Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale
Autoři:
Isabel Díaz-Caro aff001; Soledad García Gómez-Heras aff003
Působiště autorů:
International Doctoral School, Rey Juan Carlos University, Madrid, Spain
aff001; Nurse of Hospital University Severo Ochoa, Madrid, Spain
aff002; Basic Health Science Department, Health Science Faculty, Rey Juan Carlos University, Madrid, Spain
aff003
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0227052
Souhrn
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 (20.8%) and cardiovascular pathologies (20%). 129 HAPU were diagnosed in 112 patients, implying an incidence of HAPU of 8.89% (CI95%: 7.44–10.59). 106 PWHAPU (94.6%) presented up to 6 risk factors. The excess pressure and altered skin sensibility were identified as statistically significant risk factors as predictive factors of HAPU. In terms of severity, 55% of the HAPU were category I and 42.6% were category II, mainly with anatomical sacro-coxygeal location. In 65.2% of the patients the HAPU appeared in the first week of hospitalization.
Conclusion
In our study the incidence of HAPU in patients classified as minimum risk with Norton-MI scale was 8.89%. This elevated risk suggests for future investigations to develop new validity studies of the Norton-MI scale and to maintain a continuo training of professionals in the knowledge of PU risk assessment scales for their safe application in the patients, since it directs the practice of care in the prevention of PUs. It would be advisable to specially control the risk of PUs in care units, mainly in the first week of their hospital stay to minimize the HAPU incidence.
Klíčová slova:
Hospitals – Nurses – Diagnostic medicine – Surgical and invasive medical procedures – Traumatic injury risk factors – Hospitalizations – Nosocomial infections – Ulcers
Zdroje
1. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury | The National Pressure Ulcer Advisory Panel—NPUAP.Aviable At: https://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/ [Internet]. [Cited 23th September 2018].
2. Barón Burgos MM. Barón Burgos MM. Guide for the prevention and management of UPPs and chronic wounds. Madrid. Available at:https://gneaupp.info/guia-para-la-prevencion-y-manejo-de-las-upp-y-heridas-cronicas/. Madrid: Instituto Nacional de Gestión Sanitaria, Servicio de Recursos Documentales y Apoyo Institucional; 2015.
3. National Pressure Ulcer Advisory Panel (U.S.), Haesler E, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers. 2014.
4. DeCS Server—List Terms Available At: http://decs.bvs.br/cgi-bin/wxis1660.exe/decsserver/.
5. Meddings J, Reichert H, Rogers MAM, Hofer TP, McMahon LF, Grazier KL. Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment. J Am Geriatr Soc [Internet]. July 2015 [cited 1st December 2019]; 63(7):1407–12. Available at: doi: 10.1111/jgs.13475 26140454
6. Downie F, Sandoz H, Gilroy P, Royall D, Davies S. Are 95% of hospital-acquired pressure ulcers avoidable? Wounds UK. 1st January 2013; 9:16–22.
7. Hibbs P. The economics of pressure ulcer prevention. Decubitus. August 1988; 1(3):32–8 3151066
8. Zuñiga-Castro C, Espinoza-Cáceres NA, Fernandez-Pacheco MÁ. Level of risk and incidents of pressure ulcers in hospitalized patients in the medical services of a National Hospital. Revista Enfermeria Herediana [Internet]. 6th October 2015 [cited 8th May 2018]; 7(2):155. Available at: http://www.upch.edu.pe/vrinve/dugic/revistas/index.php/RENH/article/view/2566.
9. Kayser SA, VanGilder CA, Lachenbruch C. Predictors of superficial and severe hospital-acquired pressure injuries: A cross-sectional study using the International Pressure Ulcer PrevalenceTM survey. International Journal of Nursing Studies [Internet]. 1st January 2019 [cited 30th October 2019]; 89:46–52. Available at: http://www.sciencedirect.com/science/article/pii/S0020748918302116 doi: 10.1016/j.ijnurstu.2018.09.003 30339955
10. Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 3th March 2015; 162(5):359–69. doi: 10.7326/M14-1567 25732278
11. Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. July 2013; 50(7):974–1003.
12. Peralta Vargas CE, Varela Pinedo LF, Gálvez Cano M. Frequency of cases of pressure ulcers and factors associated with their development in older adults hospitalized in medical services of a general hospital. Revista Medica Herediana [Internet]. 30th Octuber 2012 [cited 4th March 2019]; 20(1):16. Available at: http://www.upch.edu.pe/vrinve/dugic/revistas/index.php/RMH/article/view/996
13. García Fernández FP, Pancorbo Hidalgo PL, Soldevilla Ágreda JJ, Blasco García C. Pressure ulcer risk assessment scales. Gerokomos. 2008;19(3):136–144.
