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Garcia S, Alòs J, Guallar J, Viu M, Serra-Prat M. Prevalence, incidence and risk factors for foot pressure ulcers in hospitalized elderly patients. An observational and prospective study. J Healthc Qual Res 2020; 36:27-33. [PMID: 33342758 DOI: 10.1016/j.jhqr.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Incidence and clinical characteristics of foot pressure ulcers (FPU) in hospitalized elderly patients are not well known. The aim of the study was to determine the incidence of FPU during hospitalization, to describe main FPU characteristics and to assess main risk factors for FPU in hospitalised elderly subjects. METHODOLOGY An observational prospective study was performed in which patients 65 years or older admitted to Vascular Surgery, Orthopaedic or Geriatric departments were followed from admission to discharge. Trained nurses evaluated all recruited patients on a daily basis for possible FPU. Main characteristics of the patient (age, sex and co-morbidities) and the ulcer (location, grade) were registered. RESULTS 299 patients were recruited (62.2% women, mean age 82.3 years, mean number of co-morbidities 2.8). Prevalence of FPU was 30.1% at admission and 73.9% at discharge. Incidence of FPU during hospitalization was 9.5 new FPU/100 person-day. 97.0% of the new FPU were grade 1 (erythema) and the most common locations were in the heel (57.6%), the external lateral part of the foot (13.1%), and the hallux of the fist toe (11.8%). Apart from immobility, main risk factors for FPU are age, geriatric residence origin and not able to outdoor life. CONCLUSIONS FPU has a high incidence among hospitalised elderly patients; most of them are grade 1 and located in the heel. More attention must be paid in the prevention of pressure ulcers in hospitalized frail subjects.
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Affiliation(s)
- S Garcia
- Vascular Surgery Department, Hospital of Mataró, Barcelona, Spain
| | - J Alòs
- Vascular Surgery Department, Hospital of Mataró, Barcelona, Spain
| | - J Guallar
- Geriatric Department, Hospital of Mataró Barcelona, Spain
| | - M Viu
- Orthopaedics Department, Hospital of Mataró, Barcelona, Spain
| | - M Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Barcelona, Spain.
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2
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Using Nursing Information and Data Mining to Explore the Factors That Predict Pressure Injuries for Patients at the End of Life. Comput Inform Nurs 2019; 37:133-141. [PMID: 30418245 DOI: 10.1097/cin.0000000000000489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the association between patient characteristics and the occurrence of pressure injuries for patients at the end of life. A retrospective study was conducted using data collected from 2062 patients at the end of life between January 2007 and October 2015. In addition to demographic data and pressure injury risk assessment scale scores, injury history, disease type, and length of hospitalization were revealed as the major independent variables for predicting the occurrence of pressure injuries. Both χ tests and t tests were employed for binary variable analysis, and logistic regression was used to conduct multivariate analysis. Classification models were formulated through decision tree analysis, backpropagation neural network, and support vector machine algorithms. The rules obtained using the decision tree algorithm were analyzed and interpreted. The accuracy rate, sensitivity, and specificity of the decision tree, backpropagation neural network, and support vector machine algorithms were 77.15%, 79.54%, and 74.76%; 78.12%, 81.37%, and 74.85%; and 79.32%, 81.03%, and 78.75%, respectively. The predictive factors, ranked in order of importance, were history of pressure injuries, without cancer, excretion, activity/mobility, and skin condition/circulation. These were the primary shared risk factors among the four models used in this study.
