Clinical variance in assessing risk of pressure ulcer development

Nurses working in one area health service (AHS) in Sydney, Australia, expressed concern about the development of pressure ulcers in hospitalized patients. Anecdotal evidence suggested that a variety of approaches were being used to assess patients to identify those at risk of pressure ulcer development. A questionnaire was distributed to all registered nurses (n = 2113) in clinical settings within the AHS. Data were analysed using frequency distribution. The response rate was 40% (n = 850), of which 444 were useable. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators. It is recommended that a pressure ulcer project group be established to evaluate existing tools or, if necessary, develop a tool for the assessment of patients to identify those at risk of developing pressure ulcers.

Collecting pressure ulcer prevention and management outcomes: 2

The first part of this article (Vol 11(4): 230-8) outlined the argument that a combination of efficacy and effectiveness is required to assess fully the impact of interventions such as pressure-redistributing (PR) beds and mattresses. In addition, it described the methodology of this multinational, multicentre, prospective, non-randomized cohort study designed to record the occurrence and characteristics of patients vulnerable to, or with, established pressure ulcers. This article reports further details of the characteristics of the 2507 UK adult hospital patients recruited to the study. Over 40% (42% n = 1046) of all subjects were considered to be at an elevated risk of developing ulcers (Waterlow score of 15 or greater) (Waterlow, 1985). Many were inactive with 332 (13%) confined to bed alone with a further 262 (10%) confined to bed and their chair. Most (74% n = 1868) were nursed upon PR beds and mattresses, while fewer subjects were provided with a PR seat cushion (n = 547; 27%). Two hundred and fifty-seven subjects (10%) experienced at least one change of bed mattress during their stay in hospital, with two subjects being nursed on five different mattresses during their hospital stay.

Evaluating the Pegasus Trinova: a data hierarchy approach

Understanding the efficacy of patient support surfaces is essential if pressure sore management is to be both efficient and effective. However, laboratory and clinical studies in this area are fraught with well recognized problems. This investigation reports a combination of laboratory, randomized controlled trial (efficacy data) and measures of effectiveness to illustrate the beneficial role of a new dynamic integrated mattress and seat cushion system: the Pegasus Trinova. Successful prevention of sores among a vulnerable patient population, along with positive comments regarding the system's comfort and 'user-friendliness' are supported by laboratory measures of interface pressure to provide a hierarchy of data. Such an approach may present one solution to the lack of timeliness of most mattress clinical trials, thus allowing decisions regarding new support surfaces to be made upon the basis of evidence, not on anecdote or solely upon marketing claims.