A new pressure ulcer conceptual framework Coleman, Susanne; Nixon, Jane; Keen, Justin ...
Journal of advanced nursing,
October 2014, Volume:
70, Issue:
10
Journal Article
Peer reviewed
Open access
Aim
This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework.
Background
Recent work to develop and validate a new ...evidence‐based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP‐PG‐0407‐10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework.
Design
Discussion Paper.
Data Sources
The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010–2011) and an international expert group meeting (conducted December 2011).
Implications for Nursing
A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally.
Conclusion
By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research.
Though preventable in most cases, pressure ulcers continue to pose a major burden to the individual and society, affecting ≤3 million adults annually in the United States alone. Despite increased ...national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while the associated costs of care continue to increase. Dermatologists can play a significant role in pressure ulcer prevention by becoming aware of at-risk populations and implementing suitable preventive strategies. Moreover, dermatologists should be able to recognize early changes that occur before skin breakdown and to properly identify and stage pressure ulcers to prevent delay of appropriate care. The aim of the first article in this continuing medical education series is to discuss the pathophysiology, risk factors, epidemiology, social and economic burdens, and clinical presentation of pressure ulcers.
Pressure Injury Hajhosseini, Babak; Longaker, Michael T; Gurtner, Geoffrey C
Annals of surgery,
04/2020, Volume:
271, Issue:
4
Journal Article
Peer reviewed
Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to $17.8 billion in the United ...States alone. Despite considerable resources it exhausts, the disease remains very prevalent, and the incidence is on the rise. This is in part due to aging population, growing number of nursing home residents, poorly understood biology, and dismal track record of clinical research in this field.
In our Review Article, we discuss the disease pathophysiology, clinical manifestation, evidence based recommendations for risk assessment, prevention and timely management, existing challenges, and directions to improve research on the field. This article encompasses dedicated sections on the full spectrum of the pressure related pathologies including "conventional pressure ulcers", "medical device related pressure injuries", "pressure injuries in mucosal membranes", "pressure injuries in pediatric population", "pressure injury at end of life", and the "role of pressure in pathogenesis of diabetic foot ulcers".
To examine the prevalence and characteristics of medical device-related pressure injuries (MDR PIs) in a large, generalizable database.
This study is a retrospective analysis of the 2016 ...International Pressure Ulcer Prevalence data. Data were limited to US and Canadian facilities. Facilities included acute care, long-term care, rehabilitation, long-term acute care hospitals, and hospice. Analysis included 102,865 adult patients; 99,876 had complete data and were the focus of the analysis and are reported in the results below.
The overall PI prevalence was 7.2% (n = 7189), and the facility-acquired prevalence was 3.1% (n = 3113). The prevalence of MDR PIs was 0.60% (n = 601), which included both mucosal and nonmucosal MDR PIs. In this study, 75% of MDR PIs were facility acquired, whereas non-MDR PIs were most commonly present on admission. Facility-acquired MDR PIs formed 3 days faster than facility-acquired non-MDR PIs (12 vs 15 days; P < .05). By stage, most MDR PIs were superficial (58% were Stage 1 or 2), 15% were deep-tissue PIs, and 22% were full-thickness PIs (Stage 3 or 4 or unstageable). The most common anatomic locations for MDR PIs were the ears (29%) and the feet (12%). The most common devices associated with MDR PIs were nasal oxygen tubes, 26%; other, 19%; cast/splints, 12%; and continuous positive airway pressure/bilevel positive airway pressure masks, 9%.
Because MDR PIs form faster than non-MDR PIs, timely proactive assessment and prevention measures are critical. Most MDR PIs occurred at the face and head region, and the ears specifically. The most common devices linked with MDR PIs were oxygen tubing and masks, making assessment and prevention efforts critical for patients who require those devices.
OBJECTIVES: To identify the impact of pressure ulcers (PUs) and PU interventions on health‐related quality of life (HRQL).
DESIGN: Systematic review and metasynthesis of primary research reporting ...the impact of PU and PU interventions on HRQL according to direct patient reports. Quality assessment criteria were developed and applied. Data extraction identified findings in the form of direct quotes from patients or questionnaire items and domain results. Combined synthesis of qualitative and quantitative research was performed using content analysis to generate categories and themes from findings. Thirteen electronic databases were searched, and hand searching, cross‐referencing, contact with experts, and an online search was undertaken. No language restrictions were applied.
SETTING: Adults with PUs in acute, community, and long‐term care settings across Europe, the United States, Asia, and Australia.
PARTICIPANTS: Thirty‐one studies including 2,463 participants with PUs were included in the review. Ages ranged from 17 to 96.
RESULTS: The review included 10 qualitative and 21 quantitative studies; 293 findings, 46 categories, and 11 themes emerged. The 11 HRQL themes were physical impact, social impact, psychological effect, PU symptoms, general health, and other impacts of PUs: healthcare professional–client relationships, need for versus effect of interventions, impact on others, financial impact, perceived etiology, and need for knowledge.
CONCLUSION: There is evidence that PUs and PU interventions have a significant impact on HRQL and cause substantial burden to patients.
Pressure injuries are frequently occurred adverse events in hospitals, affecting the well-being of patients and causing considerable financial burden to healthcare systems. However, the estimates of ...prevalence, incidence and hospital-acquired rate of pressure injury in hospitalised patients vary considerably in relevant published studies.
To systematically quantify the prevalence and incidence of pressure injuries and the hospital-acquired pressure injuries rate in hospitalised adult patients and identify the most frequently occurring pressure injury stage(s) and affected anatomical location(s).
