Reducing Hospital-Acquired Pressure Ulcers

Crawford, B; Corbett, Nancy; Zuniga, Anita

doi:10.1097/ncq.0000000000000060

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…The overall HAPI incidence rate (0.57 per 1,000 patient days, 3.7 cases per 1,000 patients, and 2.2 per 1,000 episodes) in the cohort was very low and is consistent with the previous 2014 report of 0.66 per 1,000 patient days for 21 Northern California KP hospitals (Crawford et al, 2014). The rate of 2.2 HAPI per 1,000 episodes is much lower than reported from the Agency for Healthcare Research and Quality.…”

Section: Discussionsupporting

confidence: 90%

“…The expected standard of care included use of appropriate bed and chair surfaces such as mattress overlays, regular turning, repositioning, offloading pressure, and common clinical pathways for the management of nutrition and incontinence. Further description of this standard of care is in previous publications (Crawford, Corbett, & Zuniga, 2014; Omery et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

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Hospital-Acquired Pressure Injury

et al. 2018

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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. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk. Results Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals. Discussion Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Hospital-Acquired Pressure Injury

et al. 2018

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“…Therefore, we suggest new research on the predictive capacity of PURAS Norton-MI in large data sets that could yield evidence for better individualization of preventive interventions. RFs such as advanced age > 65 years, excess pressure, malnutrition, immobility, inactivity, incontinence and altered skin sensitivity, are RFs that have been the target of many research studies [17,[42][43][44] demonstrating their value as predictors of the risk of HAPU, and therefore their presence is directly noticed in the development of HAPU. Our results show association in the following factors: excess pressure, alteration of skin sensitivity and development of HAPU, but no predictors of HAPU were found in the RFs: alteration in nutrition, side effects of medical treatment (oncological cytostatics toxics corticosteroids), incontinence (fecal and/ or urinary).…”

Section: Discussionmentioning

confidence: 99%

Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale

Díaz-Caro

Gómez-Heras

2020

PLoS ONE

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Introduction Pressure ulcers (PUs) nowadays are a major health problem in society, associated with increased morbidity and increased health care costs. The incidence of HAPU is an indicator of health care quality. Objective To describe the profile of patients with minimal risk on the Norton-MI scale who developed PUs during hospitalization, and to identify the incidence of hospital-acquired pressure ulcers (HAPU). Methods Retrospective cohort study conducted between 2014 and 2017. Study population Patients over 18 years of age classified as "minimum risk" according to Norton-MI, admitted to acute hospital units of the Severo Ochoa University Hospital-Madrid-Spain. Patients were classified as patients with hospital-acquired pressure ulcers (PWHAPU) if they developed one or more new PU during their hospitalization. Variables Sociodemographic variables, hospitalization units, Morton-MI score and characteristics of the risk factors of HAPU were studied. Results The risk of PU was evaluated in 5530 patients, being 1260 patients classified as "minimum risk", with a median of 16 points in the Norton-MI scale. The average age was 76 years old and 52.5% were women. Principal causes of admission: traumatological pathologies

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“…Third, the setting of this study is one of the largest integrated healthcare delivery systems in the United States. Decades of work in nursing care process standardization, quality improvement, and deploying innovation in professional nursing at Kaiser Permanente (Crawford, Corbett, & Zuniga, 2014; D’Alfonso, Zuniga, Weberg, & Orders, 2016; McCreary, 2010; Rondinelli, Ecker, Crawford, Seelinger, & Omery, 2012) have aimed to improve nurse-sensitive patient outcomes and decrease outcome variation. These efforts appear to be successful given that the health system is performing substantially better than the national average with a HAPI proportion of 2.3/1000 patients in this study compared to the 2014 national average of 30.9/1000 patients (Agency for Healthcare Research and Quality, 2016a).…”

Section: Limitationsmentioning

confidence: 99%

Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk

et al. 2018

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We found hospitals with higher patient mortality had lower HAPI risk. Higher patient mortality may decrease the pool of patients who live to HAPI occurrence. Such hospitals may also provide more resources (specialty staff) to care for frail patient populations. Future research should aim to combine hospital data sets to overcome power limitations at the hospital level and should investigate additional measures of structure and process related to HAPI care.

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Reducing Hospital-Acquired Pressure Ulcers

Cited by 10 publications

References 12 publications

Hospital-Acquired Pressure Injury

Hospital-Acquired Pressure Injury

Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale

Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk

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