Prevalence of Decubitus UlcerIncidence and Prevalence of Decubitus Ulcer in American Hospitals is on the Rise
This makes decubitus ulcer a serious concern for nurses.Cases of decubitus ulcer among patients are becoming common in hospitals across the planet with numerous cases reported by the World Health Organization. The prevalence of this condition ranges from 3% to 50% in the services of Intensive Care (ICU), Internal Medicine and Neurology.? In addition, their presence is related to the processes of care, prevention and care provided by nursing staff.? According to study carried out in a Lodi Memorial Hospital on the prevalence of decubitus ulcer on acute-care patients, prevalence rates ranged from 12% to 19.7% while incidence ranged from 0% to 5.4% (Jenkins & O’Neal 2010).
Decubitus ulcer and associated risk factorsLimited movementImpaired state of mind
Exposure to moistureUrinary incontinence Excessive PerspirationThe typology of patients received at various health center makes the prevalence of patients requiring Decubitus ulcer treatment very high, so that there are many material and human resources needed to meet their needs. Once the real situation is known about this problem, efforts must be focused on an efficient management of these problems.
It is essential to classify patients at risk levels of having UPP by performing a continuous assessment.
Effects of decubitus ulcers prevalence rates among patients in primary care facilities:More hospital admissions
Longer stays at hospitals
Increase in cost of careIf the care is not adequately performed, the UPP can lead to an extension of the hospital stay due to the injuries and physical incapacity it can generate, which increases the costs of care. nurses have the responsibility to implement and participate in prevention programs to reduce the incidence of UPPs. Jenkins and Oneal (2010) point out with these prevalence rates, nurses now have a greater role to play to ensure that effective prevention measures reduce the intensity or duration of pressure and the shear forces that favor the presence of the event.4The incidence of pressure ulcer was 9.4% when the scheme began.Initial objective was to reduce the incidence of PU?s by 50%.Three major root causes were identified: knowledge deficit, accountability, and communicationData on prevalenceAccording to a study carried out by Lodi Memorial Hospital, specialists found an incidence of 5.5% with the technical approach that consisted of the use of mattresses and cushions and of 4.9% with the human approach, which consisted of postural changes (Jenkins & O-Neal, 2010).
A quantitative, observational, descriptive and longitudinal study was performed to determine level of risk and prevalence.5Importance of nursing care in diminishing prevalence ratesNurses have a greater role to play in the reduction and prevention of decubitus ulcer among patients.Nurses are at the forefront of prevention of decubitus ulcer.If the care is not adequately performed, the UPP can lead to an extension of the hospital stay due to the injuries and physical incapacity it can generate, which increases the costs of care. nurses have the responsibility to implement and participate in prevention programs to reduce the incidence of UPPs. Jenkins and Oneal (2010) point out with these prevalence rates, nurses now have a greater role to play to ensure that effective prevention measures reduce the intensity or duration of pressure and the shear forces that favor the presence of the event. Hence the importance of Nursing care, where its primary role is oriented towards prevention through the early identification of risk factors (RF) and the implementation of care plans based on prevention and care guides, which is one of the main indicators to measure the quality of hospital and nursing care
Risks of decubitus ulcer prevalence
Pain and complications
Infection and possible sepsisIncreased hospital stayPrevention of new incomes andIncreased health expenditureThe prevention of pressure ulcers is an issue in which the nurse has great responsibility within her autonomous role.? It is estimated that 95% of ulcers can be prevented, so the pressure ulcer index has become an indicator of the quality of nursing care (Berlowitz, 2014). In addition, assessment and performance on the nurse diagnosis “Risk of alteration of skin integrity” has repercussions on patient comfort, prevention of pain and complications such as infection and possible sepsis, increased hospital stay, prevention of new incomes and health expenditure. If the care is not adequately performed, the UPP can lead to an extension of the hospital stay due to the injuries and physical incapacity it can generate, which increases the costs of care.
Unit and level of riskPatients admitted at ICU have greater vulnerability to developing pressure ulcers.The Intensive care Unit is an area that serves people with multiple organ failure requiring life support treatments, continuous sedation, drugs and multiple devices, such as: catheters, drains, probes and immobilizers.? These measures condition greater vulnerability in the patient and centralization in the care of hemodynamic instability of the patient, forgetting his skin, which should also be a priority for the prevention of PU.? When a patient develops an ulcer, their care demands 50% more of the time used by the nursing team (Landi et al., 2010).