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Yardley I, Yardley S, Williams H, Carson-Stevens A, Donaldson LJ. Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents. Palliat Med 2018; 32:1353-1362. [PMID: 29856273 DOI: 10.1177/0269216318776846] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population. AIM To quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving palliative care. DESIGN A mixed-methods approach was used. Following quantification of type of incidents and their location, a qualitative analysis using a modified framework method was used to interpret themes in reports to examine the underlying causes and the nature of resultant harms. SETTING AND PARTICIPANTS Reports to a national database of 'serious incidents requiring investigation' involving patients receiving palliative care in the National Health Service (NHS) in England during the 12-year period, April 2002 to March 2014. RESULTS A total of 475 reports were identified: 266 related to pressure ulcers, 91 to medication errors, 46 to falls, 21 to healthcare-associated infections (HCAIs), 18 were other instances of disturbed dying, 14 were allegations against health professions, 8 transfer incidents, 6 suicides and 5 other concerns. The frequency of report types differed according to the care setting. Underlying causes included lack of palliative care experience, under-resourcing and poor service coordination. Resultant harms included worsened symptoms, disrupted dying, serious injury and hastened death. CONCLUSION Unsafe care presents a risk of significant harm to patients receiving palliative care. Improvements in the coordination of care delivery alongside wider availability of specialist palliative care support may reduce this risk.
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Affiliation(s)
- Iain Yardley
- 1 Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK.,2 King's College, London, UK
| | - Sarah Yardley
- 3 Central and North West London NHS Foundation Trust, London, UK.,4 Marie Curie Palliative Care Research Department, University College London, London, UK.,5 Medical Education, Keele University Medical School, Keele, UK
| | - Huw Williams
- 6 Primary Care Patient Safety (PISA) Research Group, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- 6 Primary Care Patient Safety (PISA) Research Group, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,7 Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.,8 Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Liam J Donaldson
- 9 Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Clark M, Young T, Fallon M. Systematic review of the use of Statistical Process Control methods to measure the success of pressure ulcer prevention. Int Wound J 2018; 15:391-401. [DOI: 10.1111/iwj.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Trudie Young
- Welsh Wound Innovation Centre; Ynysmaerdy Wales UK
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Artico M, Dante A, D'Angelo D, Lamarca L, Mastroianni C, Petitti T, Piredda M, De Marinis MG. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. Palliat Med 2018; 32:299-307. [PMID: 29130416 DOI: 10.1177/0269216317737671] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. AIM To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. DESIGN Retrospective chart review. SETTING/PARTICIPANTS Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. RESULTS The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p < 0.001), Braden score at risk ( p < 0.001), Karnofsky Performance Scale index <30 ( p < 0.001), patients' female gender, patients' age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. CONCLUSION The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.
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Affiliation(s)
- Marco Artico
- 1 Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy.,2 Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n. 4 Veneto Orientale, San Donà di Piave, Italy
| | - Angelo Dante
- 3 Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela D'Angelo
- 4 Research Unit Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luciano Lamarca
- 2 Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n. 4 Veneto Orientale, San Donà di Piave, Italy
| | | | - Tommasangelo Petitti
- 6 Research Unit Hygiene, Statistics and Public Health, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michela Piredda
- 4 Research Unit Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
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Carlsson M, Gunningberg L. Unavoidable pressure ulcers at the end of life and nurse understanding. ACTA ACUST UNITED AC 2017; 26:S6-S17. [DOI: 10.12968/bjon.2017.26.sup20.s6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Carlsson
- Senior Lecturer, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Clinical Professor, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Carlsson ME, Gunningberg L. Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study. J Palliat Med 2017; 20:53-58. [DOI: 10.1089/jpm.2016.0166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria E. Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Sternal D, Wilczyński K, Szewieczek J. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk. Clin Interv Aging 2016; 12:37-44. [PMID: 28096663 PMCID: PMC5207332 DOI: 10.2147/cia.s122464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. PATIENTS AND METHODS This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30-96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. RESULTS Patients were hospitalized for mean of 24.8±31.4 days (1-310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057-1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339-6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693-0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955-0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729-8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092-1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814-0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929-0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672-0.960, P=0.016). CONCLUSION Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.
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Affiliation(s)
- Danuta Sternal
- Department of Nursing and Paramedical Sciences, Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala
| | - Krzysztof Wilczyński
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Pressure Ulcers: Evidence-Based Prevention and Management. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0134-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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