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Medicine Oct 2023In the United States (US), pressure ulcers affect ≤3 million people and costs exceed 26.8 billion US dollars in spending. To examine trends in primary pressure ulcer...
In the United States (US), pressure ulcers affect ≤3 million people and costs exceed 26.8 billion US dollars in spending. To examine trends in primary pressure ulcer (PPU) hospitalization mortality, length of hospital stay (LOS), and inflation-adjusted charges (IAC) in the US from 2005 to 2014 by race/ethnicity. We secondarily examined the relationship between race/ethnicity with PPU mortality, LOS, and IAC with race/ethnicity. This cross-sectional study used Nationwide Inpatient Sample (NIS) data from 2005 to 2014. The study sample included all hospitalizations with the designated ICD-9-CM code of 707.20-25 (pressure ulcer). There was a notable decline in PPU hospitalization from 11.5% to 7.77 % between 2005 and 2014. The mean mortality decreased from 2.32% to 1.12% (P < .001), the mean LOS declined from 9.39 days (P < .001), and the mean IAC per hospitalization decreased from $30,935 to $29,432 (P < .001). Positive changes observed in mortality, LOS, and IAC trends were consistent across different racial and ethnic groups. The results of multivariable logistic and linear regression analyses revealed that Black patients (β = 0.68, 95% CI 0.36-1.01, P < .001) and patients belonging to the Other race/ethnic category (β = 0.93, 95% CI 0.18-1.69) had longer hospital stays compared to their White counterparts. Regarding IAC, Black patients (β = 2846, 95% CI 1254-4439, P < .005), Hispanic patients (β = 6527, 95% CI 4925-8130), and patients from the Other race/ethnic category (β = 3473, 95% CI 1771-5174) had higher IAC for PPU treatment compared to their White counterparts. PPU hospitalization discharges, as well as hospitalization mortality, LOS, and IAC, decreased during the study period, however, our findings revealed disparities in PPU outcomes among different racial/ethnic groups. Implications of the findings are discussed.
Topics: Humans; Black or African American; Cross-Sectional Studies; Ethnicity; Hospitalization; Pressure Ulcer; United States; Hispanic or Latino; White
PubMed: 37800772
DOI: 10.1097/MD.0000000000035307 -
British Journal of Community Nursing Dec 2023Decubitus ulcers, also known as bed ulcers or pressure ulcers, result from prolonged pressure on the skin, with contributing factors such as shear forces, friction and...
Decubitus ulcers, also known as bed ulcers or pressure ulcers, result from prolonged pressure on the skin, with contributing factors such as shear forces, friction and excessive moisture. Pressure ulcers have significant physical, social and psychological consequences for patients and impose a substantial financial burden on healthcare providers. Patient and caregiver education has been suggested as a potential approach for preventing pressure ulcers. In order to investigate the potential preventive impact, O'Connor et al (2021) conducted a Cochrane systematic review. Their study aimed to assess the effectiveness of educational interventions for patients and caregivers in preventing pressure ulcers. This commentary aims to critically appraise the methods used within the Cochrane systematic review by O'Connor et al (2022) and expand on the findings in the context of clinical practice.
Topics: Humans; Caregivers; Health Personnel; Pressure Ulcer
PubMed: 38019660
DOI: 10.12968/bjcn.2023.28.Sup12.S8 -
Journal of Clinical Nursing Jul 2023Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure injury risk assessment, prevention and treatment exists, but limited research exploring the patient and carer experience of living with pressure injury.
AIMS
The aim of this meta-synthesis was to describe the patient and carer experience of living with a pressure injury.
DESIGN
Meta-synthesis.
METHODS
A prospective review protocol was registered, and systematic search conducted across five electronic databases. The PRISMA 2020 checklist for reporting systematic reviews was used. Two reviewers independently undertook screening and review of articles, using the CASP checklist for evaluating qualitative research. A meta-synthesis using thematic content analysis was undertaken.
