Pressure ulcers can arise in any field of health care settings. Salcido mentioned prevalence and incidence of pressure ulcers by quotation from National Pressure Ulcer Advisory Panel in 1998 as following:
According to Gosnell and VanEtten, approximately 1 million pressure ulcers occur in the United States. The incidence in hospitalized patients ranges from 2.7% to 29%, and the prevalence in hospitalized patients is 3.5% to 69%. Patients in critical care units have an increased risk of pressure ulcers, as evidenced by a 33% incidence and 41% prevalence. Elderly patients admitted to acute care hospitals for nonelective orthopedic procedures, such as hip replacement and treatment of long bone fractures, are at even greater risk, with a 66% incidence. The prevalence of pressure ulcer in the nursing home is in the range of 2.6%-24%.
If pressure ulcers occur, it can affect every part of patient’s life. As mentioned above, pressure ulcers can affect quality of life as well as lead to death. Barbenel, Jordan, Nicol, et al. (1977) explained that two major groups of pressure ulcers patients are spinal cord injuries and the elderly. Fifty percent of the patients who are admitted to specialized cord-injury hospitals and 8% of all deaths in these facilities are attributable to pressure ulcers (as cited in Thomas, 2001). Cullum et al. (2001) said that the financial costs to the National Health Service in the United Kingdom are considerably related to pressure ulcers (Royal College of Nursing, 2001).
The Implications of Pressure Ulcers for the Organization and the Patients
It is extremely hard to heal when pressure ulcers develop. Chronic wounds like pressure ulcers don’t respond to any known medical therapy well (Thomas, 2001). According to the static data of Michocki and Lamy (1976), estimates of complete curative for pressure ulcers are low as 10%. The curative rate of stage 3 pressure ulcers at 6 months may be as high as 59%, but other patients need a treatment for up to 1 year. Thirty-three percent of stage 4 pressure ulcers may take 6 months to heal by therapy, but one half of patients admitted with pressure ulcers die for the period of this time (as cited in Thomas, 2001). Baxter (1994) mentioned that death related to pressure ulcers has been reported among 67% of patients who develop pressure ulcers in acute hospitalization. After hospitalization, if a patient develops a new pressure ulcer within 6 weeks, they will be three times as likely to die as a patient who does not develop a pressure ulcer (as cited in Thomas, 2001).
The patients who develop pressure ulcers have to stay hospital longer than they originally expected. According to the report of Ross in 1993, in order to prevent and treat pressure ulcers in a 600-bed general hospital, the financial costs have been estimated between $900,000 and $4 million a year. Moreover, the hospitals might need some device to prevent and treat pressure ulcers. It is also part of financial cost of hospitals. Bennett, Bellantoni, and Ouslander (1989) explained about a device to treat the patients with severe pressure ulcers. 95 nursing homes that have severe pressure ulcers use air-fluidized bed to treat the patients. The air-fluidized bed helped the patients with severe pressure ulcers healed 14% of pressure ulcers in a mean of 79 days. Even though air-fluidized bed heal the patients with severe pressure ulcers, it incurs the additional cost for the bed was $50 to $100 per day (as cited in Thomas, 2001).
Pressure ulcers can be attributed to some complications. One of the most common complications related to pressure ulcers is, as mentioned before, an increased mortality rate. The other common complications are osteomyelitis, and sepsis (Thomas, 2001). These complications also make the patients hospitalization longer as well as increase mortality rate. If patients stay longer in a hospital, there is not as much available bed for other patients in the hospital. Then, the hospital cannot have more patients which would ultimately lead to a financial loss.
The Process for Investigating/Analyzing If Pressure Ulcers
There are lots of causes that can be attributed to pressure ulcers in patients. The risk management team needs to figure out what kind of things cause pressure ulcers in a patient. Some causes are preventable and some are not. If the pressure ulcers develop because of preventable causes like nutritional problems, using improper devices, and missing assessment of the risk of pressure ulcer development, then these can be fixed easily. There was a patient who had got pressure ulcers after admission in a hospital. When the patient came to the hospital first, he didn’t have any pressure ulcers and the risk of pressure ulcer was lower. A few weeks later he had got pressure sores on his sacrum. At that time he was NPO and didn’t get any nutritious food or fluid like TPN. Thomas, Goode, and Allman (1994) asserted through their prospective study that pressure ulcers occurred in patients who are in 65% of the most severely malnourished. Bergstrom and Braden (1992) also mentioned the importance of nutrition as low dietary protein intake indicated the development of pressure ulcers. So, the risk management team should ask the medical team (including a nutritionist) about the patient’s nutritional status, patient’s prescription related to nutritional facts and mobility and so on.
If the risk management team finds the cause that lead to pressure ulcers to the patients, they need to figure out how they lead to developing pressure ulcers. In the prospective study of Thomas, Goode, and Allman (1994), even though patients are in a malnourished state, only 65% of patient’s develop pressure ulcers. So the risk management team should look into other facts that cause the development of patient’s pressure ulcers. When a patient who had got pressure sores was admitted to a hospital, medical staff assessed the risk of pressure sores but they didn’t reassess when a patient’s condition changed. If the medical staff consider the change of a patient’ condition like long term NPO, and nutritional status, it might prevent pressure ulcers occurring in a patient. A patient was skinny so he has lots of bony part in his body. When a patient was in a bed, he usually lay on his back without any device to relieve pressure. That position puts pressure on sacrum. These kinds of facts combine to develop pressure ulcers in a patient. So, the risk management team should look into the system to assess the risk of pressure ulcers, usable equipments to prevent and treat pressure ulcers, staff’s understanding of pressure ulcers. Even though the facility has good devices to prevent and treat device and system to assess the risk of pressure ulcers and monitor, if the staffs don’t know about pressure ulcers, it will be hard to drop the incidence of pressure ulcers.
Interventions for Reducing the Risk of Pressure Ulcers
Once pressure ulcers develop, it is attributed to a loss related to patients’ well being and financial status of hospitals. Therefore, prevention is the best way to reduce the chance of developing pressure ulcers in patients. One of the interventions to prevent pressure ulcers is to assess the risk of pressure ulcers in patients continuously. Patients’ condition can change often while they are in hospitalization. If medical staff can notice sign and symptom of pressure ulcers earlier, it would be easy to prevent and treat pressure ulcers in patients. The other interventions to prevent pressure ulcers is education. Hopkins, Hanlon, Yauk, Sykes, Rose, and Cleary (2000) suggested that systematic education, heightened alertness and specific interventions by interdisciplinary wound teams suggest that a high incidence of pressure ulcers can be reduced (as cited in Thomas, 2001). If medical staffs are well educated about pressure ulcers, they can determine development of pressure ulcers earlier and also treat pressure ulcers well.