Systematic review and meta-analysis.
Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest databases from January 2008 to December 2018.
We included studies with observational, cross-sectional or longitudinal designs, reporting pressure injury among hospitalised adults (≥16 years) and published in English.
Outcomes were point prevalence, incidence of pressure injuries and the hospital-acquired pressure injuries rate reported as percentages. Two reviewers independently appraised the methodological quality of included studies. Heterogeneity was assessed by using the I² statistic and random effects models were employed. Sources of heterogeneity were investigated by subgroup analysis and meta-regression.
Of 7,489 studies identified, 42 were included in the systematic review and 39 of them were eligible for meta-analysis, with a total sample of 2,579,049 patients. The pooled prevalence of 1,366,848 patients was 12.8% (95% CI 11.8–13.9%); pooled incidence rate of 681,885 patients was 5.4 per 10,000 patient-days (95% CI 3.4–7.8) and pooled hospital-acquired pressure injuries rate of 1,893,593 was 8.4% (95% CI 7.6–9.3%). Stages were reported in 16 studies (132,530 patients with 12,041 pressure injuries). The most frequently occurred stages were Stage I (43.5%) and Stage II (28.0%). The most affected body sites were sacrum, heels and hip. Significant heterogeneity was noted across some geographic regions. Meta-regression showed that the year of data collection, mean age and gender were independent predictors, explaining 67% variability in the prevalence of pressure injuries. The year of data collection and age alone explained 93% of variability in hospital-acquired pressure injuries rate.
This study suggested that the burden of pressure injuries remains substantial with over one in ten adult patients admitted to hospitals affected. Superficial pressure injuries, such as Stage I and II, are most common stages and are preventable. Our results highlight healthcare institutions' focus on pressure injuries globally and supports the need to dedicate resources to prevention and treatment on pressure injuries.
Registration number: PROSPERO CRD42019118774.
Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating ...pressure ulcers and their impact on patients, healthcare, and society.
The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population.
A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies.
In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013.
Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes.
Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention to patients at risk can importantly impact health care services’ budgets, the costs to treat a severe pressure ulcer were found to be substantially higher. Methodological heterogeneity among studies identified the need to use available, and study design-specific methodological guidelines to conduct health economic studies, and the need for additional pressure ulcer specific recommendations.
The objective of this review was to synthesise the literature and evaluate the incidence, prevalence and severity of medical device-related pressure ulcers (MDRPU) in adult intensive care patients.
...Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure ulcer (PU) as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using
statistic.
We included 13 studies in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas category II followed by category I were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose.
While MDRPU are common in intensive care patients, it is an understudied area. Inconsistency in the staging of MDRPU, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.
Objectives
To determine the national and state incidence levels of newly hospital‐acquired pressure ulcers (PUs) in Medicare beneficiaries and to describe the clinical and demographic characteristics ...and outcomes of these individuals.
Design
Retrospective secondary analysis of the national Medicare Patient Safety Monitoring System (MPSMS) database.
Setting
Medicare‐eligible hospitals across the United States and select territories.
Participants
Fifty‐one thousand eight hundred forty‐two randomly selected hospitalized fee‐for‐service Medicare beneficiaries discharged from the hospital between January 1, 2006, and December 31, 2007.
Measurements
Data were ed from the MPSMS, which collects information on multiple hospital adverse events.
Results
Of the 51,842 individuals in the MPSMS 2006/07 sample, 2,313 (4.5%) developed at least one new PU during their hospitalization. The mortality risk–adjusted odds ratios were 2.81 (95% confidence interval (CI) = 2.44–3.23) for in‐hospital mortality, 1.69 (95% CI = 1.61–1.77) for mortality within 30 days after discharge, and 1.33 (95% CI = 1.23–1.45) for readmission within 30 days. The hospital risk–adjusted main length of stay was 4.8 days (95% CI = 4.7–5.0 days) for individuals who did not develop PUs and 11.2 days (95% CI = 10.19–11.4) for those with hospital‐acquired PUs (P < .001). The Northeast region and Missouri had the highest incidence rates (4.6% and 5.9%, respectively).
Conclusion
Individuals who developed PUs were more likely to die during the hospital stay, have generally longer hospital lengths of stay, and be readmitted within 30 days after discharge.
The prevalence of pressure ulcers particularly in the frail older adult population continues to be high and very costly especially in those suffering from chronic diseases and has brought a higher ...awareness to comprehensive, preventive and therapeutic measures for treatment of pressure ulcers. Internal risk factors highlighted by comorbidities play a crucial role in the pathogenesis of pressure ulcers.
Focusing on the impact of common chronic diseases (comorbidities) in aging on pressure ulcers (e.g., cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders) and the significant complicating conditions e.g., anemia, infectious diseases, malnutrition, hospitalization, incontinence and polypharmacy, frailty and disability becomes important in developing a more complete, inclusive and multidisciplinary approach to prevention of PU in older patients.
To describe chronic and acute conditions which are risk factors in elderly patients for developing PU.
We present an overview of comorbidities seen with PU in three diverse patient locations. The inclusion criteria are sites (community, acute hospital and long term facilities), older patients, chronic diseases and pressure ulcers grade 2 and over. Using a recently developed conceptual framework accepted by European and National Pressure Ulcer Advisory Panels, we examined chronic diseases to identify the risk factors of chronic conditions and complicating conditions which potentially influence risk for PU development.
Multiple chronic diseases and complicating factors which associated with immobility, tissue ischemia, and undernutrition are caused to PU in community settings, hospitals, and nursing facilities.
PDF
