An analysis of epidural related pressure sores in a specific patient population

The objective of this study was to investigate the relationship between post-operative epidural analgesia and incidence of heel pressure sores. The study sample consisted of 53 men and women over the age of 20 years who had major abdominal surgery (mean age 69 years). The main outcome measure was the number of patients who developed any degree of heel sore in the post-operative period. Pressure sore risk assessments were completed by the general surgical nurses with grade of risk recorded. Twenty-one percent of patients in the study developed pressure changes on the skin of their heels; 5.7% developed changes of Grade 2 or worse. Only 10 patients (18.9%) were scored as being at high risk of pressure sores post-operatively. Fifteen (28.3%) patients had no pressure sore risk assessment carried out post-operatively. Ward staff failed to recognise that their patients had been placed at high risk by the use of epidural analgesia post-operatively.     

Prediction of pressure sore development

ABSTRACT. The condition of 515 consecutive patients newly admitted to the long-term medical ward was followed weekly during a 26-week maximum observation period. A modified Norton scale consisting of eight variables and constructed as an additive scale was used. Serum albumin level and skin test on admission supplemented the information about the nutritional state. Eighty-three patients (16%) had skin lesions classified as pressure sores on admission and 39 patients (7.6%) developed pressure sores during the observation period. It could be shown that those who developed pressure sores during the observation period, had a lower functional level when they arrived and that this deteriorated up until the time that the pressure sore was recorded. It could also be demonstrated that low serum albumin and anergy, as indicators of poor nutritional status, had value as predictors for the development of pressure lesions. General physical condition, activity, mobility and nutritional status appear to be the most important factors in the development of pressure sores in this study. The systematic planning of care with special emphasis on the four above-named risk factors, can probably decrease the risk for the development of pressure sores.     

Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools.

Patients in intensive care units (ICU) are at high risk of developing pressure sores and the use of pressure sore risk tools has been advocated as a means of identifying patients at risk. A prospective multi-site observational study was conducted to define the incidence of pressure sores, assess two pressure sore risk scales and to define risk factors relevant to intensive care. Patients (n = 534) were assessed for the presence of pressure sores. The Waterlow and Jackson/Cubbin risk scales were completed each day for 314 and 188 of these patients respectively. A total of 75 pressure sores were recorded. Of these, 34 were present on admission. Of the remaining 41, 16 were classified as Grade 1 and 24 as Grade 2 sores. The pressure sore (PS) incidence was 5.2 per cent. Expressed as PS/1000 patient days there were 18.48 pressure sores per 1000 patient days. The ability of the risk scores to predict pressure sores was tested using a Receiver Operating Characteristic (ROC) analysis. The association of risk score with pressure sores was analysed using a survival function (Kaplan Meier) and variables compared using a logrank test (Mantel-Cox). Factors associated with pressure sore occurrence were developed and tested using a survival regression model. Both risk scales were poor predictors of pressure sores (ROC curve area approximately 70 per cent for both). The factors, coma/unresponsiveness/paralysed & sedated and cardiovascular instability were significantly associated with pressure sores with relative risks of 4.2 and 2.5 respectively. Risk increased as a function of time such that the cumulative risk was 50 per cent at 20 days.     

Patients admitted with decubital lesions: the experience of the Milanese hospital in Garbagnate

Patients may develop a pressure sore while in hospital, but some are admitted with a pressure sore. In Garbagnate hospital all patients are assessed for the risk of pressure sores. The ad hoc forms of patients with multiple lesions, in very poor conditions and with "sentinel" symptoms such as poor hygiene, malnutrition, bruises, are specifically assessed and further data from the head nurse and the family are collected to understand and reconstruct the patients' stories. From January 1999, 26 patients with pressure sores were admitted; 80% were over 75 years: 42.4% came from their homes and 7 from nursing homes. Half of the patients presented severe malnutrition. All the cases had some common characteristics: lack of well defined management of pressure sores; delays in the requests for special mattresses due to lack of attention or bureaucratic problems; or use of ineffective treatments or medications; lack of contacts between hospital and district, leading to a fragmented patient care. Two of the 26 cases are presented and their significance discussed in details.     

The Use of the Modified Norton Scale in Nursing-Home Patients

Patients in three nursing-home wards in Sweden were in 1991 assessed by the Modified Norton Scale (MNS). Of the 71 patients, 38 (49%) were considered to be at risk of developing pressure sores. Six of the patients had a total of eight pressure sores. Five sores were assessed as stage II, two sores as stage III and one sore as stage IV. Only two of the six patients with pressure sores had any preventive equipment in their beds. The nursing and medical documentation of the existing pressure sores was not satisfactory. Individual programs for skin care and routine assessment with a pressure sore prediction instrument, such as the MNS, would serve the dual purpose of directing the relevant measures to the patient groups at the greatest risk and would aid in assessing the efficacy of pressure sore treatment strategies.     

