University of Michigan , School of Nursing.
Appl Clin Inform. 2011 Dec 7;2(4):508-21. doi: 10.4338/ACI-2011-07-RA-0046. Print 2011.
Hospital stays for patients with pressure ulcers (PU) increased nearly 80% from 1992 to 2006. Most PU's developed during an admission, often despite preventive efforts from clinical staff. Data from Electronic medical records (EMR's) were used to prepare daily patient risk factor and PU information for nurses to help prevent PU development and exacerbations.
THE OBJECTIVES OF THIS STUDY WERE TO DETERMINE WHETHER: 1) dissemination of an automated daily report with patient risk and current status of pressure ulcers ("PU Daily") helps prevent the development of pressure ulcers, and 2) using the PU Daily information impacts the severity of pressure ulcers that develop in an acute care setting.
A pre-post study with four control units was designed to determine the impact of the PU Daily in intensive care units (ICU) in a large medical center. The control units included ICU's using the same EMR and similar complexity of cases with a high risk of developing a PU. The pre-post study took place over a six month period (March - August 2009).
A total of 6,735 cases were included in the study. The intervention unit showed a significant decrease (p = 0.004) in PU's at post-evaluation; none of the four comparison units showed a decrease at the p<0.05 level. The intervention led to a significant reduction in the total number of PU's documented (p <0.000) and the number of Stage II PU's (p = 0.046).
The intervention with the PU Daily showed a significant decrease in the total PU's and severity of PU's and allowed for implementation of interventions that help prevent the development of PU's. As EMR's become more widely available, this intervention showed a reduction in PU's. Future studies should further develop this intervention and include multiple institutions and patient populations.
1992 年至 2006 年，患有压疮（PU）的患者住院率增加了近 80%。大多数压疮是在住院期间发生的，尽管临床工作人员采取了预防措施。电子病历（EMR）的数据被用来为护士准备每日患者风险因素和压疮信息，以帮助预防压疮的发展和恶化。
本研究的目的是确定：1）分发带有患者风险和当前压疮状况的自动每日报告（“PU 每日报告”）是否有助于预防压疮的发展，以及 2）使用 PU 每日报告信息是否会影响急性护理环境中发生的压疮的严重程度。
采用前后对照研究设计，在一家大型医疗中心的重症监护病房（ICU）中确定 PU 每日报告的影响。对照组包括使用相同 EMR 且具有发生压疮高风险的 ICU，且病例复杂性相似。该前后对照研究持续了六个月（2009 年 3 月至 8 月）。
共有 6735 例病例纳入研究。干预组在后期评估中显示压疮显著减少（p=0.004）；四个对照组中没有一个在 p<0.05 水平下显示减少。干预措施导致记录的压疮总数（p<0.000）和 II 期压疮数量（p=0.046）显著减少。
PU 每日报告干预措施显著降低了压疮总数和压疮严重程度，并实施了有助于预防压疮发展的干预措施。随着 EMR 的广泛应用，这种干预措施减少了压疮的发生。未来的研究应进一步发展这种干预措施，并纳入多个机构和患者群体。
