Bergquist-Beringer Sandra, Dong Lei, He Jianghua, Dunton Nancy
School of Nursing, University of Kansas Medical Center, Kansas City, USA.
Jt Comm J Qual Patient Saf. 2013 Sep;39(9):404-14. doi: 10.1016/s1553-7250(13)39054-0.
Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities.
Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers.
The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status.
Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.
大多数压疮可通过循证实践预防。许多研究描述了压疮预防项目的实施情况，但很少有研究报告其对各急症护理机构结局的影响。
2010年国家护理质量指标数据库压疮调查中有关医院获得性压疮及预防的数据，与数据集中的医院特征和护士人员配置措施相关联。样本包括来自美国各地的1419家医院以及在成人重症监护、逐步降级护理、内科、外科和内科/外科病房接受压疮调查的710,626名患者。进行分层逻辑回归分析，以确定与有压疮风险患者发生医院获得性压疮相关的研究变量。
在所有接受调查的患者中，医院获得性压疮的发生率为3.6%，在有风险的患者中为7.9%。入院时接受皮肤和压疮风险评估的患者发生压疮的可能性较小。与较低的医院获得性压疮发生率相关的其他研究变量包括最近对压疮风险的重新评估、较高的Braden量表评分、最近的皮肤评估、常规翻身以及磁铁认证或申请磁铁认证。与医院获得性压疮可能性较高相关的变量包括营养支持、湿度管理、医院规模较大以及学术医疗中心地位。
研究结果为压疮预防指南中关于皮肤评估、压疮风险评估和常规翻身的建议提供了实证支持，但有风险患者中医院获得性压疮发生率为7.9%，这表明压疮预防实践仍有改进空间。