非长期卧床患者发生压疮原因分析及对策

目的总结分析临床非长期卧床患者被动发现压疮的原因,并提出针对性对策。方法回顾性分析2003年4月-2007年8月在本院住院的17例非卧床发生压疮患者的临床资料,应用Norton量表对压疮进行评分,分析发生压疮的原因。结果Norton量表评分轻度危险11例、中度危险5例、重度危险1例,通过局部清创、全身营养等支持治疗和护理,除1例患者病情恶化死亡外,其他患者压疮均得到有效控制或治愈。结论加强压疮相关知识培训,以《压疮危险因素评估表》为依据,对患者做好连续评估和分期护理,重视特殊部位皮肤交接班,可以及时、主动发现压疮,积极干预,及时控制患者压疮的发展,减少患者的痛苦。     

Monitoring the pressure sore problem in a teaching hospital

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in-patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme     

主要照顾者压疮类现场管理平台在高龄压疮高危患者中的应用

目的 观察主要照顾者压疮类现场管理平台在高龄压疮高危患者中的应用效果。 方法选择主要照顾者压疮类现场管理平台应用前(2016年7-12月)和应用后(2017年1-6月)于我院出院并诊断为高龄压疮的高危患者作为研究对象,分别设为对照组与观察组各40例。对照组接受常规护理,观察组在此基础上加用主要照顾者压疮类现场管理平台干预,比较2组压疮发生率及主要照顾者压疮知识和压疮照顾行为。 结果 出院6个月时,观察组照顾者的压疮知识与压疮照顾行为评分均显著高于对照组(t=10.240,P<0.001; t=10.513,P<0.001),观察组出院后6个月内压疮发生率低于对照组(χ²=4.507,P=0.034)。 结论 采用压疮类现场管理平台对高龄压疮高危患者的照顾者施加干预,可显著提高照顾者压疮知识水平与压疮照顾行为能力,降低压疮的发生率。     

Clinical evaluation of an electronic pressure-relieving mattress

A 12-month clinical evaluation of the Talley Quattro Deep Cell 2000 mattress manufactured by Talley Medical was undertaken on both a trauma and surgical ward at the Royal Devon and Exeter Hospital. An identified registered nurse coordinated the evaluation with support from tissue viability clinical nurse specialists. Data on patients, including diagnosis, Waterlow score, pressure area condition and general comments by nurses and patients, were collected. The evaluation involved 35 patients who were at high- to very-high risk of pressure sore formation. The results showed that 16 out of 40 sores healed during the evaluation period and 16 sores remained unchanged. Only one patient developed broken skin while nursed on the mattress. Seventeen patients maintained tissue integrity. Although the study was limited the results suggest that the Talley Quattro Deep Cell 2000 mattress is useful in preventing and managing pressure sores in high- to very high-risk patients.     

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective:To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions.Methods:A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature.After being examined and validated by experts,the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital.Among the 47 patients enrolled into the study,the 14 who developed nosocomial pressure sores were allocated to the pressure sore group,and the remaining33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group.Univariate and multivariate logistic regression analyses were employed to examine the differences in22 indicators between the two groups in an attempt to identify the risk factors for pressure sores.Results:According to the univariate analyses,the maximum value of lactic acid in the arterial blood,the number of days of norepinephrine use,the number of days of mechanical ventilation,the number of days of blood purification,and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group(P0.05).The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores(P0.05).Conclusions:The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock.The adoption of measures specific to high-risk patient groups and risk factors,including the active control of primary diseases and the application of decompression measures during the treatment of the patients,are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.     

Pressure sore prevalence within a public health services area

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure‐sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure‐sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.     

压疮高危患者临床特征及危险因素分析

目的分析压疮高危患者的临床特征、管理现状及高危患者压疮发生的影响因素,探讨切实的压疮预防对策。方法采用压疮危险因素评估表筛选压疮高惫患者,并对其临床特征、压疮发生的危险因素和管理现状进行分析。结果2007年3-12月共有315例压疮高危患者,以ICU分布最多,占32．4％,其次为神经外科,占18．74％;初评分（16．91&#177;2．29）分;压疮高危期持续时间（13．00&#177;18．00）d;315例压疮高危患者中共发生压疮19例。高危期持续时间是高危患者发生压疮的危险因素,意识清醒、扶助行走、体温正常和压疮终评分是发生压疮的保护因素。压疮高危患者管理中仍存在忽视高危患者家属教育及预防措施落实、记录不全等问题。结论重视ICU等压疮高危高发科室和压疮高危持续期长患者的管理,根据压疮发生的危险因素科学定义难免压疮,建立护理会诊制度和压疮护理指南等规范压疮高危患者的过程管理,可有效预防和减少压疮的发生。     

