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Forkuo-Minka AO, Kumah A, Asomaning AY. Improving Patient Safety: Learning from Reported Hospital-Acquired Pressure Ulcers. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:15-21. [PMID: 38406657 PMCID: PMC10887484 DOI: 10.36401/jqsh-23-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 02/27/2024]
Abstract
Introduction A hospital-acquired pressure ulcer (HAPU) is a localized lesion or injury to the underlying tissue (wound) while the patient is on admission. It occurs when standardized nursing care is not correctly followed in the presence of friction and shear, leading to skin or underlying tissue breakdown. Unfortunately, inadequate knowledge of nurses to assess and provide standardized care for pressure ulcers or manage HAPUs results in patient harm. We aim to share lessons from a reported HAPU incident and address the knowledge gap in patient safety risk assessment, identification, and wound management at Nyaho Medical Centre (Accra, Ghana). Methods A review of HAPU incidents was conducted using quality improvement tools such as cause-and-effect analyses to identify contributing factors and root causes. Subsequently, plan-do-study-act (PDSA) cycles were used to test interventions to improve pressure ulcer assessments and wound management. A run chart was used to analyze and evaluate the interventions over 12 weeks (Aug-Oct 2021). Results Development of policies and a standard operating procedure for pressure ulcers and wounds improved accuracy in identifying pressure ulcer risks and management of wounds. Eighty-three patients were assessed with the pressure ulcer assessment tool. Complete (100%) adherence to the pressure ulcer and wound policy and standard operating procedure (SOP) was achieved, and the number of HAPUs decreased from five to one during the study period. Conclusion This study demonstrated that the combined use of quality methods and tools can be suitable for improving processes and outcomes for patients at risk for HAPUs.
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Yin C, Mpofu E, Brock K, Li X, Zhan R. Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors. J Gerontol Nurs 2024; 50:32-41. [PMID: 38290099 DOI: 10.3928/00989134-20240110-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals. METHOD We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle. RESULTS Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers. CONCLUSION Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [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: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Duchesne GA, Waller JL, Baer SL, Young L, Bollag WB. Pressure Ulcer Diagnosis Is Associated with Increased Mortality in Patients with End-Stage Renal Disease: A Retrospective Study. Life (Basel) 2023; 13:1713. [PMID: 37629570 PMCID: PMC10456114 DOI: 10.3390/life13081713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Pressure ulcers are associated with multiple comorbidities and annually affect approximately 3 million Americans, directly accounting for approximately 60,000 deaths per year. Because patients with end-stage renal disease (ESRD) are known to present with unique factors which impair wound healing, pressure ulcers diagnosed in ESRD patients might independently increase the risk of mortality. To investigate the association between pressure ulcer diagnosis and mortality risk in the ESRD population, a retrospective analysis of the United States Renal Data System (USRDS) database was performed. The records of 1,526,366 dialysis patients who began therapy between 1 January 2005 and 31 December 2018 were included. Our analysis showed that the diagnosis of pressure ulcers in this population was independently associated with mortality even after controlling for confounding factors (p < 0.001). A Kaplan-Meier survival analysis demonstrated reduced survival in patients with a pressure ulcer diagnosis compared to those without a pressure ulcer diagnosis. These results establish pressure ulcers as a significant independent risk factor for mortality, as well as suggesting several comorbidities as potential risk factors for pressure ulcers in the ESRD population.
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Affiliation(s)
- Gabriela A. Duchesne
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
| | - Jennifer L. Waller
- Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA;
| | - Stephanie L. Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
| | - Lufei Young
- Department of Physiological and Technological Nursing, Augusta University, Augusta, GA 30912, USA
| | - Wendy B. Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (G.A.D.); (S.L.B.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
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Barch DH, Seibert JH, Kandilov A, Bernacet A, Deutsch A, Wang XJ, Scherer E, McMullen T, Mandl S, Levitt A, Frank J, Stephanopoulos C, Smith LM. Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care. Adv Skin Wound Care 2023; 36:128-136. [PMID: 36812077 DOI: 10.1097/01.asw.0000912008.97430.b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
GENERAL PURPOSE To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.
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Hernández-Vásquez A, Visconti-Lopez FJ, Cabanillas-Ramirez C, Díaz-Seijas D, Meléndez-Escalante J, Comandé D, Santero M. Efficacy and Safety of Topical Application of Olive Oil for Preventing Pressure Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14921. [PMID: 36429639 PMCID: PMC9690722 DOI: 10.3390/ijerph192214921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The purpose was to identify and summarize the existing evidence on the efficacy and safety of the topical application of olive oil for preventing pressure ulcers (PUs). We included only randomized controlled trials (RCTs) involving patients at risk of developing PUs, testing the topical application of olive oil versus other products for PU prevention. We assessed the risk of bias using the RoB 2 tool, and the certainty of the evidence with GRADE. Four RCTs met the eligibility criteria. All studies were judged at a low risk of bias overall. The meta-analysis showed that the clinical efficacy of olive oil for prevention occurs by reducing the incidence of PUs (RR = 0.56, 95% CI = 0.30 to 0.79, I2 = 0%); with no differences in adverse effects, it may be associated with a shorter development time of PUs and shorter hospital stays. The certainty of the evidence assessed by the GRADE approach was moderate and low. The topical application of olive oil is effective and safe in reducing the incidence of PUs compared to other treatments. These findings could provide new insights into olive oil as a preventive and alternative treatment for PUs as it is accessible and inexpensive compared to other products.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | | | | | | | | | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires C1414CPV, Argentina
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau—Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Efficacy of Nutritional Support Protocol for Patients with Pressure Ulcer: Comparison of Before andAfter the Protocol. Nutrition 2022; 99-100:111638. [DOI: 10.1016/j.nut.2022.111638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
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Yang Q, Li J, Shi D, Xie H, Wang J, Shi Z, Zhang Y. Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study. J Tissue Viability 2022; 31:332-338. [DOI: 10.1016/j.jtv.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/25/2022]
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Cho KS, Lee JH. Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study. J Wound Care 2021; 30:S38-S45. [PMID: 34882008 DOI: 10.12968/jowc.2021.30.sup12.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. METHOD A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. RESULTS Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. CONCLUSION This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.
