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Internationally, health-care systems have attempted to assess the scale of and demonstrate improvement in patient harms. Pressure ulcer (PU) monitoring systems have been introduced across NHS in-patient facilities in England, including the Safety Thermometer (STh) (prevalence), Incident Reporting Systems (IRS) and the Strategic Executive Informatio...
Contexts in source publication
Context 1
... the 24 Trusts, the majority indicated that they include reports of device ulcers within their PU adverse event monitoring systems including 75.0% for STh, 87.5% for IRS and 75.0% for STEIS. There is variation in the way in which participating Trusts indicated they reported unstageable and DTI PUs across reporting systems ( Fig. 2), with differences noted between classification for clinical records and actual reporting on the monitoring systems. An important minority of Trusts (8.3e25.0%) do not report Unstageable PUs with slightly higher levels of non-reporting for DTI (25e37.5%) (Fig. 2). However, additional comments by Trusts suggested the PU would be reported once the category of ulcer (1e4) could be established with a period of 'watchful ...
Context 2
... the 24 Trusts, the majority indicated that they include reports of device ulcers within their PU adverse event monitoring systems including 75.0% for STh, 87.5% for IRS and 75.0% for STEIS. There is variation in the way in which participating Trusts indicated they reported unstageable and DTI PUs across reporting systems ( Fig. 2), with differences noted between classification for clinical records and actual reporting on the monitoring systems. An important minority of Trusts (8.3e25.0%) do not report Unstageable PUs with slightly higher levels of non-reporting for DTI (25e37.5%) (Fig. 2). However, additional comments by Trusts suggested the PU would be reported once the category of ulcer (1e4) could be established with a period of 'watchful ...
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Citations
... The description follows a list of items developed by reviewing the literature. In particular, we considered published criteria for indicator selection [6,23,24], important methodological features for international comparisons [25,26] and challenges specific to pressure ulcer measurement [27][28][29][30]. ...
Introduction
and Aim: Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities.
Material and methods
A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements.
Results
The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems.
Conclusions
Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning.
... Prevalence studies have indicated that as many as 18% of PUs within an acute setting are not recorded within the existing reporting systems (Fletcher et al 2015;Coleman et al 2016). Furthermore, there is concern that in some care settings, e.g. ...
This report is based on an advisory board meeting that took place in London on 7th February 2019. The meeting convened an expert group to discuss the use of negative pressure wound therapy (NPWT), and specifically NPWT with instillation and dwell time (NPWTi-d), for managing Category 3 and 4 pressure ulcers (PUs). The aims and objectives of the meeting were to identify why there is currently an underuse of NPWTi-d for Category 3 and 4 PUs in the UK; to understand how to align recommendations for NPWTi-d with the national strategy for PUs; to propose actions needed to change practice; to suggest a framework for integrating NPWTi-d for this indication across trusts in the UK.
... The prevalence rate of pressure ulcers in institutional long-term care ranges between 3% and 32.2%, and their incidence rate ranges from 12.9% to 34%. 2 Pressure ulcers are an important indicator of the quality of care and are associated with patient safety. [3][4][5] Healthcare professionals should be aware that these injuries are preventable through different strategies, including risk assessment, use of pressure-relieving support surfaces, systematic patient repositioning, skincare, and nutritional care. 1 Pressure-relieving support surfaces are commonly used to prevent pressure ulcers. The decision to select a pressure-relieving support surface is based on the level of attributed risk, patient comfort, general health, and the availability of materials and support surfaces. ...
Pressure ulcers are injuries to the skin and underlying tissue and are associated with a negative impact on well‐being and health‐related quality of life. This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents' perspectives and critical success factors when implementing a new non‐powered static air mattress overlay to prevent pressure ulcers. Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair‐bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non‐powered static air mattress overlay. Interviews were conducted in the participants' personal rooms between June 2017 and March 2018. Interviews included broad, open‐ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14‐day observation period between day 3 and day 14. All interviews were audio‐recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay. Implementation of a non‐powered static air mattress overlay to prevent pressure ulcers has a far‐reaching impact on nursing home residents' experiences. This study provides insight into the true meaning of patients' perspectives by focusing on learning from the patients' experiences that provide valuable information for healthcare professionals and other stakeholders.
