Underutilization of pressure ulcer risk assessment in hip fracture patients

Patients with hip fractures are at high risk for pressure ulcer development, yet few recent studies have addressed risk assessment in this population. In this retrospective medical record survey, records of a random sample of California Medicare beneficiaries with hip fractures admitted to acute care hospitals in 1995 were selected for abstraction. Medical record abstraction (n = 545) revealed that risk assessment was performed on only 44.2% (241/545) of patients. Among these, 64.3% were identified as at risk for pressure ulcer development. Accuracy of the risk assessment was evaluated independently and compared with those performed by the nursing staff; there was agreement in only 40% of cases. Ulcers developed in 19.1% of the sample, and pressure ulcer development was not related to risk status at hospital admission. Patients with longer hospital stays developed more ulcers than those discharged earlier. This study shows that risk assessment is underutilized, inaccurate, and unrelated to pressure ulcer development in hip fracture patients.