Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium

Charlotte Anrys, Hanne Van Tiggelen, Sofie Verhaeghe, Ann Van Hecke, Dimitri Beeckman, Charlotte Anrys, Hanne Van Tiggelen, Sofie Verhaeghe, Ann Van Hecke, Dimitri Beeckman

Abstract

The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.

Keywords: high-risk population; nursing home; pressure ulcers; prevention; risk factors.

Conflict of interest statement

The authors have no conflicts of interest to report.

© 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

References

    1. Slawomirski L, Auraaen A, Klazinga N. The Economics of Patient Safety: Strengthening a Value‐Based Approach to Reducing Patient Harm at National Level. OECD Health Working Papers 96. Paris: OECD Publishing; 2017.
    1. Moore Z, Johanssen E, Etten M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (part I). J Wound Care. 2013;22(7):361‐368.
    1. Gefen A, Cornelissen LH, Gawlitta D, Bader DL, Oomens CW. The free diffusion of macromolecules in tissue‐engineered skeletal muscle subjected to large compression strains. J Biomech. 2008;41(4):845‐853.
    1. Coleman S, Gorecki C, Nelson EA, et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013;50(7):974‐1003.
    1. Moore Z, Cowman S. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. J Clin Nurs. 2012;21(3–4):362‐371.
    1. Capon A, Pavoni N, Mastromattei A, Di Lallo D. Pressure ulcer risk in long‐term units: prevalence and associated factors. J Adv Nurs. 2007;58(3):263‐272.
    1. Gunningberg L, Hommel A, Bååth C, Idvall E. The first national pressure ulcer prevalence survey in county council and municipality settings in Sweden. J Eval Clin Pract. 2013;19(5):862‐867.
    1. Tannen A, Dassen T, Halfens R. Differences in prevalence of pressure ulcers between The Netherlands and Germany—associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes. J Clin Nurs. 2008;17(9):1237‐1244.
    1. Ahn H, Stechmiller J, Fillingim R, Lyon D, Garvan C. Bodily pain intensity in nursing home residents with pressure ulcers: analysis of national minimum data set 3.0. Res Nurs Health. 2015;38(3):207‐212.
    1. Gorecki C, Brown JM, Nelson EA, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57(7):1175‐1183.
    1. Demarre L, Van Lancker A, Van Hecke A, et al. The cost of prevention and treatment of pressure ulcers: a systematic review. Int J Nurs Stud. 2015;52(11):1754‐1774.
    1. Beeckman D, Matheï C, Van Lancker A, Van Houdt S, Van Walleghem G, Gryson L, et al. Een nationale richtlijn voor decubituspreventie. Good Clinical Practice (GCP). Brussels, Belgium: Federaal Kenniscentrum voor de Gezondheidszorg (KCE); 2013. KCE Reports 193A.
    1. NPUAP/EPUAP/PPPIA . In: Haesler E, ed. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Osborne Park, Western Australia, Australia: Cambridge Media; 2014.
    1. Serraes B, Beeckman D. Static air support surfaces to prevent pressure injuries: a multicenter cohort study in Belgian nursing homes. J Wound Ostomy Continence Nurs. 2016;43(4):375‐378.
    1. Vanderwee K, Grypdonck M, Bacquer DD, Defloor T. The identification of older nursing home residents vulnerable for deterioration of grade 1 pressure ulcers. J Clin Nurs. 2009;18(21):3050‐3058.
    1. Lahmann NA, Kottner J. Relation between pressure, friction and pressure ulcer categories: a secondary data analysis of hospital patients using CHAID methods. Int J Nurs Stud. 2011;48(12):1487‐1494.
    1. Demarre L, Verhaeghe S, Van Hecke A, Clays E, Grypdonck M, Beeckman D. Factors predicting the development of pressure ulcers in an at‐risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs. 2015;71(2):391‐403.
    1. Beeckman D, Serraes B, Anrys C, Van Tiggelen H, Van Hecke A, Verhaeghe S. A multi‐Centre prospective randomized controlled clinical trial to compare the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in high risk nursing home residents. Submitted
    1. Coleman S, Nixon J, Keen J, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222‐2234.
    1. Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta‐analysis of incontinence‐associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014;37(3):204‐218.
    1. Smith IL, Brown S, McGinnis E, et al. Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study. BMJ Open. 2017;7:e013623.
    1. Beeckman D, Schoonhoven L. European pressure ulcer advisory panel. PuClas4 eLearning module. 2015. . Accessed May 2018.
    1. McInnes E, Jammali‐Blasi A, Bell‐Syer SE, Dumville JC, Middleton V, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2015;(9):CD001735.
    1. Doughty D, Junkin J, Kurz P, et al. Incontinence‐associated dermatitis: consensus statements, evidence‐based guidelines for prevention and treatment, and current challenges. J Wound Ostomy Continence Nurs. 2012;39(3):303‐315.
    1. Beeckman D, Schoonhoven L, Boucqué H, Van Maele G, Defloor T. Pressure ulcers: e‐learning to improve classification by nurses and nursing students. J Clin Nurs. 2008;17(13):1697‐1707.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159‐174.
    1. Bergstrom N. The Braden scale for predicting pressure sore risk. Nurs Res. 1987;36(4):205‐210.
    1. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short‐form mini‐nutritional assessment (MNA‐SF). J Geron A Biol Sci Med Sci. 2001;56(6):M366‐M372.
    1. Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv. 1976;6(3):493‐508.
    1. Vanderwee K, Grypdonck MH, De Bacquer D, Defloor T. The reliability of two observation methods of nonblanchable erythema, grade 1 pressure ulcer. Appl Nurs Res. 2006;19(3):156‐162.