... As of 2019, this sheet has not been updated to reflect changes in PU classification, 14 and it is not suited to community settings as it contains check boxes pertaining to type of hospital facility and length of stay but no categories for non-hospitalised patients. Furthermore, differences in the interpretation and implementation of national PU guidelines 15,16 and a lack of standardisation in terminology have produced PU data that are complex and difficult to compare between health systems. 17 Yet, health systems need reliable comparative data to assess baseline economic drivers and assure quality improvement. ...
Objective
To determine if meaningful patient characteristics pertaining to pressure ulcers (PU) can be derived from routinely collected community health data.
Methods
A retrospective cohort analysis of records was carried out. To provide a detailed dataset on PU for the community of interest, demographic, general medical and PU data were extracted from mandatory incident reports and audit of electronic and paper medical records. This study is reported in accordance with the RECORD Guidelines from the Equator Network. Adult patients were enrolled from a district nursing service in the target region (n=1085) during 2015. The target region was based on a geographical region bounded by a single postcode district (target region) consisting of 62,000 people of whom approximately 50,000 were adults, 3000 of whom were aged >75 years.
Results
The total number of recorded PUs was n=137 in 103 individuals. Data from mandatory incident reports was obtainable for nearly all variables. Electronic and paper medical records were less reliable due to missing data.
Conclusion
Detailed characteristics of community-dwelling PU patients can be derived from routinely collected data, and provides various forms and levels of information which could feed into different projects. The use of mandatory reporting fields increases the level of reporting and reduces missing data. Data enriched with information from electronic and paper records could inform the addition of variables to mandatory forms to improve characterisation of community dwellers with PUs.
... • Systematic reviews of various designs 10,[22][23][24][25] • Studies (cross-sectional, experimental, and longitudinal) [1][2][3][4]8,11,[15][16][17][18][19][20][26][27][28][29][30][31][32] • Expert consensus and government reports [5][6][7]9,14,[33][34][35] • Expert opinion (analyses on cost savings/current practice) 12,13,36 MAIN CHALLENGES Broadly, the challenges with PI measurement can be classified into four inter-related categories: measurement, detection, coding and reporting. ...
... Evidence used: Cross-sectional study on UK in-patient facilities 36 , systematic review 25 , and cross-sectional study on an American data repository 11 . ...
Pressure Injuries [PIs] are a significant health issue worldwide, and contribute substantially toward the economic burden in healthcare systems. This is primarily because PIs increase the length of hospital stays; and longer hospital stays also predict PI development. PIs are also used to measure the performance of health staff and facilities in a variety of settings. Inappropriate management of PIs can lead to further complications, necessitating an increase in resources in the hospital for assessment, monitoring, and treatment. However, over time, challenges in regards to identifying, assessing, and reporting PIs have proven to be problematic for a number of reasons. This document explains the main challenges to PI assessment, and presents a series of best practice recommendations to rectify these challenges.
... 8 National PI data collected in the UK's National Health Service (NHS) reported a prevalence of 4.2% across community and acute care settings in September 2017, 9 although the study could have underestimated the actual prevalence of PIs in the United Kingdom because of the low sensitivity of the tool used to identify the cases. 10,11 Prevalence of PIs can vary according to setting and can be as high as 26% in some settings such as long-term, acute-care, and rehabilitation settings. 12 Managing PIs can be expensive. ...
Objectives:
Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing.
Design:
Systematic review and network meta-analysis.
Setting and participants:
All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings.
Measures:
The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates.
Results:
40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18; 95% confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16; 95% CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group.
Conclusions/implications:
There was substantial uncertainty around the point estimates; however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.
... and 4 (60%) PIs. This was further validated by a second study [45] that led to international recommendations to improve PI monitoring. Other studies [46,47] also found under-reporting of PI incidents to be a key issue. ...
... The data collected, and the valuable information gathered from this study, as well as the international recommendations for PI monitoring [45], has guided further improvements in patient care and incident reporting at a local level. At this hospital and across the district, a new approach to HAPI in the IIMS reporting, patient assessment and prevention of HAPI has been implemented. ...
