Pressure ulcer prevention in acute care using the pressure ulcer bundle of care

ABSTRACT

@#<p style="text-align justify;">A study was conducted to determine the effectiveness of the pressure ulcer bundle of care (PUB) in preventing pressure ulcers among patients in acute care. The pre and post-test quasi-experimental design was utilized to predict a model of preventing pressure ulcer in acute care setting. Thirty acute care patients with moderate risk for pressure ulcers were randomly selected to receive the following five PUB interventions: assessment of pressure ulcer risk, repositioning, head elevation, heel elevation, and frequent diet monitoring. Pressure ulcer risk was assessed using the Braden risk assessment scale before and after PUB interventions. This scale assesses important aspects of ulcer formation according to six subscales sensory perception, moisture, mobility, physical activity, nutrition, and friction/shear. Profile of the patients according to age, sex, and length of hospital stay was described using frequency and percentage distribution. Bundle compliance, as measured by performance of the five interventions was described using mean scores and standard deviations. The t-test was used to determine the differences in pressure ulcer risk or occurrence between pre- and post-intervention phases. Multiple linear regression analysis was used to determine the relationship of Pressure Ulcer Risk Assessment  Scores (PURAS) to the PUB, and to identify the predictor(s)  of PURAS among the four interventions in the PUB. Statistical significance was considered at the .05 level. Pressure ulcer risk scores of patients improved significantly from "mild risk" to "not a risk" post-PUB (p=<0.001). Head elevation, heel elevation, and diet monitoring were found to be predictors of pressure ulcer risk scores after PUB interventions. Repositioning was not significantly associated with pressure ulcer risk scores of patients after PUB interventions. The three predictor model revealed the PUB interventions were able to account for 52% of the variance in pressure ulcer risk scores, which indicates a strong significant relationship between patients receiving PUB and their improvement in pressure ulcer risk. In conclusion, the pressure ulcer bundle of care intervention is effective in prevention of pressure ulcers in patients at risk. Nurses should adopt the provision of bundle of care intervention(s) to enhance patient safety and quality of care.</p>