社区居家卧床患者压疮管理质量评价指标的构建

目的构建社区居家卧床患者压疮管理质量评价指标,以规范性评价社区居家卧床患者压疮管理质量。方法查阅国内外文献、小组讨论,形成社区压疮管理质量评价指标问卷,采用Delphi法对15名专家进行2轮咨询。结果构建的社区居家卧床患者压疮管理质量评价指标包括一级指标3项,二级指标11项,三级指标32项;专家的权威系数为0.794;2轮三级指标的协调系数分别为0.613、0.622(均P0.01)。结论社区居家卧床患者压疮管理质量评价指标及其内容可靠,经目标人群(大样本)验证后,可用于社区压疮护理质量的评价。     

某三级甲等综合医院住院患者压疮连续4年监测分析

目的分析某三级甲等综合医院住院患者压疮发生、预防及治疗效果,为医院压疮的管理提供基础数据和借鉴。方法收集2008～2011年某三级甲等综合医院住院患者压疮发生及转归资料,进行压疮发生率、来源、专科分布、发生部位、分期、治疗效果、季节分布以及高危者压疮发生率分析。结果2008～2011年压疮发生率0.86%～1.25%(平均0.99%);医院外带入压疮占压疮总数的69.87%,医院内发生占30.13%;急危重症科压疮的发生率最高,为5.59%,康复科次之,为3.37%;发生部位以骶尾部最多,占压疮数的37.92%,双足跟次之,占11.80%;出院患者压疮未明显改善占39.08%,好转次之,为30.68%;压疮发生季节以春季发生率最高,为1.16%,冬季次之,为1.01%;压疮风险评估高危者占压疮总数的88.19%,中、低危者占11.81%;压疮评分高风险患者压疮总发生率为18.11%,未发生压疮者为81.89%。结论该医院住院患者压疮发生率呈中等水平和下降趋势,以医院外发生为主,医院内压疮主要来自压疮风险评估高危者。压疮高发病区为急危重症患者多的科室,高发部位为骶尾部,足跟部次之;春冬季多于夏秋季。压疮患者在住院期间转归较差,应采取压疮预警管理以提高压疮预防效果。     

压疮高危因素的量化评价

目的 通过量化评价压疮高危因素及护理会诊,降低压疮的院内发生率.方法 制订压疮高危因素量化评价记录表,对332例压疮高危患者的皮肤情况进行监控,并进行前瞻性会诊,给予皮肤护理和制订压疮个体化预防方案,采取有效的护理措施.结果 332例压疮高危患者中,发生压疮7例(2.1%),与2000～2002年(6.1%)比较,下降了4.0%.结论 对压疮高危患者及时评估并填报压疮高危因素量化评价记录表,并采取相应措施,可有效降低压疮发生率,亦使基础护理质量得到持续改进.     

集束化护理在骨科压疮高危患者管理中的应用

【摘要】目的 探索集束化护理对骨科压疮高危患者的护理效果。方法 将2015年9月～2016年9月入院的126例骨科压疮高危患者,按入院的先后顺序分为两组,其中对照组69例,研究组57例,对照组采取常规压疮预防措施,研究组采取集束化护理。结果 对照组69例,53例有效,有效率76.81%,压疮发生率17.39%;研究组57例,49例有效,有效率是85.96%,压疮发生率5.26%。两组差异显著（P<0.05）。结论 集束化护理能提高骨科压疮高危患者护理有效率、降低压疮发生率。     

基于闭环管理的压疮系统构建

目的优化压疮管理流程,做到环节管理及质量持续改进。方法在医院信息系统(HIS)建立压疮管理模块,与6级电子病历有效结合,通过压疮监控模块筛查高危患者并进行预警提示,对不同来源压疮数据信息上报,并记录治疗护理措施、压疮愈合等情况。结果实施压疮闭环管理后,2013~2015年压疮发生率分别为0.06%、0.06%、0.08%,低于国内12所医院的调研结果。结论压疮闭环管理体系的构建能够科学分析压疮发生现状,对治疗护理过程中存在的问题进行整改,进而提高压疮护理和管理质量。     