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Affiliation(s)
- Kyu Sang Cho
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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Kobara K, Nagata Y, Fujita D, Takahashi H, Osaka H, Suehiro T. Investigation of the effect of a 15-degree tilt-in-space on the fluctuation of shear forces exerted on the buttocks when the back support is reclined. J Phys Ther Sci 2021; 33:838-844. [PMID: 34776619 PMCID: PMC8575471 DOI: 10.1589/jpts.33.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the effect of the combination of 15° tilt-in-space and recline angles on the fluctuation of shear forces exerted on the buttocks. [Participants and Methods] The participants were 11 healthy adult males. The parameters of the shear forces were the parallel and perpendicular forces exerted on the buttocks as measured by a force plate. The two conditions tested were T0R100-130 and T15R100-130. The tilt-in-space angles were set to 0° and 15° in the T0R100-130 and T15R100-130 conditions, respectively. The reclining angles were determined to be 100° to 130° in both conditions. [Results] Upon comparing the two conditions, the parallel and the perpendicular forces exerted on the buttocks in the T15R100-130 condition were significantly lower than those in the T0R100-130 condition in all positions of back support. Upon comparing the fluctuation values of the parallel and perpendicular forces, those applied in the T15R100-130 condition were significantly higher than those in the T0R100-130 condition. [Conclusion] These results suggest that the fluctuation of shear forces exerted on the buttocks could be decreased by using a combination of 15° tilt-in-space and reclining functions.
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Affiliation(s)
- Kenichi Kobara
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Yasuyuki Nagata
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Hisashi Takahashi
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Tadanobu Suehiro
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
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The 5-Factor Modified Frailty Index as a Predictor of 30-day Complications in Pressure Ulcer Repair. J Surg Res 2021; 265:21-26. [PMID: 33872845 DOI: 10.1016/j.jss.2021.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The 5-item modified frailty index (mFI-5) is a validated tool to assess postoperative risks in older surgical candidates. We sought to compare the predictive ability of mFI-5 to its individual components and other established risk factors for complications in flap reconstruction of late-stage pressure ulcer repair. METHODS The 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was queried for pressure ulcer diagnosis and reconstructive flap repair procedures. Univariate and multivariate regression analysis models were used to assess how mFI-5, the components of the mFI-5 (functional status before surgery, diabetes, history of chronic obstructive pulmonary disease, history of congestive heart failure, and history of hypertension requiring medicine), and other factors commonly used to risk-stratify (age, obesity, ASA classification, and history of smoking) were associated with complications. RESULTS 35.1% of the total 1254 flap reconstructive procedures for pressure ulcer repair experienced complications. Most cases had at least one of the five mFI-5 factors in both the complication (42.7%) and no complication (45.7%) cohorts. Compared with the factors making up the mFI-5 score and other common variables used to risk-stratify, mFI-5 was significantly associated with complications in the univariate (OR 1.17, CI 1.03 - 1.33; P = 0.02) and multivariate analysis (OR 1.16, CI 1.02 - 1.34; P = 0.043). CONCLUSIONS The mFI-5 is a useful predictor of postoperative outcomes in patients undergoing reconstructive flap surgery for pressure ulcer injuries compared to other historically considered risk factors for surgical complications.
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Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052546. [PMID: 33806436 PMCID: PMC7967548 DOI: 10.3390/ijerph18052546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.
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Zikos D, Shrestha A, Fegaras L. A Cross-Sectional Study to Predict Mortality for Medicare Patients Based on the Combined Use of HCUP Tools. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:300-318. [DOI: 10.1007/s41666-021-00091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
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Lee YJ, Moon SH. Surgical treatment of pressure ulcer: various flaps and other surgical methods. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pressure ulcers remain a common health problem, particularly among physically limited or bedridden older adults, and they can cause significant morbidity and mortality. Conservative management is ineffective for stage III or IV pressure ulcers, and surgery to create flap coverage becomes inevitable. Basic surgical principles for the treatment of pressure ulcers include complete excision of the ulcer, surrounding scar, underlying bursa, and soft tissue calcification; radical removal of underlying bone and any heterotropic ossification; padding of bone stumps and filling dead space; resurfacing with large regional pedicled flaps; and grafting the donor site of the flap, if necessary. For effective edge resection, all the flaps should be designed to be as large as possible, placing the suture line away from the area of direct pressure, and the flap design should also not violate adjacent flap territories to preserve all options for coverage if a breakdown or recurrence dictates further reconstruction. There are surgical methods for stage III or IV wide range pressure ulcers: reconstruction surgery using a skin flap, muscle flap, fascia-skin flap, or free flap. The skin graft is not generally recommended as a surgical procedure for stage III or IV pressure ulcers because it cannot provide enough strength to cover the wound. This review presents various surgical treatments of pressure ulcers including muscle, musculocutaneous, perforator-based, and free flap.
