Never Say Never: A Descriptive Study of Hospital-Acquired Pressure Ulcers in a Hospital Setting

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PURPOSE:The purposes of this study were to describe the characteristics of patients who experienced hospital-acquired pressure ulcers (HAPUs); explore risk factors with these patients, including comorbid conditions; and describe risk-reduction measures in patients who developed HAPUs.SUBJECTS AND SETTING:Eighty-two patients with at least 1 HAPU were identified at an urban Midwestern trauma center over 1 year.DESIGN:A prospective study was conducted that included chart review and patient assessment.METHODS:Assessment criteria for the data collection form were obtained from the literature. The novel instrument was designed to capture intrinsic conditions, for example, medical diagnoses; extrinsic conditions, such as microclimate factors; and organ failure. Characteristics of all patients with at least 1 HAPU were collected by a certified wound care nurse. Data were analyzed using descriptive statistics.RESULTS:Most patients who developed HAPUs were ill enough to require extended hospital stays and discharged to extended care facilities. All patients with HAPUs had multiple risk factors, categorized as intrinsic, extrinsic, or organ failures, yet nearly one-quarter were identified by current standards as “low-risk.” Many of the measured variables are well-established risk factors, but several were comorbid diagnoses that are not assessed on the Braden Scale for Pressure Sore Risk. Eighty percent of subjects had 6 or more risk factors associated with an increased risk for PU development (mean = 9.2). Two-thirds of the sample group experienced failure of at least 1 organ system. Data on the use of 5 preventive interventions was tallied. A vast majority of patients (84.1%) were using 4 or 5 (mean = 4.3, SD = 1.0) of the interventions prior to the occurrence of the HAPU.CONCLUSION:Current risk assessment methods do not assess organ failures and the effect of multiple comorbid associated with HAPU occurrence. Current risk prevention methods may not be sufficient to prevent HAPUs in all patients.

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