Pressure Ulcer : A Systemic Comparative Effectiveness Review

A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

Implementing prevention plan for pressure ulcers would become a marker for a quality of care, which ultimately leads to improvement of quality by making healthcare more reliable, accessible, patient-centered and safe. As a part of the pressure ulcer prevention plan effort, one should regularly assess the pressure ulcer rates and practices. Steps to regularly monitor are: An outcome which can be pressure ulcer prevalence or incidence rates. Minimum one to two care processes (ex: skin assessment). Key aspects of the organizational structure to support best care practices. Below are the steps that will help to develop processes and measures for assessing pressure ulcer and practices.

In 2008, the Centers for Medicare and Medicaid Services (CMS) announced that they would not be paying for any additional cost incurred for hospital-acquired pressure ulcers (Cooper, 2013). Pressure ulcers continue to be problem for health care organizations, despite their aggressive move to eliminate them in the health care setting. Furthermore, the acute care units pressure ulcers occurrences continues to be one of the most underrated problem that has a major impact on patient outcomes as well as reimbursement of care. Acute care patients are at a higher risk for developing pressure ulcers than other patients within the hospital. Primarily due to the fact that patients are hemodynamically unstable, from the use of vasopressors, the use of life saving devices, population age and other health issues. Health care must continue to place emphasis on the prevention of pressure ulcers in order to reduce co-morbidities and ensuing costs. The aim of this paper is to discuss the cost of pressure ulcers, multiple risk factors associated with the development of pressure ulcers, to show one acute care unit’s current practices to decrease pressure ulcers, look at evidence-based interventions, then to propose a change in current practice to reduce the number of pressure ulcers.

Pressure ulcers are a commonly seen problem among elderly hospitalized patients. Despite new findings about the causes and approaches to treatment, the incidence of these wounds is still increasing. Scott, Gibran, Engrav, Mack and Rivara (2006) revealed that during the thirteen years of their study, the incidence of pressure ulcer development has more than doubled. As our elderly population becomes greater in number, and older in age, this problem is expected to escalate. It is of great importance for the patients as well as for the

There is no policy or procedure in place to assess a patient’s risk for developing pressure ulcers. Nursing staff are alerted to areas of skin impairment, only by a patient or caregiver after an ulcer has developed. Once a pressure ulcer is discovered there is no standardized method of treatment to ensure appropriate wound healing. There is no standardized educational tool in place to inform a patient on the principles of pressure ulcer development and

A pressure ulcer is an area of skin with unrelieved pressure resulting in ischemia, cell death, and necrotic tissue. The constant external pressure or rubbing that exceeds the arterial capillary pressure (32 mm Hg) and impairs local normal blood flow to tissue for an extended period, results in pressure ulcer (Brunner and Smeltzer, 2013). According to National Pressure Ulcer Advisory Panel, 2014, pressure ulcers are a major burden to the society, as it approaches $11 billion annually, with a cost range from $500 to $70,000 per person pressure ulcer. It is a significant healthcare problem despite much investment in education, training, and prevention equipment. This paper includes two different studies to link cause-effect and prevention of pressure ulcers.

Throughout the history of healthcare, new techniques and advancements in medicine have been monumental in the fight against disease. However, despite the improvements in modern medicine there has been one challenge that has continued to persist like a thick thorn in the side of the healthcare profession. This hindrance in the face of modern medicine is known as a pressure ulcer. Pressure ulcers develop as a result of persistent pressure over a boney prominence from prolonged immobility or from a lack of movement (Cox & Rasmussen, pg., 15). Pressure ulcers take away not only billions of dollars from hospitals annually but also take away the well-being of hundreds of thousands of patients each year (White, pg. 554). Pressures ulcers do not discriminate

Pressure ulcers (PUs) usually develop over a bony prominence as a result of pressure, or pressure in combination with shear stress and/or friction. Additional contributing factors include immobilization and malnourishment. Groups known to have a high risk of developing PUs include bedridden patients, wheelchair-bound individuals, frail elderly persons with no or limited mobility, as well as individuals with diabetes, poor nutrition, and chronic blood-flow diseases. Pressure ulcers represent an enormous burden on our health care system and an enormous problem for health care providers. Pressure ulcers result in both an increased length of hospital stay and increased hospital costs. Once developed, PUs represents an acute health condition that

