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Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients
Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients
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
center.
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.
0090-3493
815-820
De Laat, E.H.
67d3b592-0cad-4c45-915c-4953d1ff6bc8
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Pickkers, P.
8fa9ec7b-278d-4fd1-9f98-1dca3d54fbf4
Verbeek, A.L.
eb89b82a-d5ab-40d6-852c-611e6939f0e3
Feuth, T.
3076a690-f387-478d-becc-800c34a3c9ba
van Achterberg, T.
1b413585-49b3-4989-a1b6-7fb4d4bac453
De Laat, E.H.
67d3b592-0cad-4c45-915c-4953d1ff6bc8
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Pickkers, P.
8fa9ec7b-278d-4fd1-9f98-1dca3d54fbf4
Verbeek, A.L.
eb89b82a-d5ab-40d6-852c-611e6939f0e3
Feuth, T.
3076a690-f387-478d-becc-800c34a3c9ba
van Achterberg, T.
1b413585-49b3-4989-a1b6-7fb4d4bac453

De Laat, E.H., Schoonhoven, L., Pickkers, P., Verbeek, A.L., Feuth, T. and van Achterberg, T. (2007) Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Critical Care Medicine, 35 (3), 815-820. (doi:10.1097/01.CCM.0000257072.10313.56). (PMID:17255865)

Record type: Article

Abstract

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
center.
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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Published date: March 2007
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339733
URI: http://eprints.soton.ac.uk/id/eprint/339733
ISSN: 0090-3493
PURE UUID: d84a6cfe-f0d0-44da-89f4-7cbbf475435f
ORCID for L. Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 30 May 2012 09:04
Last modified: 26 Nov 2019 01:38

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