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Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis
Jill Cox1, Sharon Roche, Virginia Murphy
1Jill Cox, PhD, RN, APN-c, CWOCN, is Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Hospital and Medical Center, Englewood, New Jersey, and Clinical Associate Professor, School of Nursing, Rutgers University, New Brunswick, New Jersey. Sharon Roche, PhD, RN, APN-c, CCRN, is Critical Care Advanced Practice Nurse; and Virginia Murphy, BSN, RN, CCRN, is Critical Care Manager, Englewood Hospital and Medical Center, Englewood, New Jersey. Acknowledgments: The authors thank the following intensive care unit staff nurses for their diligent assistance with the data collection for this study: Lisa Barrale, BSN, RN, CCRN; Iris Carros, BSN, RN; Carole Eastman, MS, RN; Suzanne Scheidegger, BSN, RN, CCRN; and Kerry Volmer, BSN, RN, CCRN. The authors have disclosed no financial relationships related to this article. Submitted September 14, 2017; accepted in revised form December 15, 2017.
Insights
Critically ill patients often develop unavoidable pressure injuries (PIs) due to factors like immobility and septic shock. Recognizing these risk factors is key to distinguishing preventable from unavoidable PIs.
Area of Science:
- Critical Care Medicine
- Nursing
- Patient Safety
Background:
- Pressure injuries (PIs) are a significant concern in critical care settings.
- Despite preventive measures, PIs can be unavoidable in some critically ill patients.
Purpose of the Study:
- To identify risk factors for PI development in medical-surgical intensive care unit (ICU) patients.
- To compare identified risk factors with those associated with unavoidable PIs.
Main Methods:
- Retrospective, descriptive study design.
- Analyzed data from 57 critically ill patients who developed PIs in the ICU.
- Patients were admitted for over 24 hours.
Main Results:
- Immobility (100%), septic shock (54%), vasopressor use (65%), head-of-bed elevation >30° (93%), sedation (87.7%), and mechanical ventilation >72 hours (81%) were common risk factors.
- The sacrum was the most frequent PI location (56%).
- Deep-tissue PIs were the most common stage (68%), developing around 7.5 days post-admission.
Conclusions:
- Findings align with literature on risk factors for unavoidable PIs in critically ill patients.
- While prevention is crucial, certain risk factors may lead to PIs that are beyond the scope of current preventive strategies.
- Differentiating between preventable and unavoidable PIs is vital for appropriate care and resource allocation.
Background:
Pressure injury (PI) development in the critical care population is multifactorial. Despite the application of evidence-based prevention strategies, PIs do occur and may be unavoidable in some patients.
Objectives:
To describe the risk factors associated with PI development in a sample of medical-surgical intensive care unit patients and determine whether these risk factors were congruent with the risk factors proposed in the work of the National Pressure Ulcer Advisory Panel on unavoidable PIs.
Methods:
A retrospective, descriptive design was used to determine the PI risk factors present in a sample of 57 critically ill patients admitted to the medical-surgical intensive care unit for more than 24 hours and who acquired a PI during their admission.
Results:
The most frequently identified risk factors were immobility (n = 57 [100%]), septic shock (n = 31 [54%]), vasopressor use (n = 37 [65%]), head-of-bed elevation greater than 30° (n = 53 [93%]), sedation (n = 50 [87.7%]), and mechanical ventilation for more than 72 hours (n = 46 [81%]). The most common PI location was the sacrum (n = 32 [56%]), and the most common stage reported was deep-tissue PI (n = 39 [68%]). The mean number of days to PI development was reported at 7.5 (SD, 7.2) days.
Conclusions:
Results of this descriptive study were congruent with the literature surrounding the clinical situations that predispose patients to unavoidable PIs. While the implementation of aggressive PI prevention strategies is essential to reducing PI rates, it is important to recognize that in certain populations, such as the critically ill, exposure to certain risk factors may potentially escalate PI risk beyond the scope of prevention and result in an unavoidable PI. Recognizing these risk factors is significant in the journey to differentiate PIs that result from a lack of preventive care from those that may be prevention immune.
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