Pressure ulcers--prevention and treatment guidelines

Characteristics of Hospital Acquired Pressure Ulcer and Factors Affecting Its Development: A Retrospective Study

Background Worldwide, pressure ulcers (PUs) have been implicated in costing billions annually, with 60,000 deaths out of 2.5 million hospitalized patients resulting from complications related to PU. The prevention of PU reduces the incidence of other illnesses, decreases the financial costs, and improves the quality of life for patients. We aimed to identify the most influential factors that increased the risk of developing PUs among hospitalized patients at a university hospital according to the Waterlow scale. Methods Data were collected retrospectively from patients who developed PUs between January 2016 and December 2018 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were evaluated using the Waterlow PU risk assessment tool. The analysis was performed using the Statistical Package for Social Science (SPSS), version 23.0 (IBM, Armonk, NY). Results A total of 272 cases were included in this study. The highest number of cases (n = 83, 30.5%) belonged to the age group of 50 to 64 years. The majority of patients had stage 2 PUs (165, 60.7%). The most frequent location of PU was the "back" (97, 35.7%). A history of undergoing major surgery was significantly associated with a higher stage of PU (p = 0.040). The mean Waterlow PU score for all cases was 27.19 ± 13.143. There was a moderate positive correlation between the neurological deficit score and the Waterlow PU score (correlation coefficient: 0.447, p < 0.001). Multinomial logistic regression analysis revealed that increasing age is a significant predictive factor for developing higher stages of PUs (p = 0.046). Conclusion Major surgery, neurological deficit, low hemoglobin level, and increasing age were strong predictors for developing higher stages of PU. Therefore, healthcare contributors should consider these risks when applying a comprehensive PU management plan.

Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers

AIMS

To determine incidence of pressure ulcers in patients at risk according to the Waterlow scale in intensive care units and to evaluate the effects of risk factors in critically ill patients.

BACKGROUND

Pressure ulcers continue to be an important health problem that increases the risk of illness and death, extends patients' length of hospital stay and increases healthcare expenses.

DESIGN

The study was conducted as a descriptive and prospective study.

METHOD

The sample consisted of 140 patients. Data were collected using a data collection form, the skin assessment instrument and the Waterlow scale.

RESULTS

The incidence of pressure ulcers in intensive care unit patients was found to be 14.3%. The majority of pressure ulcers (74%) were grade I. The mean length of time for pressure ulcer development was found to be 10.4 (SD 1.85) days. A statistically significant difference was found in the patients for pressure ulcer development according to their level of consciousness, activity, cooperation, length of stay, Waterlow scale score and C-reactive protein level. In the multiple stepwise logistic regression analysis, the most influential factors for pressure ulcer development were determined to be length of stay and activity level.

CONCLUSIONS

Extra care needs to be taken to prevent pressure ulcer development in intensive care unit patients who have an extended length of stay, are dependent for activities, have high Waterlow scores, are unconscious and are not cooperative.

RELEVANCE TO CLINICAL PRACTICE

This study determined the incidence of and factors that can affect the development of pressure ulcers in intensive care unit patients who are in a high risk group for the development of pressure ulcers and presented the importance of having Turkish nurses implement interventions directed at these factors.

Appraising and comparing pressure ulcer guidelines

BACKGROUND

Whilst considerable activity has been related to guideline development for nurses regarding pressure ulcer prevention and management, no attempt has been made to comparatively evaluate these guidelines against some form of quality indicators.

AIM

To compare and contrast four national pressure ulcer guidelines, and identify similarities and differences in their quality and content.

METHODS

An international comparative appraisal method, using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument, was undertaken to appraise four published pressure ulcer guidelines. Two further domains were added to the AGREE instrument to assess comparability of the guidelines and their perceived contribution to practice. An international group undertook the comparative appraisal.

RESULTS

The domain scores for each guideline show some but not total agreement among reviewers. One particular set of guidelines was identified as scoring highest in a majority of AGREE domains. Overall, evidence of variability exists between pressure ulcer guidelines and common areas of development to consider for all guidelines.

IMPLICATIONS FOR PRACTICE

The results raise many questions concerning the "best" pressure ulcer guideline to use, particularly related to the AGREE scoring. Some notable shortcomings exist in all the pressure ulcer guidelines reviewed and these shortcomings need to be addressed from a quality perspective. However, other issues such as style of reporting and potential contribution to practice might more fully affect choice by practitioners as opposed to guideline developers.

CONCLUSIONS

Notable differences exist among the four guidelines that are possibly explained by different approaches to development and also because of different cultural factors and intentions for use. Whilst the AGREE tool identifies the quality of the guideline development process it still requires local engagement with practitioners to determine which guideline should be implemented.

The QUATTRO ACUTE mattress and pressure ulcer prevention

There are a plethora of mattresses on the market and nurses are not always sure which mattress to select for each individual patient. This article outlines the issues in preventing and understanding pressure ulcers and the performance of the QUATTRO ACUTE trade mark mattress, manufactured by Talley Medical.

Treatment of a heel blister caused by pressure and friction

The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort.