Pressure ulcers in the adult intensive care unit: a literature review of patient risk factors and risk assessment scales

Abstract

Background: Critically ill patients are at high risk for pressure ulcer (PrU) development due to their high acuity and the invasive nature of the multiple interventions and therapies they receive. With reported incidence rates of PrU development in the adult critical care population as high as 56%, the identification of patients at high risk of PrU development is essential. This paper will explore the association between PrU development and risk factors. It will also explore PrU development and the use of risk assessment scales for critically ill patients in adult intensive care units. Method:A literature search from 2000 to 2012 using the CINHAL, Cochrane Library, EBSCOHost, Medline (via EBSCOHost), PubMed, ProQuest and Google Scholar databases was conducted. Key words used were: pressure ulcer/s; pressure sore/s; decubitus ulcer/s; bed sore/s; critical care; intensive care; critical illness; prevalence; incidence; prevention; management; risk factor; risk assessment scale.Results: Nineteen articles were included in this review; eight studies addressing PrU risk factors, eight studies addressing risk assessment scales and three studies overlapping both. Results from the studies reviewed identified 28 intrinsic and extrinsic risk factors which may lead to PrU development. Development of a risk factor prediction model in this patient population, although beneficial, appears problematic due to many issues such as diverse diagnoses and subsequent patient needs. Additionally, several risk assessment instruments have been developed for early screening of patients at higher risk of developing PrU in the ICU. No existing risk assessment scales are valid for identification high risk critically ill patient, with the majority of scales potentially over-predicting patients at risk for PrU development. Conclusion:Research studies to inform the risk factors for potential pressure ulcer development are inconsistent. Additionally, there is no consistent or clear evidence which demonstrates any scale to better or more effective than another when used to identify the patients at risk for PrU development. Furthermore robust research is needed to identify the risk factors and develop valid scales for measuring the risk of PrU development in ICU.

Attitudes of intensive care nurses towards pressure ulcer prevention

“…[25] Consequently, their physical activity is severely limited and their intake of nutrients is likely to be insufficient. [26] All of these factors could place ICU patients at greater risk of PU development.…”

Pattern and Risk Assessment of Bedsore in Hospitalized Patients

“…With reported incidence rates of bedsore development in the adult critical care population as high as 56%; the identification of patients at high risk of bedsore development is essential. This paper will explore the association between bedsore development and risk factors 8 . Pressure ulcer risk assessment is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer.…”

Part 2: pressure ulcer assessment: implementation and revision of CALCULATE

“…Explanations for the varying rates are likely to be with the various methods used to calculate incidence, particularly with the varying categories of pressure ulcers included in the calculations, plus whether those pressure ulcers included were truly critical care acquired. Despite the varying incidence, pressure ulcers are often preventable (NICE, ) and pressure ulcer assessment is an important first step in the prevention of serious consequences such as pain, scaring and increased likelihood of survival (Alderden et al , ; Tayyib et al , ).…”

“…Critically ill patients have an increased incidence of pressure ulcers when compared to other acute care areas (Brindle, ; Alderden et al , ; Lahmann et al , ; Cox, ; Tayyib et al , ) and within critical care variation exists in the reported incidence. Recently, pressure ulcer incidence was calculated in an intensive and high dependency unit in Finland and was found to be 11.1% (Ahtiala et al , ).…”