RESULTS
Twelve studies met the inclusion criteria. Meta-synthesis led to the construction of three primary themes: loss of autonomy and independence, psychological effects, and adjustment. Within these primary themes, sub-themes of dependence, social isolation and social avoidance behaviours, feelings and emotions, loss, managing, physical consequences, service provision, and functional challenges, were identified.
CONCLUSION
The psychology and mindset of those involved, and support to navigate the challenges that arise are two unique and clinically relevant categorisations to guide provision of pressure injury care. Adaptation to a pressure injury is multi-faceted and contextual, challenges to adaptation create additional psychological burden. Interventions encompassing all facets of the experience are necessary. Current research into experiences is limited, and further research to support interventions is necessary.
Topics: Humans; Caregivers; Pressure Ulcer; Prospective Studies; Qualitative Research
PubMed: 35768933
DOI: 10.1111/jocn.16431 -
Journal of Wound, Ostomy, and...This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute... (Review)
Review
PURPOSE
This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management.
DESIGN
A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project.
PARTICIPANTS AND SETTING
The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center. Both institutions are located in the Southeastern United States (Mobile, Alabama).
METHODS
The A-P council used a participatory action research approach and developed a practice-informed active learning program incorporating Melnyk's evidence-based practice (EBP) steps, the Donabedian Model and the Patient-Centered Outcomes Research Institute (PCORI) Stakeholder Engagement in Question Development and Prioritization (SEED).
METHOD
Hospital-acquired pressure injuries were selected as the quality outcome to address. To identify HAPI prevention/management evidenced-based practices, the A-P council conducted an integrative literature review and developed a concept map and the Pressure Injury Prevention Gap Analysis Instrument. The gap analysis identified significant gaps between EBP and current pressure injury prevention practices, with priority ranking of gaps for action by key stakeholders.
OUTCOME
Following the practice-informed active learning program objectives, the A-P council identified 79 HAPI best EBPs organized by Donabedian domains of structure, process, and outcome and prioritized 3 gaps for action. Actions to address the HAPI gaps included: restructuring the hospital HAPI program, incorporating appropriate leadership to guide the HAPI program, modifying the HAPI reporting process, hiring specialized experts (WOC nurses) with emphasis on pressure injury prevention, establishing a standardized HAPI prevalence survey, improving electronic documentation, increasing transparency of HAPI reporting, improving HAPI accountability at the unit level, and exploring technology to enhance skin assessment. While HAPIs increased by 6.3% from 2019 (n = 104) to 2021 (n = 111), HAPI severity (Stages 3 and 4) decreased by 9.9% from 2019 (n = 14, or 13.46%) to 2021 (n = 4, or 3.6%).
IMPLICATIONS FOR PRACTICE
Our experience with this quality improvement initiative indicates that an A-P partnership can provide a model to address complex clinical problems, quality indicators, and quality improvement while advancing a culture of inquiry and scholarship and building nursing capacity.
Topics: Humans; Pressure Ulcer; Quality Improvement; Southeastern United States; Nursing Care
PubMed: 37698422
DOI: 10.1097/WON.0000000000001019 -
The American Surgeon Dec 2023Decubitus ulcers are a morbid and costly problem faced by healthcare systems and patients across the country. We aim to examine current patterns and characteristics of...
INTRODUCTION
Decubitus ulcers are a morbid and costly problem faced by healthcare systems and patients across the country. We aim to examine current patterns and characteristics of patients admitted to the hospital with a pressure ulcer.
MATERIALS AND METHODS
From a nationally representative sample of hospital discharge records, the Nationwide Inpatient Sample (NIS), patients with a diagnosis of pressure ulcer 2008-2019 were identified. Patient volume, demographic and clinical data were analyzed for change over time.
RESULTS
The volume of pressure ulcer patients as a proportion of all hospital patients remained constant from 2008 to 2019 ( = .479). During the study period, the proportion of ulcer patients that underwent an ulcer-related procedure significantly decreased ( < .001) while the proportion of ulcers considered severe significantly increased ( < .001).