    1. Defloor T, Schoonhoven L, Fletcher J, et al. Statement of the European pressure ulcer advisory panel‐pressure ulcer classification: differentiation between pressure ulcers and moisture lesions. J Wound Ostomy Continence Nurs. 2005;32(5):302‐306.
    1. Beeckman D, Van den Bussche K, Alves P, et al. Towards an international language for incontinence‐associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent global IAD categorisation tool (GLOBIAD) in 30 countries. Br J Dermatol. 2018;178(6):1331‐1340.
    1. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17.
    1. Chan Y. Biostatistics 201: linear regression analysis. Singapore Med J. 2004;80:140.
    1. Twisk JWR. Inleiding in de toegepaste biostatistiek. Amsterdam, the Netherlands: Reed business Education; 2014.
    1. Reed RL, Hepburn K, Adelson R, Center B, McKnight P. Low serum albumin levels, confusion, and fecal incontinence: are these risk factors for pressure ulcers in mobility‐impaired hospitalized adults? Gerontology. 2003;49(4):255‐259.
    1. Nixon J, Cranny G, Iglesias C, et al. Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of PRESSURE ulcers: PRESSURE (pressure relieving support surfaces) trial. BMJ. 2006;332(7555):1413.
    1. International Review . Pressure ulcer prevention: pressure, shear, friction and microclimate in context. A consensus document. London, UK: Wounds International; 2010.
    1. Witkowski JA, Parish LC. Histopathology of the decubitus ulcer. J Am Acad Dermatol. 1982;6(6):1014‐1021.
    1. Halfens R, Bours G, Van Ast W. Relevance of the diagnosis ‘stage 1 pressure ulcer’: an empirical study of the clinical course of stage 1 ulcers in acute care and long‐term care hospital populations. J Clin Nurs. 2001;10(6):748‐757.
    1. Vanderwee K, Grypdonck M, Defloor T. Non‐blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized‐controlled trial. J Clin Nurs. 2007;16(2):325‐335.
    1. Nixon J, Nelson E, Cranny G, et al. Pressure relieving support surfaces: a randomised evaluation. Health Technol Assess. 2006;10(22):1.
    1. Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc. 1992;40(8):747‐758.
    1. Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Multi‐site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. J Am Geriatr Soc. 1996;44(1):22‐30.
    1. Schultz AA, Bien M, Dumond K, Brown K, Myers A. Etiology and incidence of pressure ulcers in surgical patients. AORN J. 1999;70(3):443‐444.
    1. Webster J, Coleman K, Mudge A, et al. Pressure ulcers: effectiveness of risk‐assessment tools. A randomised controlled trial (the ULCER trial). BMJ Qual Saf. 2011;20(4):297‐306.
    1. Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013;22(15–16):2183‐2191.
    1. Moore ZE, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2014;(2):CD006471.
    1. Wilchesky M, Lungu O. Predictive and concurrent validity of the Braden scale in long‐term care: a meta‐analysis. Wound Repair Regen. 2015;23(1):44‐56.
    1. Chen HL, Shen WQ, Liu PA. Meta‐analysis to evaluate the predictive validity of the Braden scale for pressure ulcer risk assessment in long‐term care. Ostomy Wound Manage. 2016;62(9):20‐28.
    1. Park SH, Lee YS, Kwon YM. Predictive validity of pressure ulcer risk assessment tools for elderly: a meta‐analysis. West J Nurs Res. 2016;38(4):459‐483.
    1. Bell C, McCarthy G. The assessment and treatment of wound pain at dressing change. Br J Nurs. 2010;19(11):S4‐S10.
    1. Gorecki C, Closs SJ, Nixon J, Briggs M. Patient‐reported pressure ulcer pain: a mixed‐methods systematic review. J Pain Symptom Manage. 2011;42(3):443‐459.
    1. McGinnis E, Briggs M, Collinson M, et al. Pressure ulcer related pain in community populations: a prevalence survey. BMC Nurs. 2014;13(1):16.
    1. Briggs M, Collinson M, Wilson L, et al. The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients. BMC Nurs. 2013;12(1):19.
    1. Lichtner V, Dowding D, Esterhuizen P, et al. Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr. 2014;14(1):138.
    1. VanVoorhis CW, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3(2):43‐50.
    1. Serraes B, van Leen M, Schols J, Van Hecke A, Verhaeghe S, Beeckman D. Prevention of pressure ulcers with a static air support surface: a systematic review. Int Wound J. 2018;15(3):333‐343.
    1. Rich SE, Shardell M, Hawkes WG, et al. Pressure‐redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients. J Am Geriatr Soc. 2011;59(6):1052‐1059.
    1. Sideranko S, Quinn A, Burns K, Froman RD. Effects of position and mattress overlay on sacral and heel pressures in a clinical population. Res Nurs Health. 1992;15(4):245‐251.
    1. Jiang Q, Li X, Zhang A, et al. Multicenter comparison of the efficacy on prevention of pressure ulcer in postoperative patients between two types of pressure‐relieving mattresses in China. Int J Clin Exp Med. 2014;7(9):2820.
    1. Malbrain M, Hendriks B, Wijnands P, et al. A pilot randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention and treatment of pressure ulcers among medical ICU patients. J Tissue Viability. 2010;19(1):7‐15.
    1. Beeckman D, Defloor T, Schoonhoven L, Vanderwee K. Knowledge and attitudes of nurses on pressure ulcer prevention: a cross‐sectional multicenter study in Belgian hospitals. Worldviews Evid Based Nurs. 2011;8(3):166‐176.
    1. Horn SD, Bender SA, Ferguson ML, et al. The National Pressure Ulcer Long‐Term Care Study: pressure ulcer development in long‐term care residents. J Am Geriatr Soc. 2004;52(3):359‐367.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