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Nadukkandiyil N, Syamala S, Saleh HA, Sathian B, Ahmadi Zadeh K, Acharath Valappil S, Alobaidli M, Elsayed SA, Abdelghany A, Jayaraman K, Al Hamad H. Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar. Aging Male 2020; 23:1066-1072. [PMID: 31608745 DOI: 10.1080/13685538.2019.1670156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Preventing pressure ulcers is an essential part of patient care and it is important to be aware of the best way to prevent it. Hence, the present study aims to look for the demographics, clinical characteristics, and risk factors in patients with and without pressure ulcer among elderly patients. METHODS A retrospective longitudinal study was conducted in elderly (above 65 years) patients from a period of October 2014 to October 2015 in the medical ward under acute Geriatric care at Hamad General Hospital in Qatar. RESULTS Overall, a total of 90 patients were included with an average age of 79 ± SD 11.3 years of which 45 patients developed pressure ulcer. There was male (64.4%) preponderance in the study population. Most common comorbidity was hypertension (77.8%). Anemia correction (91%), high protein diet supplementation (1.5 g/kg body wt.) (100%), and 2 h repositioning (100%) were implemented for majority of the pressure ulcer patients as preventive intervention. CONCLUSIONS From the study finding, it is observed that, anemia correction, high protein diet supplementation and 2 h repositioning are the best practices for the management of pressure ulcer. Hence, these best practices are recommended for the early prevention of pressure ulcer among elderly.
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Affiliation(s)
| | - Shirmila Syamala
- Geriatrics, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar
| | | | - Brijesh Sathian
- Surgery, Trauma Surgery Section, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Sameer Acharath Valappil
- Geriatric Medicine, Hamad Medical Corporation, Rumailah Höspital, HMC, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Hanadi Al Hamad
- Geriatric Medicine, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar
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Sprigle S, McNair D, Sonenblum S. Pressure Ulcer Risk Factors in Persons with Mobility-Related Disabilities. Adv Skin Wound Care 2020; 33:146-154. [PMID: 32058440 DOI: 10.1097/01.asw.0000653152.36482.7d] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. METHODS The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. MAIN RESULTS The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. CONCLUSIONS The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.
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Affiliation(s)
- Stephen Sprigle
- Stephen Sprigle, PhD, PT, is Professor, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. Douglas McNair, MD, PhD, is Senior Advisor, Global Health - Analytics Innovation, Bill and Melinda Gates Foundation, in Seattle, Washington. Sharon Sonenblum, PhD, is Principal Research Engineer, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. The authors have disclosed no financial relationships related to this article. Submitted August 30, 2019; accepted in revised form October 1, 2019
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Abstract
There are well-documented physiologic changes that occur in the human body during the aging process, such as decreased body fat, decreased muscle mass, cellular senescence, changes in skin pH, decreased metabolism, decreased immune function, vascular changes, altered tissue perfusion, nutritional status changes, and poor hydration. These changes affect skin integrity and wound healing, and raise the risk of pressure-related skin injury. This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults.
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Kim MO. Prevention and treatment of pressure sore following spinal cord injury. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.10.623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.
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Kobara K, Takahashi H, Nagata Y, Osaka H, Suehiro T, Fujita D. An investigation into the effectiveness of a novel wheelchair seat-cover assembly for the reduction of forces exerted onto the buttocks. Disabil Rehabil Assist Technol 2020; 17:304-309. [PMID: 32552176 DOI: 10.1080/17483107.2020.1780484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: This purpose was to investigate developed seat-cover assemblies' effect on decreasing the fluctuation of the shear force exerted onto the buttocks as the factors causing decubitus ulcers when the back-support was inclined.Materials and Methods: The participants were 10 wheelchair users. The force plate was used to measure the horizontal force as the shear force. The back-support was inclined at increasing angles, starting from the upright position (IUP), then proceeding to a fully reclined position (FRP), and returning to the upright position (RUP). The experimental conditions were two conditions; the seat-cover assembly conditions and without the seat-cover assembly as the control conditions.Results: The average values in the seat-cover assembly condition were 14.4 ± 3.3, 13.9 ± 2.3, and 17.3 ± 3.3% body weight in the IUP, FRP, and RUP, respectively. The average values in the control condition were 14.8 ± 2.6, 11.4 ± 1.7, and 24.0 ± 6.7% body weight in the IUP, FRP, and RUP, respectively. In the FUP and the RUP, there were significant differences between two conditions (p < .01).Conclusion: These results suggested that the shear force exerted onto the buttocks may to be decreased by using novel seat-cover assembly.Implications for rehabilitationIt is possible to decrease the fluctuations in the shear force by moving the body up and down according the novel seat-cover assembly attached the back-support incline.Disabled, older individuals can be provided with a comfortable life on a reclining wheelchair while preventing decubitus ulcers.
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Affiliation(s)
- Kenichi Kobara
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hisashi Takahashi
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Yasuyuki Nagata
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Tadanobu Suehiro
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
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Berihu H, Wubayehu T, Teklu T, Zeru T, Gerensea H. Practice on pressure ulcer prevention among nurses in selected public hospitals, Tigray, Ethiopia. BMC Res Notes 2020; 13:207. [PMID: 32276650 PMCID: PMC7149915 DOI: 10.1186/s13104-020-05049-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives Pressure ulcers are localized cellular damages to the skin and underlying tissues caused by pressure, shearing and frictional force. The aim of this study is to assess practices towards pressure ulcer prevention among nurses in the Central Zone of Tigray, Ethiopia, from September 10, 2017 to June 15, 2018. This study has also identified the major barriers that hamper nurses from preventing pressure ulcers. These barriers were heavy workload, inadequate training, and lack of universal guideline and shortage of resource. 17.2% of the participants had a good practice and 82.2% of the respondents had a poor practice of pressure ulcer prevention. Result Finding of this study showed that respondents have inadequate knowledge which may have led to their poor practice towards pressure ulcer prevention. Immediate intervention should be done on public hospitals of central Tigray to improve nurses’ practice towards pressure ulcer prevention.
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Affiliation(s)
- Hagos Berihu
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, P.O.Box: 298, Tigray, Ethiopia
| | - Tewolde Wubayehu
- School of Medicine, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Tewolde Teklu
- Departement of pharmacy, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Teklay Zeru
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, P.O.Box: 298, Tigray, Ethiopia
| | - Hadgu Gerensea
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, P.O.Box: 298, Tigray, Ethiopia.
