Risk factors for and prevalence of pressure ulcers among hospitalized patients

A pressure ulcer prevalence study was conducted at a large, university-based hospital in the Midwest to establish a baseline of information for the evaluation of equipment and the interventions used for pressure ulcer prevention. Presence and stage of pressure ulcers, demographic data, attending service, type of mattress surface, and patient classification scores were recorded. The Braden Scale was used to measure the patients' risk for the development of pressure ulcers. Fifty-three of 440 patients studied had 85 ulcers, a prevalence rate of 12% including stage I ulcers. Thirty-eight percent of the 53 patients with ulcers were admitted to the cardiology or cardiovascular surgery services. Stage II pressure ulcers were the most prevalent, comprising 44% of total ulcers. The coccyx, the right and left ischia, and the heels were the most commonly ulcerated sites. One third of the total sample size, 145 patients, were assessed as at significant risk for the development of pressure ulcers (Braden Scale score < or = 16). A positive correlation was reported between the patients' risk for pressure ulcer development (total Braden Scale score) and patient acuity level as measured by a patient classification system (Medicus Interact Staffing Productivity System, Type VI; Medicus Systems Corporation, Evanston, Ill.). The bed surface of each patient was evaluated with respect to the presence of pressure ulcers, Braden Scale score, and patient acuity score. From the descriptive data, it was determined that patients with either high acuity, high risk (total Braden Scale scores 6 to 10), or existing pressure ulcers were readily identified by the staff and placed on a therapeutic sleeping surface (e.g., low-air loss bed). Although the number of patients at moderate risk (total Braden Scale score 11 to 16) was significant, most were not placed on a therapeutic sleeping surface. Further evaluation of the availability and use of pressure-reduction and pressure-relief devices is indicated. Other preventive practices also require closer consideration, particularly those used with cardiovascular patients. The relationship between risk for development of pressure ulcers and acuity level is an interesting finding that deserves further investigation.