14. Šáteková L, Žiaková K, Zeleníková R. Predictive validity of the Braden scale, Norton scale and Waterlow scale in Slovak Republic. Central European Journal of Nursing and Midwifery [Internet]. 2015 [cited 21st October 2018]; 6(3):283–90. Available at: http://periodicals.osu.eu/cejnm/4_85_predictive-validity-of-the-braden-scale-norton-scale-and-waterlow-scale-in-slovak-republic.html
15. Romanos Calvo B, Casanova Cartié N. Norton scale modified by INSALUD and its differences in clinical practice. Gerokomos. 2017;28(4):194–199.
16. TECHNICAL DOCUMENT GNEAUPP NoXI PURAS [Internet]. [Cited 6th May 2018]. Available at: http://gneaupp-1fb3.kxcdn.com/wp-content/uploads/2014/12/19_pdf.pdf
17. Schmitt S, Andries MK, Ashmore PM, Brunette G, Judge K, Bonham PA. WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers/Injuries. Journal of Wound, Ostomy and Continence Nursing [Internet]. 2017 [cited 29th Augusto 2019]; 44(5):458–68. Available at: http://Insights.ovid.com/crossref?an=00152192-201709000-00012
18. Tizón Bouza E, Espino M, Paula M. Clinical practice guideline for the care of people with pressure ulcers or at risk of suffering. Generalitat Valenciana, 2013. Gerokomos. 2014;25(1):53–54.
19. Instituto Nacional de la Salud (Espanya), Subdirección General de Coordinación Administrativa. Nursing Care Guide. Pressure Ulcer. Madrid: Instituto Nacional de la Salud. Subdirección General de Coordinación Administrativa; 1996.
20. Guide to Evidence Based Recommendations on Prevention and Treatment of PUs [Internet]. [Cited 16th October 2018]. Available at: https://www.osakidetza.euskadi.eus/contenidos/informacion/osk_publicaciones/es_publi/adjuntos/enfermeria/3_guia_recomendaciones_ulceras.pdf
21. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel (U.S.), Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: quick reference guide. 2014.
22. First Consensus of the Pressure Ulcers—PriCUPP.pdf [Internet]. [Cited 25th Septembere 2018]. Available at: http://www.acamedbai.org.ar/PriCUPP.pdf
23. 2012_AWMA_Pan_Pacific_Guidelines.pdf [Internet]. [Cited 16th October 2018]. Available at: http://www.woundsaustralia.com.au/publications/2012_AWMA_Pan_Pacific_Guidelines.pdf
24. Pancorbo-Hidalgo PL, García-Fernández FP, Soldevilla-Agreda JJ, Martínez-Cuervo F. Assessment of the risk of developing pressure ulcers: clinical use in Spain and metaanalysis of the effectiveness of scales. Gerokomos. 2008;19(2):40–54.
25. Scales and Risk Assessment Instruments to Develop PU Technical Doc No XI [Internet]. [Cited 3th March 2019]. Available at: https://gneaupp.info/wp-content/uploads/2014/12/19_pdf.pdf
26. Berlowitz D. Incidence and Prevalence of Pressure Ulcers. En: Thomas MD DR, Compton MD GA, editores. Pressure Ulcers in the Aging Population [Internet]. Totowa, NJ: Humana Press; 2014 [cited 23th September 2018]. p. 19–26. Available at: http://link.springer.com/10.1007/978-1-62703-700-6_2
27. Pressure Ulcers in the United States’ Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study [Internet]. Wound Management and Prevention. [Cited 3th March 2019]. Available at: https://www.o-wm.com/article/pressure-ulcers-united-states-inpatient-population-2008-2012-results-retrospective.
28. Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. abril de 2007;13(2):227–35. doi: 10.1111/j.1365-2753.2006.00684.x 17378869
29. Pancorbo-Hidalgo PL, García-Fernández FP, Torra i Bou J-E, Verdú Soriano J, Soldevilla-Agreda JJ. Epidemiology of pressure ulcers in Spain in 2013: 4. o National Prevalence Study. Available At: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2014004400006. Gerokomos [Internet]. 2014 [cited 7th March 2017]; 25(4):162–170. Available at http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2014004400006
30. 5th National study on the prevalence of pressure ulcers and other cutaneous lesions related to dependence, LRD. Available At: https://cuidsalud.com/inv/5enp/ [Internet]. CuiDsalud. 2017 [cited 13th May 2019]. Available at: https://cuidsalud.com/inv/5enp/
31. Frequency and association measures in clinical epidemiology [Internet]. [Cited 8th october 2018]. Available at: http://appswl.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90259936&pident_usuario=0&pcontactid=&pident_revista=51&ty=151&accion=L&origen=apccontinuada&web= www.apcontinuada.com&lan=es&fichero=51v11n06a90259936pdf001.pdf&anuncioPdf=ERROR_publi_pdf
32. Granados JAT. Incidence: concept, terminology and dimensional analysis. Med Clin (Barc). 1994;103:140–142.
33. Pieper B. Pressure Ulcers: Impact, Etiology, and Classification.:16.
34. Organic Law 3/2018, of 5 December, on the Protection of Personal Data and the Guarantee of Digital Rights BOE.es—Document BOE-A-2018-16673 [Internet]. [Cited 28th february 2019]. Available at: https://boe.es/diario_boe/txt.php?id=BOE-A-2018-16673
35. Official Bulletin of the StateBO. Organic Law 15/1999, of 13 December, on the Protection of Personal Data. BOE. 1999;298:43088–99.