家庭护理干预对晚期老年痴呆患者家居安全及并发症的影响

目的探讨提高晚期老年痴呆患者家居安全,减少并发症发生率的有效方法。方法将47例晚期老年痴呆患者随机分为观察组24例,对照组23例。对照组采用常规出院指导,出院后不进行护理干预;观察组对患者、家庭照顾者进行为期1年的老年痴呆相关知识和护理技能、家居安全等家庭护理干预,指导照顾者为患者进行预防肺部感染、泌尿系感染、压疮,肢体功能锻炼,并对照顾者进行心理疏导等。比较两组干预1年期间全身并发症及家居安全意外发生率。结果观察组肺部感染、泌尿系感染、压疮发生率及家居安全意外发生率显著低于对照组(P0.05,P0.01)。结论充分有效的家庭护理干预可减少晚期老年痴呆患者并发症的发生,延缓病情进展,提高其家居安全。     

压疮居家照顾者负担的相关因素分析

目的了解压疮患者居家主要照顾者的照顾负担,分析其相关影响因素。方法采用问卷调查法对便利抽取的146名Ⅱ~Ⅳ期压疮患者居家主要照顾者进行调查。结果照顾者照顾负担得分(35.51±14.15)分,各维度条目均分由高到低依次为时间依赖性负担(2.80分)、身体性负担(1.87分)、发展受限性负担(1.71分)、社交性负担(0.85分)、情感性负担(0.35分);每日不同照顾时间、不同压疮持续时间患者的照顾者其照顾负担得分比较,差异有统计学意义(均P<0.05)。照顾者感知到的易感性与情感性负担、社交性负担呈负相关(均P<0.01),其感知到的严重性与情感性负担呈负相关(P<0.01)。结论压疮患者居家主要照顾者时间依赖性负担和身体性负担较重;护理人员应着重关注每日照顾时间较长和压疮持续时间较长患者的照顾者,提高照顾者的压疮认知水平,以减轻照顾者情感性负担和社交性负担。     

家庭护理干预对晚期老年痴呆患者家居安全及并发症的影响

目的探讨提高晚期老年痴呆患者家居安全,减少并发症发生率的有效方法。方法将47例晚期老年痴呆患者随机分为观察组24例,对照组23例。对照组采用常规出院指导,出院后不进行护理干预;观察组对患者、家庭照顾者进行为期1年的老年痴呆相关知识和护理技能、家居安全等家庭护理干预,指导照顾者为患者进行预防肺部感染、泌尿系感染、压疮,肢体功能锻炼,并对照顾者进行心理疏导等。比较两组干预1年期间全身并发症及家居安全意外发生率。结果观察组肺部感染、泌尿系感染、压疮发生率及家居安全意外发生率显著低于对照组（P〈0．05,P〈0．01）。结论充分有效的家庭护理干预可减少晚期老年痴呆患者并发症的发生,延缓病情进展,提高其家居安全。     

图片资料用于晚期肺癌患者压疮防治的效果

目的探讨图片资料用于晚期肺癌患者压疮防治的效果。方法将160例压疮高危患者分为对照组78例和观察组82例。对照组给予常规护理干预,观察组在此基础上给予图片资料进行健康教育干预。结果与对照组比较,观察组压疮防治依从性提高,压疮发生率显著降低,压疮治疗效果提高(P0.05,P0.01)。结论图片资料的使用提高压疮高危患者对压疮防治的依从性,降低压疮发生率和促进压疮治疗。     

压疮高危因素的量化评价

目的 通过量化评价压疮高危因素及护理会诊，降低压疮的院内发生率。方法 制订压疮高危因素量化评价记录表，对332例压疮高危患者的皮肤情况进行监控，并进行前瞻性会诊，给予皮肤护理和制订压疮个体化预防方案，采取有效的护理措施。结果 332例压疮高危患者中，发生压疮7例（2．1％），与2000～2002年（6．1％）比较，下降了4．0％。结论 对压疮高危患者及时评估并填报压疮高危因素量化评价记录表，并采取相应措施，可有效降低压疮发生率，亦使基础护理质量得到持续改进。     

Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database

In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.     

Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries

In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.     

