De Laat, E.H., Schoonhoven, L., Pickkers, P., Verbeek, A.L., Feuth, T. and van Achterberg, T.
Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients.
Critical Care Medicine, 35, (3), . (doi:10.1097/01.CCM.0000257072.10313.56). (PMID:17255865).
Objective: To describe the short-term and long-term effects of
a hospital-wide pressure ulcer prevention and treatment guideline
on both the incidence and the time to the onset of pressure ulcers
in critically ill patients.
Design: Prospective cohort study.
Setting: Adult intensive care department of a university medical
Patients: Critically ill patients (n � 399).
Interventions: A guideline for pressure ulcer care was implemented
on all intensive care units. The attention of nurses for
timely transfer to a specific pressure-reducing device was an
important part of this guideline.
Measurements and Main Results: Patient characteristics, demographics,
pressure ulcer risk profile at admission, daily pressure
ulcer grading, and type of mattress were determined to
describe the short-term and long-term effects 3 and 12 months
after the implementation. The incidence density of pressure ulcers
grade II–IV decreased from 54 per 1000 patient days at baseline
to 32 per 1000 days (p � .001) 12 months after the implementation.
The median pressure ulcer-free time increased from 12 days
to 19 days (hazard rate ratio, 0.58; p � .02). After adjustment for
differences in risk factors in a Cox proportional hazard model, the
number of preventive transfers to special mattresses was the
strongest indicator for the decreased risk of pressure ulcers
(hazard rate ratio, 0.22; p < .001). The number needed to treat to
prevent one pressure ulcer during the first 9 days was six.
Conclusions: The implementation of a guideline for pressure
ulcer care resulted in a significant and sustained decrease in
the development of grade II–IV pressure ulcers in critically ill
patients. Timely transfer to a specific mattress (i.e., transfer
before the occurrence of a pressure ulcer) was the main
indicator for a decrease in pressure ulcer development.
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