I`m happy to hear you want to expand your knowledge and learn about pressure ulcers as this is a common issue in healthcare. About 11 years ago I had a patient who was admitted to the rehabilitation center for treatment of a sickness. The client’s condition was settled and she was exchanged to a nursing home because the insurance would not cover the rest of her stay. It was normal that the patient would return home in a couple of weeks. Two weeks later, the patient was grumbling of somewhat coccyx agony. Amid visits, the patient was by all accounts lying or sitting similarly situated. Nobody associated that rather with urging the patient to get up, the staff had never repositioned her consistently. As a result of this negligence a bedsore

Some of the problems we learned that could be encountered in reducing hospital acquired pressure ulcers is when dealing with patients who have diseases like diabetes mellitus, obesity, corticosteroids, coronary artery disease, renal disease. We learn that elderly people are the most prone to pressure ulcers because of their skin changes associated with aging, some of them have two or three chronic medical conditions at the same time; their decreased nutritional status, their mobility conditions, their ability to be aroused and respond to stimuli from their environment, tissue perfusion, frictional force and shear, and exposure to moisture (Plácido de Brito, Ferreira de Oliveira, Costa, Barros, & Dias, 2016). Also patients who are overweight and are immobile as a result can also be problematic in reducing HAPUs. Another problem we learned that can be encountered in trying to reduce hospital acquired pressure ulcers is inadequate staffing, lack of motivation, and not adequately educating the staff.

Excellent writing Durga! UTI and pressure sore are most common infections during hospital stay.“If he has a bedsore, it’s generally not the fault of the disease, but of the nursing”(Florence nightingale ,1859)Nurses play a major role on prevention of bed sores. Pressure ulcers develop when capillaries impedes blood supply to skin subcutaneous tissue. Pressure ulcer risk assessment tools help to aid in the identification patient who may be at high risk. Braden scale use used in most of the hospitals in US. The score on this scale range from 6-23.Above 18score consider as low risk for pressure ulcer while below 18 should be high risk for pressure

The assessment of the skin is no different and just as important. The Braden scale evaluates the patient’s sensory perception, moisture, activity, mobility, nutrition, friction and shear. After the evaluation of these aspects, a score is given in relation to the risk that the patient is at for developing a pressure ulcer. The Braden scale is the highest predictive tool used to assess the patient’s skin integrity (Yatabe, Saito, & Ishida, 2011). According to Mallah, Nassar, Badr (2015), the sensitivity of the Braden scale in predicting a hospital-acquired pressure ulcers was 92.30%. Following the assessment, appropriate interventions can be initiated. The patients who are most at risk for developing pressure ulcers are unable to effectively reposition themselves or are not able to provide the sensory feedback needed (which is assessed on the Braden scale). With the loss of mobility and sensation, the patients need assistance in distributing their weight (Sprigle & Sonenblum, 2011). Sprigle and Sonenblum (2011) also show a study that indicates the importance of turning patients every two hours. A study concluded that redness and oxygen reduction while lying in bed can occur in less than two hours. The use of specialty beds, sheets, and redistribution devices are shown to significantly reduce the incidences or pressure ulcers. Tools such as Mepilex

According to the abstract of the article, it states that the purpose of this article was to prevent pressure ulcer in two Saudi intensive care units by studying the effectiveness of a pressure ulcer prevention bundle. this information was presented clearly and concisely because it acknowledges the problem in the beginning of the article, so the readers can know what the study was conducted about. The focus of the article was based around two hypotheses, the first hypothesis stated that “Saudi ICU patients who receive the PU prevention bundle will have a decreased PU incidence of 25% or greater compared to patients who received standard care”. The second parted of the hypothesis stated “Saudi ICU patients who received the PU prevention bundle