Aim:
The aim of this study was to (1) examine the reasons for the increased incidence of hospital-acquired pressure injuries (HAPIs) reported in the Incident Information Management System (IIMS), and (2) gain feedback from nurses regarding HAPI being reported in the IIMS at one tertiary hospital in Australia.
Materials and methods:
This prospective descriptive study included a review of patients with a reported HAPI from July 2015 to June 2016. Patient assessment and semi-structured interviews with nurses were conducted. Interview data were anonymised and content thematically analysed.
Results:
Data were collected on 417 patients who were reported to have a HAPI; of these, 363 patients were clinically assessed. 69.7% (253/363) were inaccurately reported in the IIMS, based on stage, location, not a true pressure injury or not hospital-acquired. A high number of patients (176/363, 48.5%) were found to have various skin conditions that were not HAPIs. Three themes were identified from the interviews: (1) meeting the mandated reporting requirements; (2) incident reporting and communication; (3) difficulties documenting aetiology.
Conclusion:
This study identified inaccuracies in diagnosing, classifying and reporting pressure injuries. Nurses described barriers and challenges to classifying and reporting HAPIs. Inaccurate reporting can lead to incorrect conclusions especially when reported data alone is relied upon for patient treatment, benchmarking and analysis. Guidelines are needed at a national and international level to support the quality of clinical assessment, reporting and documentation. Findings from this study have led to a new approach to patient assessment and to minimise errors in incident reporting at this organisation.
... PUs are considered to be an adverse event and constitute a constant chal lenge for all health profes sionals and institutions, both for human and material resources, and for the pain and suff ering caused to patients and their families. In fact, the development of PUs is complex and multifactorial [4] and nurs ing staff needs to manage several PU risk factors [5,6] in order to prevent PU development. ...
... Bias could be associated to data recording because the study was designed as a retrospective cohort analysis of electronic health record database. In recent studies in NHS hospitals in England [6,21] showed high levels of underreporting for all pressure ulcer categories and provided some recommendations to improve care quality, patient safety and future pressure ulcer monitoring. He found that some data records contained signifi cant missing information that if left unaddressed could reduce the validity of the data. ...
Background: Pressure ulcers (PU) are considered to an adverse event and constitute a constant challenge for all health professionals and institutions. Aim: Study the prevalence and incidence of PU in a intensive care unit (ICU) and the difficulties of classification and characterization of the lesions in critical ill patients. Materials and methods: Retrospective cohort analysis of electronic health record database from adult patients admitted to a ICU during 2012/1013. Barriers/difficulty's to classification of PUs were also studied in the nursing staff. Results: Epidemiologic sample study included 600 participants, and differential diagnoses study 27 nurses. The episodes in the study period (n = 600), 98 were identified with at least one PU present during hospitalization period, corresponding to a prevalence rate of 16.3%. The remaining 502 had no PU recording at entry or during hospitalization, 98 patients who were identified with PU, 40.8% presented it upon admission, and 59.2% developed ulceration in the service after 24 hours of admission (n = 58), which resulted in an incidence rate of 11.4%. The categorization of the PU ulcers identified in the present study, the most prevalent was category II (36,1%), followed by IV (35,4%), then I (13.1%) and III (10.8%). Regarding barriers of the differential diagnosis, 77.7% reported difficulty in evaluating PU in patients with peripheral arterial disease; 92.5% refer red difficulty in evaluating Category I in dark skin; 81.5% referred subjectivity in the characterization in the mucosa; 40.7% reported difficulty PU associated to medical devices; 96.3% considered essential training as a way to reduce subjectivity. Conclusion: Extra attention needs to be taken to prevent PU in ICU. The incidence of PU is higher if associated with a medical device, Staffmust adopt multiple strategies to prevent it. More education and sharing experiences is needed to reduce the subjectivity of differential diagnosis in PU.
... PUs are considered to be an adverse event and constitute a con- stant chal lenge for all health profes sionals and institutions, both for human and ma- terial resources, and for the pain and suff er- ing caused to patients and their families. In fact, the development of PUs is complex and multifactorial [4] and nurs ing staff needs to manage several PU risk factors [5,6] in order to prevent PU development. ...