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Gazineo D, Chiari P, Chiarabelli M, Morri M, D'Alessandro F, Sabattini T, Ambrosi E, Forni C. Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study. J Wound Care 2020; 28:593-599. [PMID: 31513499 DOI: 10.12968/jowc.2019.28.9.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. METHOD A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. RESULTS A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806-0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183-2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010-1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006-1.019) and diaper (HR: 1.007; 95% CI 1.001-1.013) in the postoperative period. CONCLUSION Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.
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Affiliation(s)
- Domenica Gazineo
- Evidence-based Nursing Centre, Azienda Ospedaliero-Universitaria, Via Albertoni 15, 40138, Bologna, Italy
| | - Paolo Chiari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Chiarabelli
- Cardio-thoracic vascular Department, Azienda Ospedaliero-Universitaria, Via Massarenti 9, 40138, Bologna, Italy
| | - Mattia Morri
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Tania Sabattini
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Elisa Ambrosi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristiana Forni
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
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Real-Time Pressure Assessment and Monitoring With a Fluid Immersion Simulation Support Surface Show Clinical and Financial Benefits for Flap Management. Plast Surg Nurs 2020; 40:48-53. [PMID: 32102081 DOI: 10.1097/psn.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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Yilmazer T, Inkaya B, Tuzer H. Care under the guidance of pressure injury prevention protocol: a nursing home sample. Br J Community Nurs 2019; 24:S26-S33. [PMID: 31804884 DOI: 10.12968/bjcn.2019.24.sup12.s26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pressure injury is a healthcare problem frequently encountered in nursing homes. This study evaluated the effects of the care delivered under the guidance of a protocol for pressure injury prevention at a nursing home. It was implemented in four phases. In the pre-protocol period, the pressure injury incidence and nurses' care practices were evaluated. In the second phase, nurses were trained to use the protocol. In the third phase, the nurses provided care under the guidance of the protocol (post-protocol period). In the fourth phase, the incidence of pressure injury and nurses' care practices were compared between the pre- and post-protocol periods. The average age of the older residents was 78.40±7.12 years, and all were at high or very high risk of pressure injury according to the Braden scale scores. Some 30% were bed bound; 90% had faecal and urinary incontinence; and 70% had malnutrition. The results showed that the pressure injury incidence reduced from 17.39% in the pre-protocol period to 10.87% in the post-protocol period, while the nurses' care practices improved in the post-protocol period. Thus, use of pressure injury-prevention protocols can reduce the incidence of these injuries in vulnerable care home residents.
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Affiliation(s)
- Tuba Yilmazer
- The Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bahar Inkaya
- The Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hilal Tuzer
- The Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Gong X, Chen HL, Shen JH, Zhu BF. Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study. J Wound Care 2019; 28:527-531. [PMID: 31393797 DOI: 10.12968/jowc.2019.28.8.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department. METHODS The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR). RESULTS A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224). CONCLUSION Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.
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Affiliation(s)
- Xiang Gong
- Senior Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
| | - Hong-Lin Chen
- Associate Professor, Nantong University, School of Nursing
| | - Jun-Hua Shen
- Senior Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
| | - Bao-Feng Zhu
- Chief Consultant, Department of Emergency, the Second Affiliated Hospital of Nantong University, Nantong First People's Hospital
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Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
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Pressure Ulcer Prevalence by Level of Paralysis in Patients With Spinal Cord Injury in Long-term Care. Adv Skin Wound Care 2019; 32:122-130. [DOI: 10.1097/01.asw.0000553109.70752.bf] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Widiati E, Nurhaeni N, Gayatri D. Medical-Device Related Pressure Injuries to Children in the Intensive Care Unit. Compr Child Adolesc Nurs 2017; 40:69-77. [DOI: 10.1080/24694193.2017.1386973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eka Widiati
- Faculty of Nursing, Universitas Indonesia, Jalan Bahder Djohan Campus, Depok, Indonesia
| | - Nani Nurhaeni
- Faculty of Nursing, Universitas Indonesia, Jalan Bahder Djohan Campus, Depok, Indonesia
| | - Dewi Gayatri
- Faculty of Nursing, Universitas Indonesia, Jalan Bahder Djohan Campus, Depok, Indonesia
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Komici K, Vitale DF, Leosco D, Mancini A, Corbi G, Bencivenga L, Mezzani A, Trimarco B, Morisco C, Ferrara N, Rengo G. Pressure injuries in elderly with acute myocardial infarction. Clin Interv Aging 2017; 12:1495-1501. [PMID: 29033559 PMCID: PMC5614743 DOI: 10.2147/cia.s135676] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To assess pressure injury (PI) incidence among patients hospitalized for acute myocardial infarction (AMI) in an intensive coronary care unit (ICCU) and to detect the impact of specific risk factors on the development of PI in this clinical setting. Patients and methods Prospective cohort study in ICCU setting. Patients admitted for AMI: patients mean age 67.5±11.5 years (n=165). Norton Scale, Mini Nutritional Assessment (MNA), demographic, clinical and biochemical data collected at the time of ICCU admission have been tested in a logistic model to assess the odds ratios (ORs) of PI risk development. The jackknifed area under the receiver operating characteristic curve (AUC) and the decision curve analysis have been employed to assess the additive predictive value of a factor. Results Twenty-seven (16.3%) patients developed PIs. An increased PI risk was associated with advanced age (OR =2.5 every 10-year increase; 95% CI =1.1–5.7), while probability of PI development was reduced in patients with higher left ventricular ejection fraction (LVEF) (OR =0.4 every 5% increase; 95% CI =0.24–0.66), MNA score (OR =0.65 every unit change; 95% CI =0.44–0.95) and Norton Scale score (OR =0.7 every unit change; 95% CI =0.57–0.88). The AUC and the decision curve analysis showed that LVEF inclusion improved the discrimination power and the clinical net benefit of the final model. Conclusion Age, LVEF, Norton Scale and MNA scores have a strong and independent clinical value as predictors of in-hospital PI development in patients with AMI. This finding has the potential to improve the clinical management of patients admitted in ICCU.
