PATIENT-SPECIFIC AND SURGICAL CHARACTERISTICS IN THE DEVELOPMENT OF PRESSURE ULCERS

Background Implementation of the ruling on the Inpatient Prospective Payment System by the Centers for Medicare and Medicaid has challenged nurses to focus on the prevention of pressure ulcers. Despite years of research, pressure ulcers are still one of the most common complications experienced by patients in health care facilities. Objective To examine the relationship between patients' characteristics (age, sex, body mass index, history of diabetes, and Braden Scale score at admission) and care characteristics (total operating room time, multiple surgeries, and vasopressor use) and the development of pressure ulcers. Methods In a cohort study, data from the electronic medical records of 3225 surgical patients admitted to a Midwest hospital, from November 2008 to August 2009 were analyzed statistically to determine predictors of pressure ulcers. Results A total of 12% of patients (n = 383) had at least 1 pressure ulcer develop during their hospitalization. According to logistic regression analysis, scores on the Braden Scale at admission (P<.001), low body mass index (P<.001), number of vasopressors (P=.03), multiple surgeries during the admission (P<.001), total surgery time (P<.001), and risk for mortality (P<.001) were significant predictors of pressure ulcers. Conclusion Scores on the Braden Scale at admission can be used to identify patients at increased risk for pressure ulcers. For other high-risk factors, such as low body mass index and long operative procedures, appropriate clinical interventions to manage these conditions can help prevent pressure ulcers. (American Journal of Critical Care. 2012; 21:116-125)