Collecting pressure ulcer prevention and management outcomes: 2

The first part of this article (Vol 11(4): 230-8) outlined the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing (PR) beds and mattresses. In addition, it described the methodology of this multinational, multicentre, prospective, non-randomized cohort study designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers. This article reports further details of the characteristics of the 2507 UK adult hospital patients recruited to the study. Over 40% (42% n = 1046) of all subjects were considered to be at an elevated risk of developing ulcers (Waterlow score of 15 or greater) (Waterlow, 1985). Many were inactive with 332 (13%) confined to bed alone with a further 262 (10%) confined to bed and their chair. Most (74% n = 1868) were nursed upon PR beds and mattresses, while fewer subjects were provided with a PR seat cushion (n = 547; 27%). Two hundred and fifty-seven subjects (10%) experienced at least one change of bed mattress during their stay in hospital, with two subjects being nursed on five different mattresses during their hospital stay.     

Collecting pressure ulcer prevention and management outcomes: 1

This article, the first of two parts, presents the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing beds and mattresses. The methodology adopted within a multinational, multicentre, prospective, non-randomized cohort study, designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers, is described. General demographic data and the characteristics of the pressure ulcers experienced by the 2507 UK subjects recruited to the study across four UK hospitals between July 1996 and May 1998 are presented, with pressure ulcers affecting 218 subjects of whom 100 presented with ulcers on admission to hospital. Fourteen subjects developed severe ulcers, while a further 24 were admitted with full-thickness pressure ulcers. The second part of this article will report further details of the characteristics of the UK sample. Future articles will consider the subjects examined in greater detail and will also discuss the combination of this dataset with similar data collected in the USA.     

Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses

The authors have conducted a series of pressure sore prevalence surveys within one health district over a 4-year period. Additional surveys of the availability and deployment of pressure redistributing (PR) bed mattresses have also been made within the same district. The prevalence of pressure sores increased from 6.8% (1986) to 14.2% (1989) while the available stocks of PR mattresses increased from 69 (1987) to 186 (1989). Our results appear to question the common assumption that successful pressure sore prevention can be achieved through expanding the stocks of PR mattresses. Five possible reasons why the increase in mattress provision was matched with an increased prevalence of pressure sores are forwarded. The use of measures of prevalence rather than incidence rates to monitor the effects of clinical initiatives is discussed.     

Use of Pressurease and Airform mattresses in pressure ulcer care

Large cell dynamic air mattresses are effective in the prevention of pressure ulcers but they still have inherent problems, e.g. the ability of the mattresses to move patients along the mattress through the inflation and deflation of the cells. Also, there have been reports that the inflation and deflation of cells can cause motion sickness. This article reviews two mattresses from Sareo Healthcare Ltd: a static system, Pressurease; and a unique dynamic system, Airform. These two systems offer a cost-effective and clinically effective method of pressure ulcer prevention and therapy.     

Alternating pressure air mattresses as prevention for pressure ulcers: a literature review

OBJECTIVES: The purpose of this paper is to examine and synthesise the literature on alternating pressure air mattresses (APAMs) as a preventive measure for pressure ulcers. DESIGN: Literature review. DATA SOURCES: PubMed, Cinahl, Central, Embase, and Medline databases were searched to identify original and relevant articles. Additional publications were retrieved from the references cited in the publications identified during the electronic database search. RESULTS: Thirty-five studies were included. Effectiveness and comfort of APAMs were the main focuses of the studies evaluating APAMs. Pressure ulcer incidence, contact interface pressure, and blood perfusion were the most frequently used outcome measures to evaluate the effectiveness of APAMs. Fifteen randomised controlled trials (RCTs) analysed the pressure ulcer incidence. One RCT compared a standard hospital mattress with an APAM and found that the APAM was a more effective preventive measure. RCTs comparing APAMs with constant-low-air mattresses resulted in conflicting evidence. There was also no clear evidence as to which type of APAM performed better. All RCTs had methodological flaws. The use of contact interface pressure and blood perfusion measurements to evaluate the effectiveness of APAMs is questionable. Comfort of APAMs was the primary outcome measure in only four studies. Different methods for assessment were used and different types of APAMs were evaluated. Better measures for comfort are needed. A few studies discussed technical problems associated with APAMs. Educating nurses in the correct use of APAMs is advisable. CONCLUSION: Taking into account the methodological issues, we can conclude that APAMs are likely to be more effective than standard hospital mattresses. Contact interface pressure and blood perfusion give only a hypothetical conclusion about APAMs' effectiveness. Additional large, high-quality RCTs are needed. No conclusions can be drawn regarding the comfort of APAMs. A number of technical problems associated with APAMs are related to nurses' improper use of the devices.     