CONCLUSIONS
Our analysis suggests the prevalence of decubitus ulcers remained stable during the time period, with increased severity but reduced frequency of operative intervention.
Topics: Humans; United States; Pressure Ulcer; Ulcer; Cross-Sectional Studies; Hospitalization; Inpatients
PubMed: 36825400
DOI: 10.1177/00031348231158691 -
Revista Latino-americana de Enfermagem 2023to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument,... (Review)
Review
OBJECTIVE
to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments' use/limitations.
METHOD
a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample.
RESULTS
we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments.
CONCLUSION
the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units. (1) The risk assessment instrument must be applied to the patient's specificities. (2) The instruments are divided into two groups: generalist and specific. (3) The EVARUCI and CALCULATE instruments presented better results. (4) The EVARACI presented better results in terms of performance indicators. (5) The CALCULATE highlights itself for being recent scale, appropriate, simple, and easy to use.
Topics: Humans; Adult; Pressure Ulcer; Risk Assessment; Intensive Care Units
PubMed: 37820213
DOI: 10.1590/1518-8345.6659.3983 -
Archives of Gerontology and Geriatrics Aug 2023Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however,...
INTRODUCTION
Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however, little is known about the characteristics of their PUs or the role of other risk factors. This study estimates the prevalence of PUs, describes characteristics of PUs, and quantifies associations between risk factors and PUs in nursing home residents with diabetes.
METHODS
We conducted a cross-sectional study of nursing home residents aged ≥50 years with diabetes mellitus using national 2016 Minimum Data Set 3.0 data. Pressure ulcers were defined as the presence of any stage PU and by subgroups of stage and tissue type. Prevalence estimates of PUs were calculated overall and by covariate subgroups. Unadjusted and adjusted odds ratios were calculated using logistic regression.
RESULTS
The prevalence of any unhealed PU was 8.1%. Of those with a PU, 19.4% had at least two ulcers and the most common subtypes were identified as unstageable and stage 2 ulcers. These were most often treated by pressure reducing devices. In our fully adjusted model, risk factors that were strongly associated with PUs were related to mobility, nutrition, incontinence, and infections.
CONCLUSION
We observed that the prevalence of PUs remains high in nursing home residents with diabetes and that higher stage ulcers were common in this population. Our adjusted model highlights the importance of suspected risk factors in the development of PUs. Further research is needed to understand the unique needs of nursing home residents with diabetes.
Topics: Humans; Pressure Ulcer; Nursing Homes; Ulcer; Cross-Sectional Studies; Diabetes Mellitus; Prevalence; Suppuration
PubMed: 37004252
DOI: 10.1016/j.archger.2023.104969 -
International Wound Journal Apr 2024Pressure ulcers are persistent skin lesions that have substantial detrimental effects on the physical well-being of patients. Moreover, their psychological ramifications...
Pressure ulcers are persistent skin lesions that have substantial detrimental effects on the physical well-being of patients. Moreover, their psychological ramifications for both patients and their caregivers are becoming more widely acknowledged. This research was conducted to examine the psychological ramifications of pressure ulcers and ascertain efficacious approaches to mitigate these effects and improve overall well-being. A cross-sectional study was conducted from March 2022 to December 2023 across tertiary care centres located in Beijing. The cohort consisted of 431 participants, which included primary caregivers and patients who were diagnosed with pressure ulcers. The data were gathered through the utilization of structured questionnaires and semi-structured interviews. These methods encompassed demographic details, clinical characteristics and validated scales that assessed psychological parameters, including quality of life, anxiety, stress and depression. The research exposed substantial psychological toll on both individuals receiving care and those providing care, with caregivers enduring diminished quality of life and elevated levels of anxiety, depression and stress (p < 0.05). A significant positive correlation was identified between the degree of psychological distress and severity of pressure ulcers (p < 0.05). Both location of the ulcer and duration of care were substantial contributors to the psychological burden (p < 0.05). In spite of the apparent necessity, a significant proportion of the participants refrained from obtaining psychological counselling. The results underscored the significant psychological ramifications of pressure ulcers for both individuals receiving care and the caregivers. As a result, comprehensive care strategies that incorporate psychological assistance into the prescribed treatment plan are imperative. This research highlighted the criticality of implementing all-encompassing, interdisciplinary approaches to tackle the complex issues presented by pressure ulcers in an effort to enhance the general welfare of those influences.
