Pressure ulcer prevention:
A Framework for Quality control and Research
Guðbjörg Pálsdóttir, Guðrún Sigurjónsdóttir, Ásta St. Thoroddsen
Iceland
Population and main health care centres
Total population is 300,000
Capital area population is 190,000
Population gravity - major health care centres
Pressure ulcer prevalence in Iceland
• Study in medical wards, geriatric wards and home care in 1992 and 1994 (Thoroddsen, 1997)
– Prevalence 8.9 and 9.6% respectively – 82% were grade 1 or 2
• Study in Akureyri regional Hospital in 2005 and 2007 (Lindholm, 2007)
– 2005
– Prevalence 16% (88% were grade 1, 12% were grade 2, NO grade 3 and 4) – 2007
– Prevalence 20% (96% were grade 1, 4% were grade 2, NO grade 3 and 4)
• Nursing homes by Residence Assessment Instrument (RAI) database (Directorate of Health, 2008)
– Reykjavik area 10%
– Other areas 11%
– >80% were grade 1 and 2
A Framework for
Pressure Ulcer Prevention
• Pressure ulcer prevalence study was conducted in
Landspitali in May 2008
• EPUAP
• European Pressure Ulcer Prevalence - Study sheet
– Care setting
– Expected length of stay – Age and gender
– Risk assessment (Braden) – Skin observation and staging
of PU identified
– Preventive interventions
• Data collected in 28 wards within Landspitali
• Team of 16 nurses trained
for this purpose
Study results
• 28 hospital wards participated (medical, surgical, oncological, geriatric, rehabilitation)
• n=219/328, external loss=33%, male 51% / female 49%
• Prevalence 21.5%
• Patients with PU = 47, 32 men and 15 women (68% / 32%)
• Pressure ulcers = 66 altogether
Study results
Grade 1 Grade 2 Grade 3 Grade 4 Total
Men 15 9 4 4 32
Women 5 4 6 0 15
Total 20 (42%) 13 (28%) 10 (21%) 4 (9%) 47
Pressure ulcers by gender
Study results
Pressure ulcers; prevalence and grade by age
Age Grade 1 Grade 2 Grade 3 Grade 4 Total %
18-39 (N=5) 2 2 40,0
40-59 (N=27) 1 1 2 7,4
60-69 (N=31) 4 2 2 1 9 29,0
70-79 (N=68) 9 3 4 1 17 25,0
80-89 (N=73) 5 8 1 14 19,2
> 89 (N=15) 1 2 3 20,0
Total (N=219) 20 13 10 4 47
Location of
pressure ulcers
80% located below waist 29% located on the feet Sacrum (n = 20)
Heels (n = 16)
Tuberosites (n = 9) Elbows (n= 8)
Other locations (n = 13)
ears(3), toes(2), metatarsus(2), trochanter(2), scapula (1), knee(1), malleolus(1), occiput(1)
(Sår, 1993)
At risk by Braden scale
• 38% of patients (n=80) were at risk (scoring ≤18 on Braden scale)
2
3% 8
10%
51 63%
19 24%
Very high risk (< 9 ) High risk (10-12 ) Moderate risk (13-14) At risk (15-18)
Risk and Prevention - Bed
• Support surface in bed was according to risk in most cases.
• Exceptions:
– 14 patients at risk were lying on a standard foam mattress
– 4 patients not at risk were lying on an air fluid mattress
• Turning schedules at bed = 5
• Turning schedules at wheelchair = 1
Conclusions from study
• Prevalence rates similar to other comparable studies
• The study has created an important background for further studies and evaluation within this
population
• Prevalence in home care still remains
unknown
The purpose of the guidelines:
Decrease the number of pressure ulcers among individuals at risk by:
– Identifying individuals at risk
– Maintaining and improving tissue tolerannce to pressure
– Protecting individuals from effects of external forces (pressure, friction, shear)
– Improving knowledge, awareness and responsibility of individuals and health care providers
Prevalence studies
Teamwork
Multidisciplinary teamwork
where all team players, including the individual at
risk, are responsible and work together towards
the goal of preventing the development of a
pressure ulcer is the focus in the clinical
guidelines presented.
Conclusions
The clinical decision making based on multidisciplinary clinical practice guidelines will help with appropriate
nursing diagnoses
nursing interventions
nursing outcomes
Thank
Thank you you
Risk and Prevention - Wheelchair
0 1 2 3 4 5 6 7 8
Very high risk Braden
< 9
High risk Braden 10-
12
Moderate risk Braden
13-14
At risk Braden 15-
18
Not at risk Braden > 19
Standard foam cushions
Pressure distributing cushions Roho air-cushions
