Gunningberg Lena, Stotts Nancy A
Nursing Research and Development, Surgery Division, Uppsala University Hospital, Uppsala, Sweden.
Int J Qual Health Care. 2008 Aug;20(4):246-53. doi: 10.1093/intqhc/mzn009. Epub 2008 Apr 6.
To compare the prevalence of pressure ulcers and prevention before and after a quality improvement program; determine whether patient characteristics differed for those who did and did not develop pressure ulcers; identify pressure ulcer prevention implemented at admission and whether prevention and risk factors varied by pressure ulcer severity.
Descriptive comparative study based on two cross-sectional pressure ulcer surveys conducted in 2002 and 2006, complemented with a retrospective audit of the electronic health record and administrative system for patients identified with pressure ulcers.
1100-bed Swedish university hospital.
612 hospitalized patients in 2002 and 632 in 2006.
Prevalence of pressure ulcers and prevention (pressure-reducing mattresses; planned repositioning; chair, heel and 30 degrees lateral positioning cushions).
Pressure ulcer prevalence was 23.9% in 2002 and 22.9% in 2006. When non-blanchable erythema was excluded, the prevalence was 8.0 and 12.0%, respectively. The use of pressure-reducing mattresses increased while planned repositioning decreased. Those who developed ulcers were older, at-risk for ulcers, incontinent and had longer length of stay. Little prevention was documented at admission. Some prevention strategies and risk factors were related to severity of ulcers.
Pressure ulcer prevalence did not decrease, despite a comprehensive quality improvement program. Special attention is needed to provide prevention to older patients with acute admission. Skin and risk assessment, as well as prevention, should start early in the hospitalization. Identifying those persons with community-acquired versus hospital-acquired ulcers will strengthen pressure ulcers as an accurate marker of quality of care for hospitalized patients. If possible, data should be reported by ward level for comparison over time.
比较质量改进项目前后压疮的患病率及预防情况；确定发生和未发生压疮的患者在特征上是否存在差异；确定入院时实施的压疮预防措施，以及预防措施和危险因素是否因压疮严重程度而异。
基于2002年和2006年进行的两项横断面压疮调查的描述性比较研究，并对确诊为压疮的患者的电子健康记录和管理系统进行回顾性审核。
拥有1100张床位的瑞典大学医院。
2002年有612名住院患者，2006年有632名。
压疮的患病率及预防措施（减压床垫；计划性翻身；椅子、足跟及30度侧卧位垫）。
2002年压疮患病率为23.9%，2006年为22.9%。排除不可压褪色红斑后，患病率分别为8.0%和12.0%。减压床垫的使用增加，而计划性翻身减少。发生压疮的患者年龄较大、有压疮风险、大小便失禁且住院时间较长。入院时记录的预防措施很少。一些预防策略和危险因素与压疮严重程度有关。
尽管实施了全面的质量改进项目，压疮患病率并未降低。需要特别关注急性入院的老年患者，以提供预防措施。皮肤和风险评估以及预防措施应在住院早期开始。区分社区获得性与医院获得性压疮患者将强化压疮作为住院患者护理质量准确指标的作用。如有可能，应按病房级别报告数据以便进行时间上的比较。