Topics: Humans; Quality of Life; Caregivers; Pressure Ulcer; Cross-Sectional Studies; Patients
PubMed: 38531386
DOI: 10.1111/iwj.14836 -
Journal of Tissue Viability Aug 2023Pressure injuries are a significant health care problem worldwide, and many factors influence their occurrence and development. The purpose of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
AIM
Pressure injuries are a significant health care problem worldwide, and many factors influence their occurrence and development. The purpose of this systematic review and meta-analysis was to investigate the role of nutritional status in the development rate of pressure injuries as a potentially modifiable risk factor.
METHODS
Study designs included cohort (prospective and retrospective), case-control, and RCTs if the association between nutrition status and pressure injuries was reported. Databases searched included: PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Library on April 20th, 2022. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software. Report this systematic review and meta-analysis according to the PRISMA 2020 statement.
RESULTS
A total of 22 separate studies were retained in this systematic review. Of these, 16 articles were included in the meta-analysis. Three studies were assessed as low risk and sixteen as a moderate risk of bias. All RCTs were B quality. The odds ratio of the incidence of pressure injuries in malnourished and non-malnourished patients was 3.66(95% CI: 2.77-4.83). In the three RCTs studies(n = 870), the odds ratio of the incidence of pressure ulcers in patients with standard nutrition to those with specific nutritional interventions was 1.35(95%CI:1.02-1.78).
CONCLUSIONS
This systematic review and meta-analysis showed that nutritional status is significantly associated with pressure injuries. Malnutrition can increase the incidence of pressure injuries, and specific nutritional interventions can reduce the incidence of pressure injuries compared to standard nutrition.
Topics: Humans; Adult; Nutritional Status; Pressure Ulcer; Incidence; Retrospective Studies; Prospective Studies; Crush Injuries
PubMed: 37117126
DOI: 10.1016/j.jtv.2023.04.005 -
Advances in Wound Care Sep 2023Pressure ulcers are very difficult to treat and pose an economic burden, just below cancer and cardiovascular illness, at 4.82 billion U.S. dollars. It is important to... (Review)
Review
Pressure ulcers are very difficult to treat and pose an economic burden, just below cancer and cardiovascular illness, at 4.82 billion U.S. dollars. It is important to understand the pathophysiology of the condition, risk stratification, and ways of preventing it. Prevention forms the most important aspect of their management. The authors systematically evaluated the existing risk prediction scales and explored the evidence from literature regarding the role of additional factors including body mass index, obesity, subcutaneous tissue thickness, and skin integrity in pressure ulcers. With this review it is hoped that the future management of pressure ulcers will concentrate on the preventable and alterable factors in its pathophysiology. The review focuses on how adipose tissue thickness can predict the occurrence of pressure ulcer. If adequately proved that a definite thickness of peripheral adipose tissue is efficient in prevention of pressure ulcers, then methods of maintaining the thickness of this tissue will be the next effective strategy in the management of this chronic issue. The review addresses the management of pressure ulcers to wound care providers and emphasize on confounding parameters of obesity, subcutaneous tissue thickness, and skin integrity during the treatment regimen of pressure ulcers. The main objective of this review is to draw a consensus concerning the role of adipose tissue in pressure ulcers, based on the published research. A review of the various preexisting predictive scales for pressure ulcers is a secondary objective to highlight the shortcomings in ulcer management. This review finally aims in the future at paving a way to refine our prognosticating scales for pressure sores based on these results. Accurate preventative injury risk scales are needed so that preventative resources can be directed to the patients for whom they are the most appropriate.
Topics: Humans; Pressure Ulcer; Obesity; Adipose Tissue
PubMed: 36301930
DOI: 10.1089/wound.2020.1275