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Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients
Erik H de Laat1, Peter Pickkers, Lisette Schoonhoven
1Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Centre, The Netherlands.
Insights
A hospital guideline significantly reduced pressure ulcer development in critically ill patients. Timely transfers to specialized mattresses were key to preventing these hospital-acquired conditions.
Area of Science:
- Critical care medicine
- Nursing science
- Patient safety research
Background:
- Pressure ulcers pose a significant risk to critically ill patients.
- Effective prevention strategies are crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate the impact of a hospital-wide pressure ulcer prevention and treatment guideline.
- To assess the effects on pressure ulcer incidence and onset time in intensive care unit (ICU) patients.
Main Methods:
- Prospective cohort study involving 399 critically ill adult patients in a university medical center.
- Implementation of a comprehensive pressure ulcer care guideline, emphasizing timely patient repositioning onto pressure-reducing devices.
- Data collection on patient characteristics, risk factors, ulcer grading, and mattress type over 3 and 12 months post-implementation.
Main Results:
- Incidence density of grade II-IV pressure ulcers decreased from 54 to 32 per 1000 patient-days (p = .001) at 12 months.
- Median pressure ulcer-free time increased from 12 to 19 days (p = .02).
- Preventive transfers to specialized mattresses were the strongest predictor of reduced pressure ulcer risk (hazard rate ratio, 0.22; p < .001).
Conclusions:
- A hospital-wide pressure ulcer care guideline led to a sustained reduction in pressure ulcer development among critically ill patients.
- Proactive patient transfers to specialized support surfaces are critical for preventing pressure ulcers.
Objective:
To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients.
Design:
Prospective cohort study.
Setting:
Adult intensive care department of a university medical center.
Patients:
Critically ill patients (n = 399).
Interventions:
A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline.
Measurements And Main Results:
Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six.
Conclusions:
The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.
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