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Affiliation(s)
- Klara Komici
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dino F Vitale
- Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Telese Terme, Italy
| | - Dario Leosco
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Angela Mancini
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise Campobasso, Campobasso, Italy
| | - Leonardo Bencivenga
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Mezzani
- Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Morisco
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Ferrara
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Telese Terme, Italy
| | - Giuseppe Rengo
- Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Telese Terme, Italy
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Abstract
PURPOSE The objective of this study was to examine the attitudes of baccalaureate nursing students toward their role in pressure injury prevention (PIP) and describe how clinical experiences influence their attitudes. Understanding students' attitudes and experiences related to PIP may facilitate development of evidence-based interventions for PIP by nurses. DESIGN Qualitative exploratory descriptive design. SETTING AND SUBJECTS Participants were 16 senior nursing students enrolled in a prelicensure baccalaureate nursing program in an accredited school of nursing. Half of the participants had completed their first 2 years of the nursing major in the baccalaureate program. The remaining participants completed their first 2 years in a community college associate degree nursing program. METHOD Semistructured, in-depth, open-ended interviews were conducted. Interviews were digitally recorded and transcribed verbatim; data were analyzed for key themes using content analysis. RESULTS Four categories of attitudes about PIP were identified: (1) ambivalence, (2) emerging awareness, (3) committed, and (4) passionate. Diverse clinical experiences in pediatrics, the operating room, trauma units, and long-term care facilities enhanced nursing students' learning related to PIP. Experiences observing WOC nurses and other staff role models engaged in PIP were associated with student commitment and passion for PIP. CONCLUSIONS Findings from this study can be used to guide interventions to enhance attitudes of commitment to PIP. WOC nurses, clinical preceptors, and clinical staff can involve nursing students in intentional PIP learning activities to improve clinical practice and patient outcomes. Intentionally incorporating key learning activities about PIP in the nursing curriculum is recommended.
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Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study. Spinal Cord 2017; 56:28-34. [PMID: 28895575 DOI: 10.1038/sc.2017.96] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Secondary analysis of data from a prospective cohort study. OBJECTIVES The objective of this study was to identify the medical and demographic factors associated with the development of pressure ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. SETTING The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. METHODS Adults with acute traumatic spinal cord injury (n=104) were recruited within 24-72 h of admission to the hospital. Pressure ulcer incidence was recorded. RESULTS Thirty-nine participants out of 104 (37.5%) developed at least one pressure ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure ulcer incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1-20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3-16.63), P=0.01. CONCLUSION Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure ulcers. Pneumonia was noted to be associated with the formation of pressure ulcers.
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Rahim K, Saleha S, Zhu X, Huo L, Basit A, Franco OL. Bacterial Contribution in Chronicity of Wounds. MICROBIAL ECOLOGY 2017; 73:710-721. [PMID: 27742997 DOI: 10.1007/s00248-016-0867-9] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/21/2016] [Indexed: 05/11/2023]
Abstract
A wound is damage of a tissue usually caused by laceration of a membrane, generally the skin. Wound healing is accomplished in three stages in healthy individuals, including inflammatory, proliferative, and remodeling stages. Healing of wounds normally starts from the inflammatory phase and ends up in the remodeling phase, but chronic wounds remain in an inflammatory stage and do not show progression due to some specific reasons. Chronic wounds are classified in different categories, such as diabetic foot ulcer (DFU), venous leg ulcers (VLU) and pressure ulcer (PU), surgical site infection (SSI), abscess, or trauma ulcers. Globally, the incidence rate of DFU is 1-4 % and prevalence rate is 5.3-10.5 %. However, colonization of pathogenic bacteria at the wound site is associated with wound chronicity. Most chronic wounds contain more than one bacterial species and produce a synergetic effect that results in previously non-virulent bacterial species becoming virulent and causing damage to the host. While investigating bacterial diversity in chronic wounds, Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia were found most frequently in chronic wounds. Recently, it has been observed that bacteria in chronic wounds develop biofilms that contribute to a delay in healing. In a mature biofilm, bacteria grow slowly due to deficiency of nutrients that results in the resistance of bacteria to antibiotics. The present review reflects the reasons why acute wounds become chronic. Interesting findings include the bacterial load, which forms biofilms and shows high-level resistance toward antibiotics, which is a threat to human health in general and particularly to some patients who have acute wounds.
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Affiliation(s)
- Kashif Rahim
- Institute of Biochemistry and Molecular Biology, College of Life Sciences, Beijing Normal University, Beijing, 100875, China
| | - Shamim Saleha
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - Xudong Zhu
- Institute of Biochemistry and Molecular Biology, College of Life Sciences, Beijing Normal University, Beijing, 100875, China
| | - Liang Huo
- Institute of Biochemistry and Molecular Biology, College of Life Sciences, Beijing Normal University, Beijing, 100875, China
| | - Abdul Basit
- College of Biological Sciences, China Agricultural University, Beijing, 100193, China
| | - Octavio Luiz Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brazil, 70790-160, Brazil.
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, CEP 79.117-900, Brazil.
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Real-Time Pressure Assessment and Monitoring With a Fluid Immersion Simulation Support Surface Show Clinical and Financial Benefits for Flap Management. Plast Surg Nurs 2017; 37:39-44. [PMID: 28244964 DOI: 10.1097/psn.0000000000000175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1187. [PMID: 28203494 PMCID: PMC5293292 DOI: 10.1097/gox.0000000000001187] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
Background: Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage. Methods: This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection. Results: All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34). Conclusions: Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.
