Details

Autor(en) / Beteiligte

• de Laat, Erik H
• Pickkers, Peter
• Schoonhoven, Lisette
• Verbeek, André L
• Feuth, Ton
• van Achterberg, Theo

Titel

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

Ist Teil von

• Critical care medicine, 2007-03, Vol.35 (3), p.815-820

Ort / Verlag

Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Erscheinungsjahr

2007

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.