36. Vega Clemente V. Royal Decree 1720/2007, of 21 December, approving the Regulation implementing Organic Law 15/1999. Revista de Estudios Económicos y Empresariales. 2013;
37. Prieto JMR, Areosa LA, Romero M ( Romero M, Collado FG, Pizano AR. Adverse events related to pressure ulcers: an avoidable problem? Enfermería Dermatológica [Internet]. 2010 [cited 3th March 2019]; 4(11 (September-December)):21–6. Available at: https://dialnet.unirioja.es/servlet/articulo?codigo=4293918
38. Papanikolaou P, Lyne P, Anthony D. Risk assessment scales for pressure ulcers: A methodological review. International Journal of Nursing Studies [Internet]. 1st February 2007; 44(2):285–96. Available at: http://www.sciencedirect.com/science/article/pii/S0020748906003002 doi: 10.1016/j.ijnurstu.2006.01.015 17141782
39. Roa Díaz ZM, Parra DI, Camargo-Figuera FA, Roa Díaz ZM, Parra DI, Camargo-Figuera FA. Validity and Quality indices of Braden and Norton scales. Gerokomos [Internet]. 2017 [cited 27th April 2019]; 28(4):200–4. Available at: http://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S1134-928X2017000400200&lng=es&nrm=iso&tlng=es
40. Rodríguez Torres M del C, Soldevilla Ágreda JJ. Clinical trial or assessment scales to identify patients at risk of developing pressure ulcers? Gerokomos [Internet]. March 2007 [cited 20th April 2019]; 18(1). Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2007000100007&lng=en&nrm=iso&tlng=en
41. Hidalgo PLP, Fernández FPG, Ágreda JJS, Cuervo FM. Assessment of the risk of developing pressure ulcers: clinical use in Spain and metaanalysis of the effectiveness of scales. Available At: https://dialnet.unirioja.es/servlet/articulo?codigo=2669156. 2008 [cited 10th February 2019]; 19(2):84–98. Available at:ttps://dialnet.unirioja.es/servlet/articulo?codigo = 2669156
42. Crawford B, Corbett N, Zuniga A. Reducing Hospital-Acquired Pressure Ulcers: A Quality Improvement Project Across 21 Hospitals. Journal of Nursing Care Quality [Internet]. 2014 [cited 2nd April 2019]; 29(4):303–10. Available at: https://insights.ovid.com/crossref?an=00001786-201410000-00002 doi: 10.1097/NCQ.0000000000000060 24647120
43. Bauer K, Rock K, Nazzal M, Jones O, Qu W. Pressure Ulcers in the United States’ Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study.:9.
44. Hospital-Acquired Pressure Injury [Internet]. [Cited 25th August 2019]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013055/#R5
45. Díez-Manglano J, Fernández-Jiménez C, Lambán-Aranda MP, Landa-Santesteban MC, Isasi de Isasmendi-Pérez S, Moreno-García P, et al. Pressure ulcers in patients admitted to Internal Medicine: associated factors and mortality. Revista Clínica Española [Internet]. December 2016 [cited 3th December 2018]; 216(9):461–7. Available at: https://linkinghub.elsevier.com/retrieve/pii/S0014256516301242 doi: 10.1016/j.rce.2016.07.003 27544841
46. Stegensek Mejía EM, Jiménez Mendoza A, Romero Gálvez LE, Aparicio Aguilar A. Pressure sores in various services of a second level hospital. Enfermería Universitaria [Internet]. October 2015 [cited 19th October 2018]; 12(4):173–81. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1665706315000615
47. Peralta Vargas CE, Varela Pinedo LF, Gálvez Cano M. Frequency of cases of pressure ulcers and factors associated with their development in older adults hospitalized in general hospital medical services. Revista Medica Herediana [Internet]. 2009 [cited 27th April 2017]; 20(1):16–21. Available at: http://www.scielo.org.pe/scielo.php?pid=S1018-130X2009000100005&script=sci_arttext
48. Aydin C, Donaldson N, Stotts NA, Fridman M, Brown DS. Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care. Health Serv Res [Internet]. April 2015 [cited 21st August 2019]; 50(2):351–73. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369213/ doi: 10.1111/1475-6773.12244 25290866
Článok vyšiel v časopise
PLOS One
2020 Číslo 1
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Úspěšná resuscitativní thorakotomie v přednemocniční neodkladné péči
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- Psychometric validation of Czech version of the Sport Motivation Scale
- Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis
- Effects of supplemental creatine and guanidinoacetic acid on spatial memory and the brain of weaned Yucatan miniature pigs
- Accelerated sparsity based reconstruction of compressively sensed multichannel EEG signals