.Setting and subjects Adult residents (n = 136) of 2 skilled nursing homes consented to participate in this study. Seventy percent were women; the sample average age of 82 years. INSTRUMENTS: A researcher-designed data recording form documented resident demographics, incidence and type of skin breakdown or pressure ulcer, presence of urinary or fecal incontinence, and assessment of the effectiveness of body wash and skin protectant. METHODS: Baseline data on prevalence of pressure ulcers and skin protocol were collected weekly for a 3-month period followed by a week-long educational program by the researchers about skin care and the body wash and skin protectant. During the 3-month trial with the body wash and skin protectant incorporated into routine care, research assistants recorded resident data weekly and researchers again assessed prevalence and incidence of pressure ulcers and skin breakdown weekly. RESULTS: Incorporation of a body wash and skin protectant into a skin care prevention and early intervention protocol in 2 nursing homes documented a decrease in skin breakdowns from 68 pre-intervention to 40 postintervention; the decrease in agency B was statistically significant. There was a statistically significant decrease in stage I and II pressure ulcer incidence overall (pre-intervention = 19.9%, postintervention = 8.1%). Nurses evaluated the body wash and skin protectant as effective for 98% of the time used. CONCLUSION: Implementation of a protocol for skin care along with staff education, including the prophylactic use of a body wash and skin protectant, reduced the incidence of skin breakdown, including pressure ulcers and perineal dermatitis, in 2 long-term care facilities.     

Pressure ulcer prevention: nurses' knowledge, attitudes and behaviour

Despite the increased expenditure on pressure ulcer prevention strategies, incidence and prevalence is increasing. Exploring nurses' attitudes about these programmes offers an insight into why, in some cases, they are not working.     

Prevalence, incidence, and prediction of pressure ulcers on a rehabilitation unit.

OBJECTIVE: This retrospective chart review study was conducted to determine the prevalence and incidence of pressure ulcers, and the contribution of known risk factors toward the predicted occurrence of pressure ulcers in a long-term rehabilitation setting. SUBJECTS AND SETTING: A continuous series of 170 adult men with a mean age of 69.2 years were studied during a 1-year period. METHODS: Patient charts were reviewed retrospectively for risk factors and documentation of pressure ulcer development by 1 researcher on a data recording form. RESULTS: The pressure ulcer prevalence was 12% and the incidence over the 1-year observation period 6%. Using the odds ratio test, significant risk factors in the sample were identified as hypoalbuminemia (odds ratio = 11:1), low diastolic blood pressure (odds ratio = 4.6:1), stool and urine incontinence (odds ratio = 1.5:1), and peripheral edema (odds ratio = 3.5:1). CONCLUSION: Specific characteristics in this sample of patients in a long-term rehabilitation center contributed to the increased risk for pressure ulcer development. Risk assessment based on knowledge of specific risk factors, prevention, and early intervention is crucial to lowering the prevalence and incidence of pressure ulcers in this setting.     

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study

Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi‐centre, one‐day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU‐acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU‐acquired pressure injuries were at stage I, one‐fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air‐filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU‐acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.     

实施压疮患病率调查持续改进压疮管理

目的了解住院患者压疮患病率,为压疮管理及监测提供依据。方法采用修正的美国护士协会护理质量指征委员会设计的压疮患病率调查表,组织伤口小组成员、科护士长、护士长和护理研究生组成的30个小组对1所三级甲等医院61个病区的2913例患者进行调查。结果住院患者压疮患病率为1．78％,院内压疮患病率为1．54％,排除Ⅰ期压疮（28例）,压疮患病率为0．82％;168例患者有压疮风险评估和复评,其中压疮患病39例,占23．21％;135例有采取减压措施的护理记录,仍发生压疮36倒,占26．67％;197例患者采取了压疮预防措施,其中135例（68．53％）有压疮风险评估。结论住院患者压疮患病率低于国外相关研究,护理人员执行压疮护理记录意识欠缺。护理管理者需转变管理理念,建立非惩罚性压疮管理制度;正确认识压疮患病率,加强过程管理;完善压疮监控制度,提升压疮护理水平。