全球压疮发生率和现患率分析及启示

介绍了美国、英国、欧洲其他国家压疮发生率和现患率的研究及其结果,认为压疮发生率和现患率不容乐观。简要分析了我国压疮预防的现状,提出迫切需要制定符合我国国情和需要的压疮预防实践指南,迫切需要进行多中心、大样本量的压疮发生率和现患率调研。     

The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients

Aims and objectives. To determine whether use of a risk assessment scale reduces nosocomial pressure ulcers. Background. There is contradictory evidence concerning the validity of risk assessment scales. The interaction of education, clinical judgement and use of risk assessment scales has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Design. Pretest–posttest comparison. Methods. A risk assessment scale namely the Braden was implemented in a group of wards after appropriate education and training of staff in addition to mandatory wound care study days. Another group of staff received the same education programme but did not implement the risk assessment scale and a third group carried on with mandatory study days only. Results. Nosocomial Pressure Ulcer was reduced in all three groups, but the group that implemented the risk assessment scale showed no significant additional improvement. Allowing for age, gender, medical speciality, level of risk and other factors did not explain this lack of improvement. Clinical judgement seemed to be used by nurses to identify patients at high risk to implement appropriate risk reduction strategies such as use of pressure relieving beds. Clinical judgement was not significantly different from the risk assessment scale score in terms of risk evaluation. Conclusions. It is questioned whether the routine use of a risk assessment scale is useful in reducing nosocomial pressure ulcer. It is suggested clinical judgement is as effective as a risk assessment scale in terms of assessing risk (though neither show good sensitivity and specificity) and determining appropriate care. Relevance to clinical practice. Clinical judgement may be as effective as employing a risk assessment scale to assess the risk of pressure ulcers. If this were true it would be simpler and release nursing time for other tasks.     

Improving pressure ulcer prevention through education

Pressure ulcers adversely affect the quality of life of many patients and cause anxiety and distress for their families. Pressure ulcer prevention and management is an integral part of nursing practice, but despite numerous policies and guidelines, research, and improvements in equipment, the incidence and prevalence of pressure ulcers have not fallen. In this article, the author examines issues involved in promoting more effective pressure ulcer management.     

Effective interventions for pressure ulcer prevention

This article examines the causes of pressure ulcers and provides an overview of the best advice available in preventing them in the clinical setting. This should enable nurses to provide more effective interventions for preventing patients from developing pressure ulcers.     

加强压疮预防管理的对策

目的:提高压疮的防治率,最大限度降低压疮的发生率。方法:制定压疮管理措施,应用《褥疮危险因素评估量表》,实施压疮登记预报制度。结果:提高了预防压疮的护理能力和意识,降低了压疮的发生率。结论:预见性地进行有效的健康教育,加强过程管理,保证护理措施的落实,是防治压疮的关键和有效手段。     

Risk factors for pressure ulcer: suggestions for prevention

Pressure ulcers is one of the most severe complication in the spinal cord injured patients begin the prevention aspects and the early identification of the risk factors are imperative action for the nursing assistance of these patients. This study evaluated the nursing care plans for these patients that at the time of the study were already included in the rehabilitation program in order to identify the risk factors for the pressure ulcer development by analysing the nursing documentation adapting the Taxonomy of NANDA. Evaluate the nursing procedures proposed to the diagnosis risk for impaired skin integrity. The identified risk factors are referred to the physical alterations determinate by the neurologic lesion, wound's history and initial lesions. The proposed nursing procedures were sixteen (16) that emphasized patient and family's instructions on body cleaning, position on bed and wheel chair based on the diagnosis established.     

Establishing the cost of comfort. Effectiveness of mattresses in pressure sore prevention.

The treatment of pressure sores exerts a significant drain on NHS resources. Identifying mattresses which help to prevent pressure sores can result in substantial long-term savings.     

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: a review

The formation and underlying causes of pressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with the use of dynamic surfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions--some with more scientific evidence than others.     

E-learning in wound care: developing pressure ulcer prevention education

Patients with pressure ulcers suffer pain and distress from wounds that can require treatment for many months following discharge from hospital (Havard, 2007). This initial and ongoing treatment accounts for around four per cent of the NHS annual budget (Bennett et al, 2004), therefore pressure ulcer prevention and management is beneficial not only to patients but also the NHS. Education for healthcare professionals is an important factor in the prevention and management of pressure ulcers; however, in the current climate releasing staff to attend study days is becoming difficult. In some locations staff have to travel long distances in order to attend while locally-based study days are poorly attended. Developing e-based learning was seen as a realistic option for nurses working in Trust within a large geographical area.     

压疮防护标识及防护方案的设计与使用

制作醒目的压疮防护标识并制订系统的防护方案,总结两者结合应用于糖尿病卧床患者的临床效果,主要有:增强护士、家属及陪护感官刺激及压疮防护意识,掌握患者的皮肤动态,准确实施相应方案,从而有效提高压疮防护水平,预防压疮。