Extent of problem

Recommendations

Identify and Treat the Cause
1 Assess patient risk for pressure ulcer development at admission. Level of Evidence
Not Assessed
2 Implement appropriate strategies to prevent pressure ulcer development in patients with identified risk as soon as possible after admission. Level of Evidence
Not Assessed


Address Patient-Centered Concerns
3 Discuss with patients risk, prevention, management and psychosocial issues related to pressure ulcers Level of Evidence
Not Assessed


Provide Local Wound Care
4 Follow TREATMENT recommendations Level of Evidence
Not Assessed


Provide Organizational Support
5 Develop and implement comprehensive staff education on risk assessment and pressure ulcer prevention. Level of Evidence
Not Assessed
6 Ensure that institutional policies and procedures support this preventive approach. Level of Evidence
Not Assessed


Background

Pressure ulcers are largely, but not completely, preventable. As a result, they are more and more frequently being regarded as an indicator of quality of care. Pressure ulcers have a high prevalence, substantial impact on quality of life for patients and family members and significant associated financial costs. These factors make pressure ulcers a significant healthcare concern.

Canadian studies have estimated the cost of treating a pressure ulcer for 3 months to be over $24,000 in a long-term care setting and more than $27,000 in the community. In 1992, the Association of Health Care Policy and Research estimated the annual cost of treating pressure ulcers in the United States at $1.3 billion USD.

Factors predisposing to the development of pressure ulcers include advanced age, debility, immobility, severe acute illness and the presence of neurological deficits. Malnutrition is both a common finding among the elderly and a risk factor for pressure ulcer development. Pressure ulcers are also associated with mortality, more often as a result of declining health status than as a cause of death.

Estimates of the prevalence of pressure ulcers vary, but a recent study found the overall prevalence in Canadian healthcare institutions to be 26.2%. More than half of pressure ulcers (60%) develop in acute care hospitals, and up to 10% of hospitalized patients develop a pressure ulcer. In the community setting, the prevalence of pressure ulcers was 15.1%. Up to 70% of pressure ulcers occur in the elderly. Pressure ulcers are likely to increase in prevalence in future, due to the aging population, increased acuity of hospitalized individuals and increased survival of patients with significant healthcare problems.

The development of pressure ulcers is associated with external pressure, especially over a bony prominence. Contributing factors include shearing forces, such as those occurring with improper transfer techniques; friction, including that produced by involuntary patient movements; and moisture-related skin damage due to incontinence, perspiration or wound exudate. In the acute-care setting, pressure ulcers generally develop within 2 weeks of hospitalization, whereas in long-term care, most pressure ulcers develop within 4 weeks.

Routine risk factor assessment and use of preventive strategies is essential in patients who are at risk of developing pressure ulcers. Not all pressure ulcers can be prevented, but early intervention can reduce the incidence of pressure ulcers and their severity. Early intervention includes routine assessment of patient risk on admission, early implementation of preventive strategies in high-risk patients, and education of healthcare providers and patients. Appropriate institutional policies and procedures are necessary to support these approaches.

References

Essential Publications
1 Prevalence and Incidence of Pressure Ulcers Quality Indicator
 Type: Narrative Review
Shahin E, Dassen T, Halfens R. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nursing in Critical Care 13 (2) , 71–79, 2008.
This study examines the incidence and prevalence of pressure ulcers in intensive care settings. Its results demonstrate prevalence from 4% in Denmark to 49% in Germany, and incidences from 38% to 124%.


Enablers for practice

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