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Hospital acquired pressure ulcer

Lee Squitieri, Daniel A Waxman, Carol M Mangione, Debra Saliba, Clifford Y Ko, Jack Needleman, David A Ganz
OBJECTIVES: To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. DATA SOURCES/STUDY SETTING: Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). STUDY DESIGN: Retrospective cross-sectional study. DATA COLLECTION/EXTRACTION METHODS: We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011...
January 25, 2018: Health Services Research
Angela D Rowe, Karen McCarty, Amy Huett
PURPOSE: A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention...
March 13, 2018: Journal of Pediatric Nursing
Kerri Elsabrout, Eleanor Orbacz, Leigh Anne McMahon, Susan Apold
BACKGROUND: Identifying strategies to protect patients most at risk for hospital-acquired pressure ulcers (HAPU) is essential. HAPUs have significant impact on patients and their families and have profound cost and reimbursement implications. AIMS: This article describes the successful implementation of a hospital-wide mattress switch-out program using a Multidisciplinary Task Force, which resulted in a decrease in HAPUs and significant cost savings. RESULTS: As a result of this quality improvement project supported by evidence, the hospital realized a 66...
March 8, 2018: Worldviews on Evidence-based Nursing
Hong-Lin Chen, Bin Zhu, Rong Wei, Zhen-Yu Zhou
Patients with a hip fracture are at high risk for pressure injury. A retrospective review of the electronic medical records of consecutive patients with a hip fracture treated in 2016 in a single tertiary hospital in east China were examined to investigate whether time of year affected the incidence of hospital-acquired pressure injury. Data collected included demographic characteristics (patient name, hospital number, age, gender, and body mass index); possible risk factors for pressure injury, such as presence of diabetes mellitus, admission hemoglobin, admission albumin, length of surgery, and the lowest and/or last Braden Scale score before pressure injury developed; and pressure injury information, which included time of occurrence (days after surgery), location (sacrum and coccyx, ischial tuberosity, or heel), stage, and treatment outcome...
February 2018: Ostomy/wound Management
Elena Espejo, Marta Andrés, Rosa-Maria Borrallo, Emma Padilla, Enric Garcia-Restoy, Feliu Bella
The objective of this study is to evaluate the clinical and microbiological characteristics of bacteremia associated with pressure ulcers (BAPU) and factors associated with mortality. This study was a prospective observational cohort study of patients with BAPU at a teaching hospital between January 1984 and December 2015. Fifty-six episodes were included. The incidence of BAPU decreased from 2.78 cases per 10,000 hospital discharges in the period from 1984 to 1999 to 1.05 cases per 10,000 hospital discharges in the period from 2000 to 2015 (p < 0...
February 26, 2018: European Journal of Clinical Microbiology & Infectious Diseases
Chul-Gyu Kim, Kyun-Seop Bae
BACKGROUND: Nurse staffing level is an important factor on nursing sensitive outcome. The relationships of nurse staffing level with nursing sensitive outcomes such as mortality, upper gastrointestinal bleeding and pressure ulcer have been explored in the United States, Canada, Australia, and New Zealand. Lower level of hospital nurse staffing seems associated with more adverse outcomes, especially mortality. However, there is insufficient evidence of the nurse staffing level-outcome relationship in other indicators...
January 2, 2018: International Journal of Nursing Studies
Eduardo Montag, Thiago Ueda, Alberto Okada, Bruno Onishi, Rolf Gemperli
Background: Flap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series...
2018: European Journal of Plastic Surgery
Pamela Clay, Casey Cruz, Keith Ayotte, Jeremy Jones, Susan B Fowler
PROBLEM: From 2014 to 2016, device related pressure injuries accounted for 62-81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients. METHODS: Collaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies...
January 31, 2018: Journal of Pediatric Nursing
Patricia Finch Guthrie, Shelley Rayborn, Howard K Butcher
Delirium is a common cause of morbidity and mortality in hospitalized older adults often superimposed on dementia. Older patients with delirium are more likely than other populations to develop hospital-acquired infections, pressure ulcers, and immobility and nutritional issues, as well as to have increased health care costs, longer hospital stays, and long-term care following discharge. Interventions that prevent or mitigate the effects of delirium while promoting recovery are essential for caring for hospitalized older patients...
February 1, 2018: Journal of Gerontological Nursing
Marion Lepelley, Céline Genty, André Lecoanet, Benoit Allenet, Pierrick Bedouch, Marie-Reine Mallaret, Pierre Gillois, Jean-Luc Bosson
Objective: Adverse events during hospitalization are a major worry considering their frequency and their burden. Many could be avoided by immediate identification of at-risk patients at admission and adapted prevention. The complexity of a patient's medication regimen immediately available at admission is a good indicator of the complexity of the patient's condition. This study aims to determine whether the electronic Medication Regimen Complexity Index (MRCI) at admission is associated with complications during hospitalization...
