Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

• Main Authors: De Laat, E.H (Author), Schoonhoven, L. (Author), Pickkers, P. (Author), Verbeek, A.L (Author), Feuth, T. (Author), van Achterberg, T. (Author)
• Format: Article
• Language: English
• Published: 2007-03.
• Subjects: Article
• Online Access: Get fulltext

 Objective: To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients. Design: Prospective cohort study. Setting: Adult intensive care department of a university medical center. Patients: Critically ill patients (n ? 399). Interventions: A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline. Measurements and Main Results: Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p ? .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p ? .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six. Conclusions: The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.