Prevalence of decubitus ulcer in emergency servicesIn emergency services, it is probably where there is “less prevention culture” since, in most cases, the nurse, in addition to not knowing the existence of the problem in the service, as well as the scale of risk assessment is unknown also classification of injuries and basic treatment.? At all levels, prevention is not considered as a function of the emergency nurse, despite the magnitude of the potential problem and almost exclusive responsibility in patients with high risk, a phenomenon that is surprising considering the importance given to it in intensive care units (Landi et al., 2010).
Helps in identifying patients at riskBraden scale is used to measure the riskBraden scale, includes aspects such as nutrition, mobility, skin moisture, state of consciousness and sensory perception.? Pressure ulcer risk assessment scales are the basis of prevention protocols, since they help to identify patients at risk, assuming an objective criterion in the use of preventive resources.? The Braden scale is the used in hospitals.
It is validated by multiple studies, and authors recommend it (Berlowitz, 2014). After a thorough bibliographical revision, for its capacity to predict the risk of PU and its relation sensitivity or specificity (ability to identify true positives, minimizing false negatives).? In addition, they also advise against the clinical judgment of nurses, which has been shown that in itself is not able to predict the risk of developing PU of all patients.
Nurses should identify all individual risk factors in order to be able to modify care according to the individual factors.Risk assessment (continuation) Hence the importance of Nursing care, where its primary role is oriented towards prevention through the early identification of risk factors (RF) and the implementation of care plans based on prevention and care guides, which is one of the main indicators to measure the quality of hospital and nursing care (Berlowitz, 2014).
Tissue pressure is examined in relation to three factors, considering the etiology of ulcers:Pressure Intensity Duration of Pressure Tissue ToleranceTissue tolerance is influenced by several factors:
1. Shearing – caused by the combination of gravity and friction. It exerts a force parallel to the skin and results from the gravity that pushes the body down and from the friction or resistance between the patient and the support surface. When the head of the bed is raised, the skin adheres to the bed but the skeleton pushes the body down.
The blood vessels are stretched or elbowed making it difficult or interrupting blood flow.
Shearing causes most of the damage observed in pressure ulcers. 12Involve patients and their families in the prevention of decubitus ulcer at the earliest possible opportunities
Nurses should develop a contract of care with patient.
What can we do together to help prevent decubitus ulcers.
Role of Nurses
Several studies emphasize that the prevention of PUs should be considered, the priority objective within the nursing care plan and in this way it becomes the fundamental tool to reduce the incidence of this event.? Actions should be directed towards the identification of risk, postural changes, hygiene and hydration of the skin, adequate nutritional support, protection of strong pressure and monitoring of epidemiological indicators such as incidence and prevalence.
Why it is important to measure the risk The measurement of the risk of developing pressure ulcers allows establishing the appropriate preventive measures according to the risk presented by the patient at each moment of their process and thus optimize existing resources and nursing activities.
Incidence and quality of care
Pressure ulcer (PU) is a problem of silent origin in the hospital environment that occurs mainly in services where patients stay more than 3 days.Incidence of PUs reflects the quality of care of the hospital network of a country.? Additionally, pressure ulcer prevention is a fundamental aspect of nursing, and that quality improvement methods are more cost-effective and intuitive to address this potentially serious problem (Shahin et al., 2008). Taking into account that it is necessary to use instruments that help to predict early a patient’s risk of developing a PU, it is essential that they be valid and reliable.
Accurate documentation and staging of decubitus ulcers on admission by medical practitioners such as nursing staff.Accuracy and precision in dealing with pressure ulcersIt is affirmed that when there are instruments that detect with maximum precision the potential or actual risk of patients to develop pressure ulcers, they can be prevented from appearing and implement and optimize preventive measures early in those who really need them.
Several authors have developed EVRUPPs to identify and assess risk which is an important factor in determining level of risk.The Braden scale is an instrument that contains a conceptual scheme of risk factors, which allows clarifying the prediction of PU.? Risk assessment is a key aspect for the prevention of PU in hospitalized patients.Nurses are at important in the prevention of decubitus ulcers.
Shahin, E. S., Dassen, T., & Halfens, R. J. (2008). Pressure ulcer prevalence and incidence in intensive care patients: a literature review.? Nursing in critical care,? 13(2), 71-79.
Landi, F., Onder, G., Russo, A., & Bernabei, R. (2007). Pressure ulcer and mortality in frail elderly people living in community.? Archives of gerontology and Geriatrics,? 44, 217-223.
Jenkins, M. L., & O’neal, E. (2010). Pressure ulcer prevalence and incidence in acute care.? Advances in skin & wound care,? 23(12), 556-559.
Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In? Pressure Ulcers in the Aging Population? (pp. 19-26).