The clinical relevance of the waterlow pressure sore risk scale in the ICU

Objective: To evaluate whether the Waterlow pressure sore risk (PSR) scale has prognostic significance for intensive care patients. Design: A prospective study. Setting: The surgical intensive care unit (ICU) of the University Hospital Rotterdam. Patients: Data were evaluated from 594 patients who had been admitted to the ICU during the year 1994. Methods and results: Each patient was assessed daily with respect to their Waterlow PSR score and the development of pressure sores in the sacral region. Actuarial statistical methods were used to analyse the predictive value of the risk score. When a patient had a Waterlow PSR score > 25 on admission, the risk of developing a pressure sore was significantly increased compared to patients with a PSR score < 25. After admission, the daily Waterlow PSR scores obtained were significantly associated with the risk of developing a pressure sore. For each additional point this risk increased by 23 % (95 % confidence interval 17 to 28 %). Conclusions: The Waterlow PSR scale provides the medical and nursing staff at an early stage with reliable information about the risk patients have in developing a pressure sore. Received: 8 August 1997 Accepted: 24 April 1998     

La escala APACHE III: un factor pronóstico en la aparición de úlceras por presión en una Unidad de Cuidados Intensivos

ObjectiveTo analyze total APACHE III score association to pressure ulcers development in patients hospitalized in an intensive care unit (ICU).Material and methodsProspective cohort study conducted in an intensive care unit of the Hospital General de VIC. All the patients hospitalized between January 2001 to December 2001 were enrolled. Age, gender, length of stay, total Norton and APACHE III score and pressure sore development were collected.ResultsPressure sore incidence was 12.5% of the patients. The factors were significantly associated with the appearance of pressure sores in those patients with a length of stay in the intensive care unit, total Norton and severity of the disease measured by the APACHE III score. Patients having the greatest risk of pressure ulcers development were those whose Norton score was less than or equal to 14, and an APACHE III score higher than or equal to 50 (Odds Ratio: 37.9, 95% CI 11.16-128.47)ConclusionThe severity of the diseases measured with the APACHE III scale showed a relationship with the appearance of in-hospital pressure ulcers.The joint use of the APACHE III and Norton scale could be a good strategy to detect patients with very high risk of suffering pressure sores.     

风险管理策略在预防压疮中的应用

[目的]探讨对高危皮肤病人实施风险管理的实用价值.[方法]采用风险管理策略,制定压疮风险管理流程,对皮肤风险进行评估.[结果]98例病人中,96例未发生压疮,2例系院外转入,采用风险管理策略后,压疮痊愈出院.[结论]实施风险管理可增强护理人员的风险意识,是杜绝或减少压疮发生的有效措施.     

Pressure Sores and Pressure Sore Prevention in a Rehabilitation Setting: Building Information for Improving Outcomes and Allocating Resources

Quantifiable information regarding pressure sore prevention and management is a prerequisite for program development, outcome evaluation, and resource allocation. In this study, all patients admitted to an acute rehabilitation setting (N = 446) during a 2-month period were assessed for the presence of a pressure sore, the risk for developing a pressure sore, the rate of agreement between “objective” (Braden scale) and “subjective” (standard nursing admission data) measures of risk and outcome, and the status of pressure sores at discharge. This article provides the details of the project and implications for rehabilitation nursing practice.     

Setting the standard for pressure sore prevention on a trauma orthopaedic ward

This article describes an innovation used to tackle the problem of high prevalence and severity of pressure sores on an orthopaedic trauma ward. Simple data from the pressure sore prevalence survey were used to build the case and provide the rationale for action. Actions taken included targeting the elderly with hip fractures and having the prevention strategy start in Accident and Emergency (A&E) Department. A standard with a monitoring tool was devised at ward level to review and monitor our practice in pressure sore prevention. This has resulted in the reduction of the prevalence rate of pressure sores on the ward from 21% to 8% over four years. The severity of pressure sores also decreased.     

压疮高危病人护理质量的全程控制

目的探讨压疮高危病人的护理质量控制方法，提高护理质量，降低压疮发生率。方法2006年1月成立匿疮管理指导小组，对预报高危的病人进行床边核查，每月随机榆查在院的离危病人护理质量，运用质量持续改进流程纠正护理中的不足，对发生压疮的病人进行跟踪观察，指导、会诊等。结果537例预报高危的病人中37例发生压疮，发生率为6．9％，低于同类报道；高危病人护理质量均合格。护理人员熟练掌握评估工具的使用。结论对压疮高危病人护理质量进行全程控制，能提高卧床病人的基础护理质量，促进护士列压疮的预防知识和技术的掌握与应用，保证预防措施落实到垃，降低高危病人压疮发生率。