ABSTRACT
Pressure ulcers cause considerable pain and suffering and are also a very expensive drain on NHS funding. Measuring prevalence is particularly useful for guiding use of resources whereas incidence is an outcome indicator of quality of care. Patients and illnesses vary and it may be misleading to make assumptions based on crude incidence figures. A system of case-mix adjustment has been developed in Glasgow (GPSISS). This study used GPSISS to measure case-mix adjusted incidence of pressure ulcers in over 15,000 acute hospital patients. The incidence of pressure ulcers ranged from 1.1% to 2.7%. These low rates, and the time cost and effort involved in ensuring quality data, suggests that significant differences in quality of care may be demonstrated more quickly using processes rather than outcomes and may more directly identify where changes in practice are required.
Subject(s)
Intensive Care Units/statistics & numerical data , Pressure Ulcer/epidemiology , Quality of Health Care , Surgery Department, Hospital/statistics & numerical data , Adult , Aged , Diagnosis-Related Groups , Female , Humans , Incidence , Intensive Care Units/standards , Length of Stay , Male , Middle Aged , Pressure Ulcer/etiology , Risk Factors , Surgery Department, Hospital/standardsABSTRACT
The history of surgical wound management illustrates how dressings have evolved over the years and sets the scene for modern wound-healing products. The aim of this article is to discuss the management of surgical wounds and the value of wound-healing products for carers and patients in the current healthcare climate of cost-efficacy and clinical governance.
Subject(s)
Bandages/standards , Postoperative Care/nursing , Skin Care/nursing , Surgical Wound Infection/prevention & control , Adult , Bandages/economics , Cost-Benefit Analysis , Female , Humans , Infection Control/methods , Male , Nurse's Role , Nursing Assessment , Patient Selection , Patient-Centered Care , Postoperative Care/economics , Postoperative Care/instrumentation , Postoperative Care/methods , Skin Care/economics , Skin Care/instrumentation , Skin Care/methods , Surgical Wound Infection/nursingABSTRACT
Although emphasis in the literature may be on the use of pressure-relieving mattresses and specialist beds, seating is also an important part of preserving tissue viability. A collaborative approach within the multidisciplinary team is of value. Equipment is of limited value if not complemented by best practice, carried out by well-educated staff. Patients' views should be elicited.
Subject(s)
Equipment and Supplies, Hospital , Geriatrics , Medical Audit , Pressure Ulcer/prevention & control , Aged , Humans , PostureABSTRACT
The Glasgow Acute Clinical Audit Sub-Committee on Pressure Sores has previously carried out studies of incidence of pressure ulcers in the medical directorates and case-mix-adjusted the figures for length of hospital stay and risk assessment score. Case-mix classification is 'classification of people or treatment placed into groups using characteristics associated with condition, treatment or outcome that can be used to predict need, resource, use of outcomes'. In this instance, crude pressure ulcer incidence figures may be adjusted for length of hospital stay and pressure sore risk assessment score, and stratified into groups, which allows like to be compared with like. The value in case-mix-adjusted figures lies in repeating the exercise, thus determining the trend for individual areas and assessing whether improvement in the quality of care is being achieved. This is more positive than creation of 'league tables' comparing simultaneous studies in a number of areas. The figures showed that there was no statistically significant difference between surgical directorates in trusts with regard to risk assessment scores and length of hospital stay. Gathering data on the incidence of pressure ulcer development allows us to identify where new sores are occurring, but does not critically analyse the nursing intervention taken in individual cases, which identifies preventive strategies. The Glasgow group's primary aim was to gather data on case-mix-adjusted incidence of pressure damage; the secondary objectives were to scrutinize the data to gather more general information on intrinsic and extrinsic factors which may predispose to pressure ulcer development. The study was carried out in the surgical directorate. Findings showed that incidence was low (1.1%), with the majority of sores being superficial. There was a correlation between pressure ulcer development and incontinence, evidence of under-utilization of moving and handling aids for prevention of pressure ulcers, and a need for greater collaboration between nursing staff and dietitians. All patients had access to pressure-reducing surfaces, with cut-foam pressure-reducing mattresses with vapour-permeable covers on all beds. Dynamic systems were available if the primary nurse identified a need for them.
Subject(s)
Diagnosis-Related Groups/statistics & numerical data , Outcome Assessment, Health Care/organization & administration , Pressure Ulcer/epidemiology , Pressure Ulcer/prevention & control , Quality Assurance, Health Care/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , Child , Data Collection/methods , Humans , Incidence , Length of Stay/statistics & numerical data , Middle Aged , Needs Assessment , Nursing Assessment , Nursing Audit , Perioperative Nursing/standards , Pressure Ulcer/nursing , Risk Assessment , Risk FactorsABSTRACT
Although wound exudate is necessary for healing, when its production becomes excessive it becomes a problem, contributing to skin maceration and delaying wound healing. Treating the underlying cause of excessive exudate-generation and selecting appropriate dressings are the keys to effective management.
