Cath Lab Digest

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Index: Ostomy Wound Manage. 2008;54(2):40-54.

  The authors disclose they are employees of Hill-Rom®, Batesville, IN. Hill-Rom® provided funding for the study.

  Pressure ulcers are a significant burden to the healthcare environment in the US, Europe, and other countries.^1-6 Over the last 5 to 6 years, healthcare facilities have increased their focus on prevention and several accrediting agencies and professional societies in the US view pressure ulcer prevalence as an overall quality indicator for facilities. Related prevention endeavors include the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) 2007 Long Term Care National Safety Goal #14, the National Pressure Ulcer Advisory Panel’s Board of Directors directives, and the American Nursing Association’s Safety and Quality initiatives.^7-9 However, data are limited as to whether this increased focus has reduced the number of nosocomial pressure ulcers (NPU) in healthcare facilities.

  In order to assist healthcare facilities benchmark their pressure ulcer prevalence against like institutions, as well as internally for quality improvement initiatives, Hill-Rom®, Inc., Batesville, IN, facilitated the International Pressure Ulcer Prevalence™ survey among acute (AC), long-term acute care (LTAC), and long-term care (LTC) facilities. Acute care facilities in this report comprise inpatient hospital facilities that predominantly treat patients for relatively short amounts of time for crisis or episodic illness. Longterm, acute care facilities include hospitals focused on patients who require intense, specialized treatment for a longer time (usually, 20 to 30 days). Long-term care facilities offer continuing maintenance and inpatient health services to chronically ill, disabled, or developmentally disabled patients.

  Survey data were collected from 1989 to 2005. The study included all patients admitted to or residing in the reporting facilities (the “at risk” population). Data were collected during a specific 24-hour pre-selected period within a 2- to 3-day window determined by the sponsor. The purpose of this report is to provide an indepth analysis of the International Pressure Ulcer Prevalence™ Survey data collected from 1989 to 2005.

Prevalence of Pressure Ulcers

  The National Pressure Ulcer Advisory Panel (NPUAP)⁸ has defined prevalence as “a cross-sectional count of the number of cases at a specific point in time, or the number of people with pressure ulcers who exist in a patient population at a given point in time.” Prevalence is calculated using the following formula¹⁰ and reported as a percentage: [Number of patients with pressure ulcers} x 100.

  Number of patients surveyed. Overall prevalence includes both pre-existing and NPUs. Pressure ulcers are considered to be nosocomial if the ulcer was not documented on facility admission, regardless of whether it developed during the current admission; prevalence is calculated as specified, with only the number of NPU patients included in the numerator. Therefore, skin assessment on facility admission is critical for accurate quality assessment and NPU reporting.

  Measuring the prevalence of pressure ulcers over time allows facilities to use data benchmarks to compare process improvements within their own facility and against facilities of similar size and patient acuity. Measuring unit-specific (eg, intensive care) prevalence facilitates identification of areas of concern within the facility and implementation of targeted improvement programs.