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Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study. PLoS One 2017; 12:e0169909. [PMID: 28068425 PMCID: PMC5222344 DOI: 10.1371/journal.pone.0169909] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
Background Older adult patients with fragility hip fractures constitute a population at high risk for complications, in particular pressure ulcers. The aim was to evaluate the incidence of pressure ulcers and potential predictive factors. Methods and Findings A prospective multicentric prognostic cohort study in orthopedic wards in three Italian public hospitals. Participants were all consecutive patients 65 years of age or older diagnosed with a fragility hip fracture. Outcomes were incidence of pressure ulcers. The exposure variables were grouped into three macro areas in order to facilitate reading: “intrinsic” variables, “extrinsic” variables and variables linked to the organization of patient care. One thousand eighty-three older adult patients with fragility hip fractures were enrolled from October 1st, 2013 to January 31st, 2015, and pressure ulcers developed in 22.7%. At multivariate analysis, the following were found to be risk factors: age> 80 years (odds ratio (OR) 1.03; p = 0.015), the length of time a urinary catheter was used (OR 1.013; p<0.001), the length of time pain was present (OR 1.008; p = 0.008), the absence of side rails on the bed (OR 1.668; p = 0.026) and the use of a foam position valve (OR 1.025; p<0.001). Instead, the protective factors were the presence of a caregiver for at least half a day daily (OR 0.994; p = 0.012) and the number of positionings during the postoperative period (OR 0.897; p = 0.008). Conclusions The study allowed the identification of the patients most at risk for developing pressure ulcers, and the construction of a pragmatic predictive model using significant risk or protective factors in order to reduce the number of pressure ulcers.
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Laranjeira CA, Loureiro S. [Risk factors of pressure ulcers in hospitalized patients of a Portuguese hospital]. Rev Salud Publica (Bogota) 2017; 19:99-104. [PMID: 30137162 DOI: 10.15446/rsap.v19n1.42251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 09/12/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify and characterize the risk factors of pressure ulcers (PU) in patients admitted in a Portuguese Hospital. MATERIALS AND METHODS Descriptive and cross-sectional study with a sample consisting of 34 individuals, 70.6 % male and 29.4 % female with a mean age of 78.93 ± 6.05 years. The data collection instrument consisted of an analysis grid that contains socio-demographic, clinical and therapeutic data. Descriptive statistics, and inferential analysis were estimated, the chi-square test of Pearson was used for p≤0.05. RESULTS Data analysis found that individuals already presented with PU upon admission to the hospital, and that most of them stay between 6 days and 1 month; the longer the hospitalization period, the longer the hospitalization time, the greater the number of PU developed by individuals. Most PU patients have a strong prevalence of severe PU in the sacrum and calcaneus region, and hypertension, respiratory disease and Diabetes mellitus are the most frequent pathologies. CONCLUSION The current gloomy picture of PUs can only be changed if there is greater investment in prevention and accurate treatment. In this sense, guidelines should be systematized for families during hospitalization and outpatient monitoring.
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Affiliation(s)
- Carlos A Laranjeira
- Ph.D. RECI. Jean Piaget Higher School of Health Sciences. Jean Piaget College. Alto do Gaio Street, Lordosa. Viseu, Portugal.
| | - Sónia Loureiro
- M.Sc. Otorhinolaryngology, Plastic & Maxillofacial Surgery Ward. Garcia da Orta Hospital. Lisbon, Portugal.
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Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK. Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality. J Am Geriatr Soc 2016; 65:1026-1033. [PMID: 28039852 DOI: 10.1111/jgs.14743] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. DESIGN Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. SETTING Large academic hospital. PARTICIPANTS Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. MEASUREMENTS (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. RESULTS Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P < .001), HACs (37% vs 12%, P < .001), other noxious insults (63% vs 49%, P = .03), and 90-day mortality (24% vs 6%, P < .001). The inverse probability weighted hazard of death due to delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. CONCLUSION Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults.
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Affiliation(s)
- Kumar Dharmarajan
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Sunil Swami
- Department of Research and Development, Philips Healthcare, Baltimore, Maryland
| | - Ray Y Gou
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Chaboyer W, Bucknall T, Webster J, McInnes E, Gillespie BM, Banks M, Whitty JA, Thalib L, Roberts S, Tallott M, Cullum N, Wallis M. The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. Int J Nurs Stud 2016; 64:63-71. [PMID: 27693836 DOI: 10.1016/j.ijnurstu.2016.09.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. OBJECTIVE To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. DESIGN Pragmatic cluster randomised trial. SETTING Eight tertiary referral hospitals with >200 beds each in three Australian states. PARTICIPANTS 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure ulcer because of limited mobility; expected to stay in hospital ≥48h and able to read English. METHODS Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients' participation in pressure ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. RESULTS Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure ulcers developed (pressure ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33; p=0.198). No adverse events or harms were reported. CONCLUSIONS Although the pressure ulcer prevention care bundle was associated with a large reduction in the hazard of ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure ulcer prevention care bundle was effective but the sample size too small to detect this.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
| | - Tracey Bucknall
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Alfred Health, Melbourne, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Joan Webster
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St. Vincent's Health Australia (Sydney), Darlinghurst, NSW 2010, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
| | - Brigid M Gillespie
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Merrilyn Banks
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia
| | - Jennifer A Whitty
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, Australia; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7JT, United Kingdom
| | - Lukman Thalib
- Public Health Program, Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Shelley Roberts
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Mandy Tallott
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Nicky Cullum
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Gold Coast Campus, QLD 4222, Australia; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Marianne Wallis
- Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing and Midwifery, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
