The purpose of this poster presentation is to share the process used at a 60-bed acute rehabilitation facility to address the individual needs of admitted patients regarding their needs for pressure ulcer prevention and/or treatment. Since nearly all patients admitted (spinal cord injury, brain injury, stroke, and general rehabilitation) are identified as being at risk for pressure ulcers upon admission, it is critical that the team quickly identify and implement measures to prevent breakdown and/or promote healing. Because the average length of stay in rehabilitation is only about 16 days, it is vital to focus both on the quality of care and the efficiency of its delivery. The thorough admission assessment process utilizes a rehabilitation interdisciplinary team consisting of the staff nurse and clinical nurse specialist (CNS), physician, physical therapist, occupational therapist, speech therapist, nutritionist, pharmacist, and psychologist. This admission assessment guides the decision making for type of bed, style of wheelchair and cushion, nutritional interventions, turning schedules, activity schedules, type of bowel and bladder programs and therapy interventions. The patient and family members are included in the assessment and decision-making process to facilitate their learning and follow-through. If a patient is admitted with a pressure ulcer, the rehabilitation CNS evaluates the wound and makes further recommendations for care. The chronic wound team, which includes the rehabilitation CNS, the WOC nurses and a plastic surgeon, are consulted for sharp debridement, for a non-healing ulcer evaluation and recommendations, or for a complicated wound that will need follow-up in the outpatient wound clinic after discharge from rehabilitation.STATEMENT OF CLINICAL PROBLEM: Donor site care and dressing changes often cause discomfort for the patient and create issues related to healing. Using evidence-based practice, healing time and complications can be decreased, and discomfort lessened for the patient. DESCRIPTION OF PAST MANAGEMENT: At our organization, standard of care for donor site dressing changes was iodine impregnated petroleum gauze* applied directly to the donor site in the operating room, along with heat lamp therapy. Dressing changes began several days post-op and consisted of traumatic removal of the gauze with intense pain and bleeding, disrupting healing and new cell growth. There was often confusion by nurses as to the best procedure, as they relied solely on the written physician order that was usually vague and incomplete. CURRENT CLINICAL APPROACH: The involvement of the CWOCNs included review of evidence-based practice and mentoring of the physicians. After utilizing the antimicrobial hydrofiber dressing with silver on several patients resulting in positive OUT-COMES, the physicians were convinced of the effectiveness of this dressing for donor site care. Eventually, the Donor Site Care Orders was formally created, increasing nurse satisfaction related to improved communication and continui...

OBJECTIVE:To examine the prevalence and characteristics of medical device–related pressure injuries (MDR PIs) in a large, generalizable database.METHODS:This study is a retrospective analysis of the 2016 International Pressure Ulcer Prevalence data. Data were limited to US and Canadian facilities. Facilities included acute care, long-term care, rehabilitation, long-term acute care hospitals, and hospice. Analysis included 102,865 adult patients; 99,876 had complete data and were the focus of the analysis and are reported in the results below.RESULTS:The overall PI prevalence was 7.2% (n = 7189), and the facility-acquired prevalence was 3.1% (n = 3113). The prevalence of MDR PIs was 0.60% (n = 601), which included both mucosal and nonmucosal MDR PIs. In this study, 75% of MDR PIs were facility acquired, whereas non-MDR PIs were most commonly present on admission. Facility-acquired MDR PIs formed 3 days faster than facility-acquired non-MDR PIs (12 vs 15 days; P < .05). By stage, most MDR PIs were superficial (58% were Stage 1 or 2), 15% were deep-tissue PIs, and 22% were full-thickness PIs (Stage 3 or 4 or unstageable). The most common anatomic locations for MDR PIs were the ears (29%) and the feet (12%). The most common devices associated with MDR PIs were nasal oxygen tubes, 26%; other, 19%; cast/splints, 12%; and continuous positive airway pressure/bilevel positive airway pressure masks, 9%.CONCLUSIONS:Because MDR PIs form faster than non-MDR PIs, timely proactive assessment and prevention measures are critical. Most MDR PIs occurred at the face and head region, and the ears specifically. The most common devices linked with MDR PIs were oxygen tubing and masks, making assessment and prevention efforts critical for patients who require those devices.

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The OP and FAP in acute care and rehabilitation have declined significantly over this 10-year period. Analysis of OP and FAP in LTC and LTACs varied without any clear-cut directional trends. General facility demographic trends indicate that mean patient age has decreased, Braden Scale scores for pressure injury risk has remained constant, and weight has increased in most care settings.VIDEO ABSTRACT available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JWOCN/A37).

PURPOSE: To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD). DESIGN: Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data. SUBJECTS AND SETTING: Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada. METHODS: IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population. RESULTS: Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores. CONCLUSIONS: Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.

PURPOSE: The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. DESIGN: Observational, cross-sectional cohort study. SUBJECTS AND SETTING: An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). METHODS: Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. RESULTS: Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. CONCLUSIONS: Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.

To assess the relationships among pressure ulcer prevalence, body mass index (BMI), and weight, this report analyzed the US data from the 2006 and 2007 International Pressure Ulcer Prevalence Surveys. Findings indicated an overall reduction in pressure ulcer prevalence from 2004 and 2005 to 2006 and 2007; there was a higher prevalence of pressure ulcers in patients with low BMI and patients with both low and high weights. One in 10 patients were extremely obese.

Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.