The identification of older nursing home residents vulnerable for deterioration of grade 1 pressure ulcers

Aims and objective. The objective of this study was to identify prognostic factors associated with the development of pressure ulcer lesions (grade 2–4) in nursing home patients with non‐blanchable erythema. Background. No studies could be found that identify risk factors for further development of pressure ulcer in patients with non‐blanchable erythema. For some patients with non‐blanchable erythema, standard preventive measures do not suffice to prevent pressure ulcers from deterioration. Identifying these patients beforehand can considerably contribute to the efficiency of pressure ulcer prevention. Design. Secondary data analyses of a previously conducted randomised controlled trial were performed. Methods. Eighty‐four wards of 16 Belgian nursing homes participated in the study. In total, 235 nursing home residents with a grade 1 pressure ulcer (non‐blanchable erythema) were included. All the residents received standard preventive care. Potential prognostic factors were collected using a standardised form. The incidence of pressure ulcers was recorded according to the European pressure ulcer classification system. Results. The cumulative pressure ulcer incidence was 18·7% (44/235). Hypotension (relative risk = 3·42, 95% CI = 1·56–7·49), a history of a cerebral vascular accident (relative risk = 1·94, 95% CI = 1·10–3·70) and contractures (relative risk = 2·02, 95% CI 1·03–3·95) were identified as independent predictive factors for developing pressure ulcers. Remarkably, being urinary incontinent decreased the risk of developing a pressure ulcer by 76%. Conclusions. In nursing home residents with non‐blanchable erythema, hypotension, contractures, and a history of cerebral vascular accident were independent risk factors for the development of pressure ulcer lesions. Relevance to clinical practice. Patients with non‐blanchable erythema who have hypotension, contractures or a history of cerebral vascular accident are in need of more intensive preventive measures. Identifying these patients can contribute considerably to a more efficient pressure ulcer prevention policy, resulting in a lower pressure ulcer lesion incidence and in lower costs.     

ICU患者压疮发生危险因素分析

目的：探讨导致ICU患者压疮发生的危险因素。方法：采用自行设计的“ICU患者压疮风险因素调查表”记录735例ICU患者的患病情况、主要治疗情况等资料。结果：性别、糖尿病、脑卒中、入ICU时间、是否持续进行动脉血压监测、水肿、平均动脉压、乳酸Lac、心率、Apachell评分是ICU患者发生压疮的影响因素。结论：ICU患者压疮发生是多因素共同参与的病理生理过程,护理人员应充分认识各种危险因素对ICU患者发生压疮的影响,对存在或可能存在危险因素的ICU患者实施重点防护以减少压疮的发生。     

肌皮瓣转移术治疗截瘫患者骶尾部压疮的围术期护理

目的探讨肌皮瓣转移术治疗截瘫患者骶尾部压疮的围术期护理方法及效果。方法回顾2009年1月~2011年8月采用肌皮瓣转移术治疗的9例截瘫患者骶尾部Ⅲ°压疮病例,均运用了规范化围术期护理,重点加强患者的心理护理、体位训练、皮瓣血运的观察及健康教育。结果随访3~12个月,本组9例患者通过肌皮瓣转移术治疗骶尾部压疮全部存活。结论围术期规范化护理为肌皮瓣转移术治疗截瘫患者骶尾部压疮提供了良好的疗效保障,可提高皮瓣存活率。     

压疮护理新进展

压疮的发生存在多种危险因素且彼此相互影响.结合近年来压疮发展各方面观念的转变,从压疮主要危险因素、发病机理和治疗护理方法等方面进行综述,认为压疮应重在预防并体现因素完整性和人群针对性.     

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.     

The prevalence of pressure ulcers in four paediatric institutions

Aim and objective. Pressure ulcers are a common nursing care issue in hospitals. They are associated with psychological and physical suffering, an increased morbidity and mortality rate and higher overall health care costs. The aim of the current study is to describe the frequency of pressure ulcers in a paediatric care setting and to identify the population at risk, as well as to assess the factors predisposing to the development of pressure ulcers. Design. A point prevalence study. Methods. The study was conducted in four paediatric hospitals in the German‐speaking part of Switzerland and included children from the age of 0–18 years. The method of data collection was a direct systematic inspection and assessment of the skin, taking into account the clinical condition of the patient for risk assessment. A valid risk assessment and data collection instrument was used and, each patient was assessed by a previously instructed rater pair. Results. Of all possible patients, 81% (n = 155) were included. An overall pressure ulcer prevalence of 27·7% (including grade 1) was registered. Thirty‐six patients (84%) had grade 1 ulcers, including many caused by external medical devices. Sixty‐five per cent (n = 100) of all patients were considered at risk (Braden score ≤ 20) of developing a pressure ulcer. Thirty‐five per cent of patients in the risk group were afflicted with one or more pressure ulcers. Conclusions. The prevalence of pressure ulcers in paediatric patients is greater then previously appreciated and the problem requires further exploration. The high percentage of grade 1 pressure ulcers caused by medical devices requires nursing interventions to prevent lesions for these patients. Relevance to clinical practice. The high prevalence rate in paediatric patients is disconcerting and requires further exploration in terms of interventions needed to improve outcomes for this patient group.     

小组责任制护理在社区压疮居家防治中的应用

目的探讨小组责任制护理形式在社区压疮居家防治中的应用效果。方法成立压疮专业小组,明确成员职责分工,制订社区压疮居家防治的护理流程、实施方法、质量监控措施,为社区居家卧床的压疮患者提供科学、连续的健康照护。结果 2013年7月至2015年6月进行压疮居家防治的患者165人,伤口数量为299个,伤口治愈率55.85%,新发压疮率6.06%,低于实施前的59.65%(P0.01)。结论小组责任制护理形式应用于社区压疮居家防治,提高了社区护理质量和工作效率,降低了新压疮发生率。     

老年神经内科住院患者的压疮危险因素分析及护理对策

目的探讨老年神经内科住院患者的压疮危险因素及相关护理干预对策。方法回顾性分析在老年神经内科住院治疗的100例高龄患者的临床资料,评估每位患者的年龄、营养状况、合并症、医疗器械相关性因素(留置胃管、导尿管、PICC管、气管插管、呼吸机管路等及使用心电监护仪器等)以及Norton量表,将2015年2—12月的51例患者纳入对照组,将2016年1—9月的49例患者纳入观察组,对照组采用常规护理,观察组在此基础上由压疮监控管理小组制定管理流程,护理人员接受压疮知识培训后对患者实施个性化、预见性护理措施,比较2组Norton量表评分、压疮发生率以及患者满意度等。结果老年性痴呆、医疗器械相关性因素、低BMI以及贫血是高龄患者发生压疮的独立危险因素;观察组Norton评分、压疮发生率均低于对照组(P0.05);观察组患者及家属满意度高于对照组(P0.05)。结论老年性痴呆、医疗器械相关性因素、低BMI以及贫血是高龄患者发生压疮的独立危险因素,对老年神经内科住院压疮高危患者采取监控管理及预见性护理措施,可有效降低压疮风险和发生率,提高患者及家属满意度。