December 21, 2017: International Journal for Quality in Health Care
Chew H-S Jocelyn, Emelia Thiara, Violeta Lopez, Shefaly Shorey
The aim of this study was to identify current research on turning frequencies of adult bed-bound patients and inform future turning practices for hospitals based on evidence-based practice. We undertook a scoping review framework that provided a transparent and systematic methodology using 8 electronic databases (CINAHL, PubMed, Cochrane Library, ScienceDirect, PsycINFO, Scopus, ProQuest, and Web of Science) to identify articles published from 2000 to 2016. Articles were included if they focused on the prevention of hospital-acquired pressure ulcers related to the frequency of turning or repositioning of bed-bound patients...
December 15, 2017: International Wound Journal
June Rondinelli, Stephen Zuniga, Patricia Kipnis, Lina Najib Kawar, Vincent Liu, Gabriel J Escobar
BACKGROUND: Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research. OBJECTIVE: The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system. METHODS: Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015...
January 2018: Nursing Research
Lauren H Griswold, Russell L Griffin, Thomas Swain, Jeffrey D Kerby
BACKGROUND: Pressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of ≤18 is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and nontrauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients...
November 2017: Journal of Surgical Research
Jian-Fei Xie, Si-Qing Ding, Zhu-Qing Zhong, Sai-Nan Zeng, Chun-Xiang Qin, Qi-Feng Yi, Li-Na Gong, Jian-da Zhou
Positive perceptions of patient safety culture are associated with lower rates of adverse events, but they have not been widely established in many health care organizations. The purpose of this study is to examine the impacts of a safety culture training program (SCTP) on enhancing the perceptions of patient safety in nurse managers. This was a quasi-experimental design. 83 nurse managers were recruited from five randomly selected 2nd level hospitals. Sixty-seven nurse managers received training under the educational SCTP...
November 2017: Nurse Education in Practice
Suzanne E Courtwright, Kari A Mastro, Christa Preuster, Navid Dardashti, Sandra McGill, Myrlene Madelon, Donna Johnson
PURPOSE: This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. DESIGN AND METHODS: An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
September 8, 2017: Journal for Specialists in Pediatric Nursing: JSPN
Ju Wang, Yang Gong
The development of hospital-acquired pressure ulcers signals low quality of care. Despite the established guidelines and best practices on pressure ulcer prevention, the incidence of pressure ulcers in hospital remains high. To meet the challenges of consistently translating best practices into effective clinical practices and promote effective teamwork communication and interprofessional collaboration, we consider the failure of consistent care delivery as loss of information and reveal the opportunities of informatics methods to reinforce information delivery, evidenced by typical cases...
2017: Studies in Health Technology and Informatics
Xiaohong Deng, Ting Yu, Ailing Hu
BACKGROUND: Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE: To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models' predictive validities with validity of the Braden Scale. METHODS: Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models...
August 2017: Critical Care Nurse
Peggy C Tallier, Patricia R Reineke, Kathy Asadoorian, John G Choonoo, Marc Campo, Christine Malmgreen-Wallen
BACKGROUND: Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. OBJECTIVES: The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior...
August 2017: Applied Nursing Research: ANR
Jennifer A Whitty, Elizabeth McInnes, Tracey Bucknall, Joan Webster, Brigid M Gillespie, Merrilyn Banks, Lukman Thalib, Marianne Wallis, Jose Cumsille, Shelley Roberts, Wendy Chaboyer
BACKGROUND: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. OBJECTIVES: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. DESIGN: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. SETTINGS: Eight tertiary hospitals in Australia...
June 27, 2017: International Journal of Nursing Studies
Lee Ann Krapfl, Julia Langin, Caitlin A Pike, Patricia Pezzella
BACKGROUND: Incremental positioning or weight shifts are often suggested as an alternative to standard repositioning/turning in critical care patients deemed clinically unstable. OBJECTIVE: This evidence-based report card reviews whether incremental positioning and/or weight shifts reduce hospital-acquired sacral/buttocks pressure injuries in critical care patients deemed too unstable to turn. METHODS AND SEARCH STRATEGY: A scoping review of the literature was conducted for studies related to repositioning and hospital-acquired pressure injuries in high-risk, critical care patients...
July 2017: Journal of Wound, Ostomy, and Continence Nursing
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