A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China
- 0 Comments
- 5830 reads
In individual countries in Europe, the reported PU prevalence rates were 11.7% in Germany in 2001–2002,13 12.8% to 20.3% in the Netherlands in 2006,14 and 18.5% in three teaching hospitals in Ireland in 2008.15 Studies in Australia reported point PU prevalence of 10% in a teaching hospital in 199716 and 6% in 18 hospitals in northern New South Wales in 2001.17
In China, PU prevalence has not yet been reported for either individual hospitals or on a national level. However, PU management has long been a part of basic patient care and considered a nursing care quality indicator. Traditionally, an ulcer that occurred in the hospital was considered shameful for nursing and the unit was punished by means of fine, naming, blaming, and the like. Recently, China has experienced a cultural and practice change from blaming the individual to preventing ulcers by identifying risk. The Ministry of Health of the People’s Republic of China now requires each hospital to establish a management protocol to prevent and manage PU and to implement a mechanism to assess ulcer size.18
Many initiatives have been implemented to prevent the development of PU in hospital patients in China. However, people usually use data reported by clinical nursing staff to measure the effectiveness of preventive intervention. For example, in one study,19 the number of patients with pressure ulcers was divided by the number of bedridden patients to find a pre-intervention rate of 0.18% and a post intervention rate of 0.04%. Another study20 compared the number of patients with nosocomial ulcers to the number of patients assessed at high risk for PU (Norton score: ≤14) and determined pre- and post intervention rates of 5.88% and 0.00%, respectively. No study thus far has reported using surveyed PU prevalence as an indicator to measure the effectiveness of the management protocol.
In the US, per the Agency for Healthcare Research and Quality (AHRQ),21 the risk-adjusted rate of PU is a safety indicator and per Germany’s National Agency for Quality Assurance22 PU status is part of the national quality assurance program for hip fracture, hip prosthesis, and heart surgery. It is evident that it is necessary to explore PU prevalence in hospitals to set the benchmark for further measurement that per the Ministry of Health now will be conducted every 6 months.
The purpose of this descriptive cross-sectional study was to create a baseline database in a 3,000-bed teaching hospital by assessing the prevalence, severity, and anatomical location of PU in an acute care hospital.
Participants and instruments. All patients in a 3,000-bed teaching hospital on the day of study were eligible to participate. The investigator translated the National Database of Nursing Quality Indicators® (NDNQI) Pressure Ulcer Prevalence Survey Scale23,24 into Chinese for data collection. The items audited included hospital unit, patient gender, age, Norton scale score (PU risk assessment) on admission, PU preventive measures, presence of PU, and PU history (present on admission or hospital-acquired). The number of ulcers per patient and ulcer anatomical location and stage also were assessed.
1. Gallagher SM. Outcomes in clinical practice: pressure ulcer prevalence and incidence studies. Ostomy Wound Manage.1997;43(1):28–40.
2. National Database of Nursing Quality Indicators® (NDNQI). Pressure Ulcer Prevalence Study. Available at: www.nursingquality.org/NDNQIPressureUlcerTraining/module1/staging17b.aspx. Accessed March 5, 2009.
3. Kottner J, Wilborn D, Dassen T, Lahmann N. The trend of pressure ulcer prevalence rates in German hospitals: results of seven cross-sectional studies. J Tissue Viability. 2008;18(2):36–46.
4. Meehan M. Multisite pressure ulcer prevalence survey. Decubitus. 1990;3(4):14–17.
5. Amlung SR, Miller WL, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care. 2001;14(6):297–301.
6. VanGilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54(2):40–54.
7. VanGilder C, Decker S, Lanigan G, et al. 2006 International Pressure Ulcer Prevalence™ Survey results. J WOCN. 2007;3(3 suppl):S561.
8. VanGilder C, Gordon M, Stephanie M, et al. Body mass index, weight, and pressure ulcer prevalence: an analysis of the 2006-2007 International Pressure Ulcer Prevalence™ Surveys. J Nurs Care Qual. 2008;23(4):1–9.
9. Baldwin KM. Incidence and prevalence of pressure ulcers in children. Adv Skin Wound Care. 2002;15(3):121–124.
10. Harrison MB, Wells G, Fisher A, Prince M. Practice guidelines for the prediction and prevention of pressure ulcers: evaluating the evidence. Appl Nurs Res.1996;9(1):9–17.
11. Orsted HL, Rosenthal S, Woodbury MG. Pressure ulcer awareness and prevention program: a quality improvement program through the Canadian Association of Wound Care. J WOCN. 2009;36(2):178–183.
12. Vanderwee K, Clark M, Dealey C, Gunningberg L, DeFloor T. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007;13(2):227–235.
13. Lahmann NA, Halfens RJ, Dassen T. Prevalence of pressure ulcers in Germany. J Clin Nurs. 2005;14(2):165–172.
14. Schoonhoven L, Bousema M, Buskens E. The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study. Int J Nurs Stud. 2007;44:927–935.
15. Gallagher P, Barry P, Hartogan I, McCluskey P, O’Connor K, O’Connor M. Prevalence of pressure ulcers in three university teaching hospitals in Ireland. J Tissue Viabil. 2008;17(4):103–109.
16. Gruen RL, Chang S, MacLellan DG. The point prevalence of wounds in a teaching hospital. Aust NZ J Surg. 2008;67(10):686–688.
17. Pearson A, Francis K, Hodgkinson B, Curry G. Prevalence and treatment of pressure ulcers in Northern New South Wales. Aust J Rural Health. 2000;8(2):103–110.
18. Ministry of Health of the People’s Republic of China. Guidance for Hospital Management Evaluation (2008). Available at: www.moh.gov.cn. Accessed May 23, 2008.
19. Wang H, Chen WJ, Zhou RP, et al. The establishment and application of the pressure ulcer management procedure. Chinese J Nurs Admin. 2007;7(2):47–48.
20. SU XH. Three-level quality control in pressure ulcer nursing in vertebral column surgery department. Chinese Nurs Manage. 2008;8(5):70–72.
21. Agency for Healthcare Research and Quality. AHRQ Quality Indicators-Guide to Patient Safety Indicators. Rockville, MD: Agency for Healthcare Research and Quality;2003.
22. National Agency for Quality Assurance in Germany. Available at: www.bqs-online.ed/. Accessed March 5, 2009.
23. National Database of Nursing Quality Indicators® (NDNQI) Pressure Ulcer Training. Pressure Ulcer Prevalence Study Protocol Module. Available at: www.nursingquality.org/ndnqipressureulcertraining/module3/protocol12.aspx. Accessed March 5, 2009.
24. National Database of Nursing Quality Indicators® (NDNQI) Pressure Ulcer Training. Pressure ulcers and staging module. Available at: www.nursingquality.org/ndnqipressureulcertlcers g/module1/default.aspx. Accessed March 5,2009.
25. National Pressure Ulcer Advisory Panel. Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement. Decubitus.1989;2:24–28.
26. Liu YL, Zhang L, Wang GL, et al. Thinking about management of nursing error in China. Chinese J Nurs. 2007;42(9):827–829.
27. Ministry of Health of People’s Republic of China. 2007 Chinese Health Statistical Digest. Number of Health Personnel. Available at: www.moh.gov.cn/open/2007tjts/P97.htm. Accessed February 6, 2008.
28. America Hospital Association. Hospital Statistics. 2007:6.
29. Gunningberg L. EPUAP pressure ulcer prevalence survey in Sweden. J WOCN. 2006;33(3):258–266.