Horton-Jones Martyne, Marsh Emma, Fumarola Sian, Wright-White Helen, McSherry Wilfred, Rowson Trish
The University Hospitals of North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK.
Department of Nursing, School of Health and Social Care, Staffordshire University, Blackheath Lane, Stafford, ST18 0YB, UK.
Healthcare (Basel). 2019 Apr 8;7(2):59. doi: 10.3390/healthcare7020059.
: Between October 2017 and March 2018, the Trust experienced significant winter pressures and an increase in category 2 and 3 hospital-acquired avoidable pressure ulcers. This review aimed to investigate the causal factors of this increase. : A 'Deep Dive' review of 37 cases was undertaken in three stages: (i) assurance; ensure the increase was not due to insufficient equipment; (ii) collation of relevant data, including age, length of time in A&E, bed surface, number of internal moves; (iii) analysis identifying factors that might account for the observed increase. : Age combined with prolonged length of time in A&E, being nursed on a trolley followed by three or four internal moves were observed in patients who developed pressure ulcers. Patient age was observed as a key factor, with those over 80 years experiencing pressure ulcers more frequently. : The small size of this data suggests a need for the greater awareness of frailty issues in older people, timely assessment and intervention to prevent a chain of detrimental factors might be key to reduce and prevent hospital-acquired avoidable pressure ulcers. Recommendations for immediate action, education and future research have been made to the Trust Quality and Safety Committee.
2017年10月至2018年3月期间，该信托机构面临巨大的冬季压力，2级和3级医院获得性可避免压疮有所增加。本综述旨在调查这种增加的因果因素。对37例病例进行了三个阶段的“深入”审查：（i）保证：确保增加不是由于设备不足；（ii）整理相关数据，包括年龄、在急诊室的时间、床面、内部转移次数；（iii）分析确定可能解释观察到的增加的因素。发生压疮的患者中观察到年龄与在急诊室的时间延长、在手推车上护理以及随后进行三到四次内部转移相结合。观察到患者年龄是一个关键因素，80岁以上的人更频繁地发生压疮。这些数据规模较小，表明需要提高对老年人虚弱问题的认识，及时评估和干预以防止一系列有害因素，这可能是减少和预防医院获得性可避免压疮的关键。已向信托质量与安全委员会提出立即采取行动、开展教育和未来研究的建议。
