A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China

  • 2/1/2010
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Start Page: 
38
End Page: 
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Author(s): 
Guanghong Zhao, RN, PhD; Elizabeth Hiltabidel, MSN, RN, CWOCN; Yilan Liu, RN, PhD; LingLing Chen, RN, MSNc; and Yongzhen Liao, RN, MSN

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.

Methods

     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.

References: 

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