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Roustit M, Genty C, Lepelley M, Blaise S, Fromy B, Cracowski JL, Bosson JL. Amiloride treatment and increased risk of pressure ulcers in hospitalized patients. Br J Clin Pharmacol 2016; 82:1685-1687. [PMID: 27639520 DOI: 10.1111/bcp.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 02/03/2023] Open
Affiliation(s)
- Matthieu Roustit
- Université Grenoble-Alpes, HP2 UMR 1042, F-38000, Grenoble, France.,Inserm, HP2 UMR 1042, F-38000, Grenoble, France.,CHU Grenoble-Alpes, Pôle Recherche, Inserm CIC1406, F-38000, Grenoble, France
| | - Céline Genty
- Université Grenoble-Alpes, TIMC-IMAG, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, F-38000, Grenoble, France
| | - Marion Lepelley
- CHU Grenoble-Alpes, Pôle Santé Publique, F-38000, Grenoble, France
| | - Sophie Blaise
- Inserm, HP2 UMR 1042, F-38000, Grenoble, France.,CHU Grenoble-Alpes, Pôle Pluridisciplinaire de Médecine, F-38000, Grenoble, France
| | - Bérengère Fromy
- CNRS, Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique (LBTI), UMR 5301, Lyon, France.,UCBL1, Université Lyon, France
| | - Jean-Luc Cracowski
- Université Grenoble-Alpes, HP2 UMR 1042, F-38000, Grenoble, France.,Inserm, HP2 UMR 1042, F-38000, Grenoble, France.,CHU Grenoble-Alpes, Pôle Recherche, Inserm CIC1406, F-38000, Grenoble, France
| | - Jean-Luc Bosson
- Université Grenoble-Alpes, TIMC-IMAG, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, F-38000, Grenoble, France.,CHU Grenoble-Alpes, Pôle Santé Publique, F-38000, Grenoble, France
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Mansi IA, Frei CR, Halm EA, Mortensen EM. Association of statins with diabetes mellitus and diabetic complications: role of confounders during follow-up. J Investig Med 2016; 65:32-42. [PMID: 27574296 DOI: 10.1136/jim-2016-000218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 12/15/2022]
Abstract
Studies have associated statin use with increased risk of diabetes and diabetic complications. These studies often ensure comparability of statin users and non-users at baseline; however, most studies neglect to consider confounders that occur during follow-up. Failure to consider these confounders, such as new medications or procedures, may result in identification of a spurious association between statins and outcomes. The objective of this study was to examine the association of statins with diabetes mellitus and diabetic complications; and to examine potential confounders during the follow-up period that might affect this relationship. We conducted a retrospective cohort study using Tricare data (from October 1, 2003 to March 31, 2012). We propensity score-matched statin users and non-users on 115 baseline characteristics before starting statins; these characteristics would be potentially associated with the use of statins or the outcomes of interest. Outcomes included the risk of diabetes mellitus and diabetic complications. Out of 60,455 patients (10,910 statin users and 49,545 non-users), we propensity score-matched 6728 statin users to 6728 non-users. Statin users had higher ORs for diabetes (OR 1.34, 95% CI 1.24 to 1.44) and diabetes with complications (OR 1.28, 95% CI 1.16 to 1.42). Adjustment for potential confounders that occurred during the follow-up period did not explain or diminish the association between statins and adverse outcomes. Statin users in comparison to similar non-users were more commonly diagnosed with diabetes and diabetic complications, even after adjustment for potential confounders that occurred during the follow-up period.
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Affiliation(s)
- Ishak A Mansi
- Medical Service, VA North Texas Health Care System, Dallas, Texas, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Departments of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher R Frei
- College of Pharmacy, The University of Texas at Austin, San Antonio, Texas, USA.,School of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Ethan A Halm
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Departments of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eric M Mortensen
- Medical Service, VA North Texas Health Care System, Dallas, Texas, USA.,Departments of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Departments of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Affiliation(s)
- Joanna Peart
- Nurse Specialist (Tissue Viability), Newcastle Hospitals, MSc student (Wound Healing and Tissue Repair), Cardiff University
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Rahim K, Qasim M, Rahman H, Khan TA, Ahmad I, Khan N, Ullah A, Basit A, Saleha S. Antimicrobial resistance among aerobic biofilm producing bacteria isolated from chronic wounds in the tertiary care hospitals of Peshawar, Pakistan. J Wound Care 2016; 25:480-6. [DOI: 10.12968/jowc.2016.25.8.480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Rahim
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - M. Qasim
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - H. Rahman
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - T. A. Khan
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - I. Ahmad
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - N. Khan
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - A. Ullah
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - A. Basit
- Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
| | - S. Saleha
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan
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Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents. Adv Skin Wound Care 2016; 29:178-90; quiz E1. [DOI: 10.1097/01.asw.0000481115.78879.63] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Predictors of pressure ulcer development in patients with vascular disease. JOURNAL OF VASCULAR NURSING 2015; 32:55-62. [PMID: 24944172 DOI: 10.1016/j.jvn.2013.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although pressure ulcer (PU) risk factors are well known in the general population, little research is available in hospitalized surgical patients admitted with vascular diseases. METHODS Using a retrospective medical records review, characteristics of hospitalized surgical patients with vascular diseases were assessed. Variables were based on literature review of PUs and availability of medical records and administrative data. Trained registered nurses collected data. Analyses included descriptive and comparative statistics, and multivariable modeling was used to determine predictors of PU. RESULTS In 849 adult admissions, 18.9% had a PU; 11.8% were hospital-acquired PU (HAPU). Patients were more likely to be elderly, male (n = 575; 67.7%), and Caucasian (n = 704; 83.3%). Common diagnoses were aneurysms/embolisms (43.2%) and atherosclerosis (31.2%). Patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with home (P < .001). In univariate analyses, 12 patient characteristics were associated with HAPU presence: Female gender, non-married status, current smoker, non-Caucasian race, non-intensive care unit (ICU) stay, primary diagnosis of atherosclerosis, higher analgesic use, higher right ankle brachial index (ABI), lower Braden score, higher blood urea nitrogen (BUN) higher serum creatinine and higher total protein levels. In multivariate analyses, nine factors predicted HAPU: Lower right ABI and Braden score, an ICU stay, low and high hematocrit values, female gender, non-White race, atherosclerosis history, and higher BUN and body mass index (BMI). The concordance index for the nine-item model was 0.854. CONCLUSION The rate of HAPU in hospitalized surgical patients with vascular diseases was greater than expected. Assessment of important HAPU factors and implementation of interventions are needed to decrease risk and improve clinical outcomes.
