Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as the foundation for future quality improvement

Abstract

The objectives of the study were to examine the prevalence of pressure ulcers and hospital-acquired pressure ulcers (HAPU) and identify modifiable factors in patients who develop HAPU as the basis for subsequent quality assurance studies and improvement in hospital care. The study was conducted in five hospitals in two Swedish County Councils. A 1-day prevalence study (n = 1192) using the standards of the European Pressure Ulcer Advisory Panel and Collaborative Alliance for Nursing Outcomes was conducted. The prevalence of ulcers was 14·9% and 11·6% were HAPU. Older age, more days of hospitalisation, less activity, problems with shear and friction and reduced sensory perception contributed significantly to HAPU. Pressure ulcer prevention strategies used more often in those with HAPU were risk assessment at admission, provision of a pressure relief mattress, having a turning schedule and using a heel or chair cushion. The prevalence of pressure ulcers continues to be a significant issue in acute care and the prevalence of HAPU is high. There is significant room for quality improvement in pressure ulcer prevention in Swedish hospitals. Future research needs to address both HAPU and community-acquired pressure ulcers and focus on preventive strategies, including when they are initiated and which are effective in mitigating the high HAPU rate.

Povezave med razjedo zaradi pritiska in ohranjanjem integritete kože pacienta v intenzivni zdravstveni obravnavi: pregled literature

“…Bolnišnice morajo biti odgovorne, če RZP niso bile odkrite in dokumentirane v tem roku. Če želimo na dokazih podprto preprečevanje RZP, bodo medicinske sestre morale uporabiti podatke o tveganju in zgodnjih spremembah na koži (I stopnjo RZP) kot podlago za izvajanje preventive (Gunningberg, et al, 2011).…”

“…Maas Burhans & Raile Alligood, 2010;Donabedian, 2005;Foster, 2012;Sutton, 2011;Turjanica, et al, 2011;Gunningberg, et al, 2011;Cox, 2011;Wilczweski, et al, 2012 Kategorija 3 -Vazoaktivne učinkovine vzdrževanje hemodinamske stabilnosti-vzdrževanje stabilnosti ciljnega krvnega pritiskapovrnitev naravnega ravnovesja -optimalna mikrocirkulacija -odgovornost in natančnost -dobava in hranjenje -priprava in aplikacija -dovajanje in titriranje (odmerjanje po zdravnikovem naročilu) -nadzor infuzijskih črpalk -povečane terapevtske aktivnostimonitoring življenjsko pomembnih organov -hemodinamika (npr. EKG, LiDCO, PiCCO, nevromonitoring itd.)…”

“…in IV. stopnje RZP (se ne bi smeli zgoditi v bolnišnici) -švedska raziskava: 77,85 % vseh razjed nastane v bolnišnici -najvišjo stopnjo RZP pridobijo pacienti na intenzivnih enotah in geriatričnih oddelkih -visoko tveganje za RZP imajo ortopedski pacienti in pacienti z zlomom kolka, že po 30 min ležanja -stopnja umrljivosti slednjih je 10 % po enem mesecu in 30 % v enem letu po poškodbi-izguba mobilnosti in neodvisnosti -RZP je tesno povezana z uporabo ustrezne preventive -belgijska raziskava: pomanjkanje znanja medicinskih sesterodgovornost na ravni strokovnjaka, politika in prizadetega človeka Braun, et al, 2010;Maas Burhans & Raile Alligood, 2010;Samuriwo, 2010;Geraghty, 2011;StephenHaynes, 2011;Thompson, 2011;Matsui, et al, 2011;Rafter, 2011;Gunningberg, et al, 2011;Beeckman, et al, 2011;Foster, 2012;Wilczweski, et al, 2012;Antonetti & Pittman, 2012;Lloyd Jones, 2012;Tschannen, et al, 2012;…”

INTroducing A Care bundle To prevent pressure injury (INTACT) in at-risk patients: A protocol for a cluster randomised trial

“…PIs are a major problem in hospitals, affecting approximately 10 -30% of patients worldwide, depending on the country, setting, patient population and presence of pressure injury prevention (PIP) strategies (Banks et al, 2010, Gunningberg et al, 2013, Igarashi et al, 2013, James et al, 2010. The majority of PIs in the clinical setting are hospital acquired pressure injuries (HAPI) (Gallagher et al, 2008, Gunningberg et al, 2011, Lyder et al, 2012. Two European studies of nearly 2000 hospitalised patients reported PI prevalence between 15 -19%, and 77 -78% of these were HAPI (Gallagher et al, 2008, Gunningberg et al, 2011.…”

“…The majority of PIs in the clinical setting are hospital acquired pressure injuries (HAPI) (Gallagher et al, 2008, Gunningberg et al, 2011, Lyder et al, 2012. Two European studies of nearly 2000 hospitalised patients reported PI prevalence between 15 -19%, and 77 -78% of these were HAPI (Gallagher et al, 2008, Gunningberg et al, 2011. In Australia, the incidence of HAPI is 7.4 -17.4% (Mulligan et al, 2011).…”