Predicting the cut‐off point for interface pressure in pressure injury according to the standard hospital mattress and polyurethane foam mattress as support surfaces

This study aimed to investigate the interface pressure (IP) of patients using a standard hospital mattress and polyurethane foam mattress as support surfaces and present cut‐off points for IP in patients who exhibited skin changes. A total of 189 inpatients enrolled from six general wards and three intensive care units at a Korean University Hospital. Skin changes were classified, and peak IP at the sacral and occipital regions was measured using a pressure scanner. Differences in IPs according to mattress type were analysed using independent t‐tests. The receiver operating characteristic curve was constructed to determine the cut‐off point, and the area under the curve with a 95% confidence interval was obtained using the Stata 15.1.program. The IP for a standard hospital mattress was significantly higher than that of a polyurethane foam mattress. The cut‐off points for IP at the sacral region were 52.90 and 30.15 mm Hg for a standard hospital mattress and polyurethane foam mattress, respectively. The cut‐off point for IP at the occipital region was 36.40 mm Hg for a polyurethane foam mattress. Using IP measurements to prevent pressure injuries is important and employ individualised interventions based on the cut‐off points for different support surfaces.     

Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators

The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term “quality indicator” regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence‐based and internationally comparable indicators to help improve patient care and safety worldwide.     

Preventing pressure injuries in the emergency department: Current evidence and practice considerations

The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence‐based PI prevention protocols for the high‐risk emergency/trauma patient. The prevention of hospital‐acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence‐based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.     

Medical device related pressure ulcers in hospitalized patients

Most pressure ulcers occur over bony prominences such as heels and the sacrum. However, the National Pressure Ulcer Advisory Panel recognises that pressure ulcers can also occur on any tissue under pressure and thereby can develop beneath medical devices. This article reports on results from a secondary analysis of existing data collected by The Nebraska Medical Center on pressure ulcer quality improvement initiatives and outcomes. The purpose of this study was to quantify the extent of the problem and identify risk factors for medical device related (MDR) pressure ulcer development in hospitalised patients. A subset of data collected during eight quarterly pressure ulcer incidence and prevalence studies (N = 2178) was created and analysed. The overall rate of hospital‐acquired pressure ulcers was 5·4% (113 of 2079). The proportion of patients with hospital‐acquired ulcers related to medical devices was 34·5% (39 of 113). Findings indicate that if a patient had a medical device, they were 2·4 times more likely to develop a pressure ulcer of any kind. Numerous risk factors for pressure ulcer development were identified; however, none differentiated between those with MDR and traditional pressure ulcers.     

Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores—A New Design

Background  “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator. Aim and Methods  After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same. Results  Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group ( p < 0.045), and in only 3 patients of the control group. Conclusions  This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.     

2019版《压疮/压力性损伤的预防和治疗:临床实践指南》解读

从压力性损伤的定义和分类、压力性损伤的特殊人群、压力性损伤的预防、压力性损伤预防和治疗的共同措施、压力性损伤的治疗方面对2019版《压疮/压力性损伤的预防和治疗:临床实践指南》的更新进行解读,旨在让临床护理人员了解国际压力性损伤的新进展,从而提高压力性损伤预防和治疗的护理质量,减轻患者的痛苦。     

Skin hydration measurement and the prediction of the early development of pressure ulcers among at risk adults: A systematic review

This systematic review aimed to examine skin hydration and determine if this biophysical parameter can predict pressure ulcer development in at risk adults. A literature search was conducted in March 2022, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 1727 records were returned, with 9 studies satisfying the inclusion criteria. Data were extracted using a pre-designed extraction tool and a narrative synthesis of the data was undertaken. The methodological quality of the included articles was assessed using the evidence-based librarianship checklist. Included studies were published between 1997 and 2021, with most using a prospective cohort design (88.9%, n = 8). The mean sample size was 74 participants (SD = 38.6; median 71). All studies measured skin hydration objectively, with 55.6% (n = 5) using the Corneometer® CM825 and 33.3% (n = 3) of studies reported a statistically significant association between skin hydration and pressure ulcer development. The mean evidence-based librarianship percentage was 66.6% (SD: 20.7%), however, only 33.3% (n = 3) of studies scored ≥75%, indicating validity. The quality of included studies, methodology variation, and reported results has reduced the homogeneity of outcomes. This review highlights the requirement for future research evidence to ascertain the role of skin hydration in pressure ulcer development.