... Bias could be associated to data recording because the study was designed as a retro- spective cohort analysis of electronic health record database. In recent studies in NHS hospitals in England [6,21] showed high le- vels of underreporting for all pressure ulcer categories and provided some recommen- dations to improve care quality, patient sa- fety and future pressure ulcer monitoring. He found that some data records contained signifi cant missing information that if left unaddressed could reduce the validity of the data. ...
Background: Pres sure ulcers (PU) are considered to an adverse event and constitute a constant
chal lenge for all health profes sionals and institutions. Aim: Study the prevalence and incidence
of PU in a intensive care unit (ICU) and the diffi culties of clas sifi cation and characterization of the
lesions in critical ill patients. Materials and methods: Retrospective cohort analysis of electronic
health record database from adult patients admitted to a ICU dur ing 2012/1013. Bar riers/diffi culty’s
to clas sifi cation of PUs were also studied in the nurs ing staff. Results: Epidemiologic sample study
included 600 participants, and diff erential dia gnoses study 27 nurses. The episodes in the study
period (n = 600), 98 were identified with at least one PU present dur ing hospitalization period, correspond
ing to a prevalence rate of 16.3%. The remain ing 502 had no PU record ing at entry or during
hospitalization, 98 patients who were identified with PU, 40.8% presented it upon admis sion,
and 59.2% developed ulceration in the service after 24 hours of admis sion (n = 58), which resulted
in an incidence rate of 11.4%. The categorization of the PU ulcers identified in the present study, the
most prevalent was category II (36,1%), fol lowed by IV (35,4%), then I (13.1%) and III (10.8%). Regarding
bar riers of the diff erential dia gnosis, 77.7% reported diffi culty in evaluat ing PU in patients with
peripheral arterial disease; 92.5% refer red diffi culty in evaluat ing Category I in dark skin; 81.5% referred
subjectivity in the characterization in the mucosa; 40.7% reported diffi culty PU as sociated to
medical devices; 96.3% considered es sential train ing as a way to reduce subjectivity. Conclusion:
Extra attention needs to be taken to prevent PU in ICU. The incidence of PU is higher if as sociated
with a medical device, Staff must adopt multiple strategies to prevent it. More education and sharing
experiences is needed to reduce the subjectivity of diff erential dia gnosis in PU.
... However, a study regarding hospital incident reporting systems found that 86% of injuries go unreported, particularly, 26% of PrI cases go unreported (stage-I, stage-II, or un-staged) [21]. Additionally, there appears to be under-reporting for less severe PrIs [22,23]. Hence, it is reasonable to assume that the incidence of PrIs in general, and of sitting-acquired DTIs in particular, is underreported. ...
A pressure injury (PrI) compromises quality of life and can be life-threatening. The fundamental cause of PrIs is sustained deformations in weight-bearing soft tissues, e.g., during prolonged sitting on inadequate surfaces such as a toilet seat. In nursing homes and geriatric facilities, patients need assistance using the restroom, and patients being left on the toilet for tens-of-minutes is a real-world scenario, unfortunately. Nevertheless, there are no published studies regarding sustained tissue loads during toilet sitting and their effects on tissue physiology. Here, the biomechanical and microcirculatory responses of the buttock tissues to toilet sitting were investigated using finite element modeling and cutaneous hemodynamic measurements, to explore the potential etiology of PrIs occurring on the toilet. We found that prolonged sitting on toilet seats involves a potential risk for PrI development, the extent of which is affected by the seat design. Additionally, we found that specialized toilet seat cushions are able to reduce this risk, by lowering instantaneous tissue exposures to internal stresses (by up to 88%) and maintaining reduced interface pressures. Furthermore, hemodynamic variables were altered during the toilet sitting; in particular, tcPO2 was decreased by 49% ± 7% (44 ± 2[mmHg] to 22 ± 4[mmHg]) during sitting. The current study confirms that investing in expensive PrI prevention (PIP) products is likely to be ineffective for an immobilized patient who is left to sit on a bare toilet seat for long times. This argument highlights the need for a holistic-care approach, employing PIP devices that span across the entire environment where bodyweight forces apply to tissues.
