Corbett Lisa Q, Funk Marjorie, Fortunato Gilbert, OʼSullivan David M
Lisa Q. Corbett, DNP, APRN, ACNS-BC, CWOCN, Wound Ostomy Continence Team, Hartford Hospital, Hartford HealthCare, Hartford, Connecticut, and Yale University School of Nursing, West Haven, Connecticut. Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University School of Nursing, West Haven, Connecticut. Gilbert Fortunato, MBA, Hartford HealthCare Research Institute, Hartford, Connecticut. David M. O'Sullivan, PhD, Hartford HealthCare Research Institute, Hartford, Connecticut.
J Wound Ostomy Continence Nurs. 2017 May/Jun;44(3):221-227. doi: 10.1097/WON.0000000000000320.
The purpose of this study was to describe present-on-admission pressure injuries (POA-PIs) in community-dwelling adults admitted to acute care. The specific aims of the study were to (1) measure the prevalence of POA-PIs during a 1-year period; (2) determine prehospital location of patients with POA-PIs; and (3) describe demographics, pressure injury (PI) characteristics, risk factors, and posthospital outcome of community-dwelling adults with PIs admitted to hospital.
Retrospective descriptive study.
The study sample was identified from a PI registry, a database maintained for quality improvement, at an 860-bed urban academic medical center in New England. The majority (n = 1022, 76.1%) were admitted to hospital from the community; and the remaining (23.9%) were admitted from long-term care facilities.
All subjects were assessed by certified wound nurses. Data were extracted electronically from selected standardized electronic health record (EHR) fields, representing variables of interest. Descriptive statistics were analyzed using percentages, means, and medians.
The prevalence of patients admitted to acute care with a POA-PI was 7.4%. Community-dwelling subjects with POA-PIs had a mean age of 72.7 ± 15.4 years; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% were college educated. They presented with a mean of 1.46 PIs; 37.5% were full thickness. Admission Braden Scale for Pressure Sore Risk scores indicated that 77% were at risk for PI; subscores indicated mobility limitations in 90.8% and inadequate/poor nutrition in 41.3%. Subjects had multiple comorbid conditions (mean 18.4 ± 5.3 admission diagnoses). Only 21.4% were receiving home care services prior to admission. More than half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%.
The overall prevalence of POA-PIs on hospital admission in this study was higher than previous published reports. The majority arrived from community-dwelling locations. The severity of community-dwelling POA-PIs was higher than known benchmarked hospital-acquired PI severity. This real-world profile of community-dwelling patients with PI suggests that these individuals are considerably vulnerable and underserved by home care services. Opportunities exist for community PI screening, prevention, and intervention.
本研究旨在描述入住急症护理的社区居住成年人入院时即存在的压疮（POA-PIs）情况。该研究的具体目标为：（1）测量1年期内POA-PIs的患病率；（2）确定患有POA-PIs患者的院前地点；（3）描述入住医院的社区居住成年压疮患者的人口统计学特征、压疮（PI）特点、危险因素及出院后结局。
回顾性描述性研究。
研究样本来自新英格兰地区一家拥有860张床位的城市学术医疗中心用于质量改进的压疮登记册数据库。大多数患者（n = 1022，76.1%）从社区入院；其余患者（23.9%）从长期护理机构入院。
所有研究对象均由认证伤口护士进行评估。数据从选定的标准化电子健康记录（EHR）字段中以电子方式提取，这些字段代表了感兴趣的变量。使用百分比、均值和中位数对描述性统计数据进行分析。
入住急症护理时患有POA-PIs的患者患病率为7.4%。患有POA-PIs的社区居住患者平均年龄为72.7±15.4岁；52.4%为男性，80.3%为白人，30.9%独自生活，99.2%有保险，30.6%接受过大学教育。他们平均有1.46处压疮；37.5%为全层压疮。入院时压疮风险Braden量表评分表明，77%的患者有发生压疮的风险；分项评分表明，90.8%的患者存在活动受限，41.3%的患者营养不足/较差。患者有多种合并症（平均入院诊断数为18.4±5.3个）。入院前只有21.4%的患者接受家庭护理服务。超过一半（51.5%）的患者出院后前往医疗机构，33%回家，14%死亡或接受临终关怀护理。30天再入院率为15.5%。
本研究中入院时POA-PIs的总体患病率高于以往发表的报告。大多数患者来自社区居住地点。社区居住的POA-PIs严重程度高于已知的医院获得性PI严重程度基准。这种社区居住压疮患者的真实情况表明，这些个体相当脆弱且家庭护理服务不足。存在进行社区压疮筛查、预防和干预的机会。
