Bruce Tracey A, Shever Leah L, Tschannen Dana, Gombert Jan
University of Michigan Health System, Ann Arbor, MI, USA.
Crit Care Nurs Q. 2012 Jan-Mar;35(1):85-101. doi: 10.1097/CNQ.0b013e31823b1f22.
Pressure ulcers are an increasing health care problem. Accurate identification and classification of pressure ulcers impacts patient outcomes, health care costs, and quality initiatives.To identify existing evidence related to answering the question "Does bedside nursing staff accurately and reliably stage pressure ulcers as evidenced in their documentation?" Further evidence from one large tertiary care center with pressure ulcer identification and staging by nurses is also reported. Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases were searched to identify existing evidence on the accuracy and reliability of pressure ulcer classification by nurses. Two reviewers independently screened results. A total of 54 full-text articles were obtained for review and 10 were included for final review. In addition, the accuracy and consistency of pressure ulcer identification and staging were examined at one large tertiary health system by extracting data from electronic health records for 1488 patient visits and assessments for 1499 patients. Comparisons were done for pressure ulcer documentation from 1 nurse's assessment to the following shift nurse's assessment and from the bedside nurse's assessment to assessments done by pressure ulcer experts.Review of the literature revealed that the reliability of pressure ulcer identification and classification is limited and highly variable. Some reports in the literature suggested nurses had difficulty distinguishing a pressure ulcer from other types of wounds. In addition, inaccuracies in pressure ulcer documentation were also identified. Further analysis of data within one large tertiary health care system revealed unreliable pressure ulcer documentation.
压疮是一个日益严重的医疗保健问题。压疮的准确识别和分类会影响患者的治疗效果、医疗成本和质量改进措施。为了找出与回答“床边护理人员在其记录中是否能准确可靠地对压疮进行分期？”这一问题相关的现有证据。本文还报告了来自一家大型三级护理中心关于护士对压疮进行识别和分期的进一步证据。检索了护理及相关健康文献累积索引（Cumulative Index to Nursing and Allied Health Literature）和医学期刊数据库（MEDLINE），以找出关于护士对压疮分类准确性和可靠性的现有证据。两名评审员独立筛选结果。共获取54篇全文文章进行评审，其中10篇纳入最终评审。此外，在一家大型三级医疗系统中，通过从1488例患者就诊的电子健康记录中提取数据以及对1499例患者进行评估，检查了压疮识别和分期的准确性与一致性。对同一名护士评估的压疮记录与下一班护士的评估结果进行了比较，以及对床边护士的评估结果与压疮专家的评估结果进行了比较。文献综述显示，压疮识别和分类的可靠性有限且差异很大。文献中的一些报告表明，护士难以将压疮与其他类型的伤口区分开来。此外，还发现了压疮记录中的不准确之处。对一家大型三级医疗保健系统内的数据进一步分析显示，压疮记录不可靠。
