Background: Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies.
Objective: The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record.
Methods: This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction.
Results: Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score ≤14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination.
Discussion: Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.
Shayna E. Rich, MA, is MD/PhD Student; and Michelle Shardell, PhD, is Assistant Professor, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore.
David Margolis, MD, PhD, is Associate Professor, Departments of Epidemiology & Biostatistics, and Dermatology, School of Medicine, University of Pennsylvania, Philadelphia.
Mona Baumgarten, PhD, is Associate Professor, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore.
Accepted for publication August 18, 2008.
This study was supported by Research Grant R01 AG14127 from the National Institute on Aging, Bethesda, Maryland.
This study was presented as a poster at the 59th Annual Scientific Meeting of the Gerontological Society of America, Dallas, Texas, November 19, 2006. Data from this study have been the subject of other analyses, the results of which have been previously published. The publications are as follows: (a) Baumgarten, M., Margolis, D. J., Localio, A. R., Kagan, S. H., Lowe, R. A., Kinosian, B., et al. (2008). Extrinsic risk factors for pressure ulcers early in the hospital stay: A nested case-control study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(4), 408-413. (b) Compher, C., Kinosian, B. P., Ratcliffe, S. J., & Baumgarten, M. (2007). Obesity reduces the risk of pressure ulcers in elderly hospitalized patients. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(11), 1310-1312. (c) Baumgarten, M., Margolis, D. J., Localio, A. R., Kagan, S. H., Lowe, R. A., Kinosian, B., et al. (2006). Pressure ulcers among elderly patients early in the hospital stay. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61(7), 749-754. (e) Localio, A. R., Margolis, D. J., Kagan, S.H., Lowe, R. A., Kinosian, B., Abbuhl, S., et al. (2006). Use of photographs for the identification of pressure ulcers in elderly hospitalized patients: Validity and reliability. Wound Repair and Regeneration, 14(4), 506-513. None of these previously published articles have examined the hypotheses that are addressed in this article.
Corresponding author: Mona Baumgarten, PhD, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, 660 West Redwood Street, Suite 200, Baltimore, MD 21201 (e-mail: firstname.lastname@example.org).