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Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults. J Gen Intern Med 2015; 30:1599-610. [PMID: 25917657 PMCID: PMC4617949 DOI: 10.1007/s11606-015-3335-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/26/2015] [Accepted: 03/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Statin use is associated with increased incidence of diabetes and possibly with increased body weight and reduced exercise capacity. Data on the long-term effects of these associations in healthy adults, however, are very limited. In addition, the relationship between these effects and diabetic complications has not been adequately studied. OBJECTIVE To examine the association between statin use and new-onset diabetes, diabetic complications, and overweight/obesity in a cohort of healthy adults. RESEARCH DESIGN This was a retrospective cohort study. PARTICIPANTS Subjects were Tricare beneficiaries who were evaluated between October 1, 2003 and March 1, 2012. Patients were divided into statin users and nonusers. INTERVENTION We excluded patients who, at baseline, had a preexisting disease indicative of cardiovascular diseases, any positive element of the Charlson comorbidity index (including diabetes mellitus), or life-limiting chronic diseases. Using 42 baseline characteristics, we generated a propensity score to match statin users and nonusers. MAIN MEASURES Outcomes assessed included new-onset diabetes, diabetic complications, and overweight/obesity. KEY RESULTS A total of 25,970 patients (3982 statin users and 21,988 nonusers) were identified as healthy adults at baseline. Of these, 3351 statins users and 3351 nonusers were propensity score-matched. Statin users had higher odds of new-onset diabetes (odds ratio [OR] 1.87; 95 % confidence interval [95 % CI] 1.67-2.01), diabetes with complications (OR 2.50; 95 % CI 1.88-3.32), and overweight/obesity (OR 1.14; 95 % CI 1.04-1.25). Secondary and sensitivity analyses demonstrated similar findings. CONCLUSIONS Diabetes, diabetic complications, and overweight/obesity were more commonly diagnosed among statin-users than similar nonusers in a healthy cohort of adults. This study demonstrates that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention.
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Kirsner R, Vivas A. Lower‐extremity ulcers: diagnosis and management. Br J Dermatol 2015; 173:379-90. [DOI: 10.1111/bjd.13953] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 01/30/2023]
Affiliation(s)
- R.S. Kirsner
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
| | - A.C. Vivas
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine 1600 NW 10th Ave RMSB Room 2023‐A Miami FL 33136 U.S.A
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Palfreyman S, Mulhern B. The psychometric performance of generic preference-based measures for patients with pressure ulcers. Health Qual Life Outcomes 2015; 13:117. [PMID: 26231179 PMCID: PMC4522149 DOI: 10.1186/s12955-015-0307-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration. METHODS A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman's correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables. RESULTS The total number of participants was 307, including 273 from the acute setting (52% response rate) and 41 from the community (32%). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score. CONCLUSIONS The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most effective method for obtaining survey data was through the hand held devices and interviewers.
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Affiliation(s)
- Simon Palfreyman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
| | - Brendan Mulhern
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK. .,Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1-59 Quay Street, Haymarket, Sydney, NSW2000, Australia.
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Nuru N, Zewdu F, Amsalu S, Mehretie Y. Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC Nurs 2015; 14:34. [PMID: 26034398 PMCID: PMC4450466 DOI: 10.1186/s12912-015-0076-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 04/30/2015] [Indexed: 12/05/2022] Open
Abstract
Background Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose significant burden on patients, their relatives and caregivers. Pressure ulcers have been described as one of the most costly and physically debilitating complications since the 20th century. The pain and discomfort due to pressure ulcer prolongs illness, rehabilitation, time of discharge and even contribute to disability and death. This study was aimed to assess knowledge, practice and factors associated with pressure ulcer prevention among nurses in Gondar University Hospital, North-west Ethiopia. Method An institution-based cross-sectional survey was conducted from March 15 - April 10, 2014 among 248 nurses in Gondar University hospital. A pretested and structured self-administered questionnaire was used for data collection. Data were entered using EPI info version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. Descriptive statistics was used to describe the study population in relation to relevant variables. Bivariate and multivariate logistic regression was also carried out to see the effect of each independent variable on the dependent variable. Result Nearly half (54.4 %) of the nurses had good knowledge; similarly 48.4 % of them had good practice on prevention of pressure ulcer. Educational status [Adjusted Odds Ratio (AOR) = 2.4, 95 % CI (1.39-4.15)], work experience [AOR = 4.8, 95 % CI (1.31-10.62)] and having formal training [AOR = 4.1, 95 % CI (1.29-9.92)] were significantly associated with knowledge on prevention of pressure ulcer. While, satisfaction with nursing leadership [AOR = 1.9, 95 % CI (1.04-3.82)], staff shortage [AOR = 0.07, 95 % CI (0.03-0.13)] and inadequate facilities and equipment [AOR = 0.4, 95 % CI (0.19-0.83)] were found to be significantly associated with the practice on prevention of pressure ulcer. Conclusion Knowledge and practice of the nurses regarding prevention of pressure ulcer was found to be inadequate. Having higher educational status, attending formal training and being experienced were positively associated with knowledge; while shortage of facilities and equipments, dissatisfaction with nursing leadership and inadequate staff number showed negative association with practice of nurse’s pressure ulcer prevention. In-service training and upgrading courses are some of the important steps to improve nurses’ knowledge and practice on prevention of ulcer pressure. Electronic supplementary material The online version of this article (doi:10.1186/s12912-015-0076-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Fisseha Zewdu
- Department of Nursing, University of Gondar, Gondar, Ethiopia
| | - Senafikish Amsalu
- Department of Reproductive Health, Institute of Public health, University of Gondar, Gondar, Ethiopia
| | - Yohannes Mehretie
- Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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