Pressure ulcer prevalence in Europe: a pilot study
01 Apr 2007-Journal of Evaluation in Clinical Practice (J Eval Clin Pract)-Vol. 13, Iss: 2, pp 227-235
TL;DR: The methodology is sufficiently robust to measure and compare pressure ulcer prevalence in different countries and indicates that more attention to prevention is needed in Europe.
Abstract: Rationale and aims Numerous prevalence studies have been conducted. The problem with these studies is that prevalence proportions cannot be compared with each other, because of differences in performance of each survey. There is no agreed standardized method for determining prevalence proportions. This study aimed to develop and pilot a uniform data collection instrument and methodology to measure the pressure ulcer prevalence and to get some insight into pressure ulcer prevalence across different patient groups in Europe.
Methods Pressure ulcer experts from different European countries developed a data collection instrument, which included five categories of data: general data, patient data, risk assessment, skin observation and prevention. A convenience sample of university and general hospitals of Belgium, Italy, Portugal, UK and Sweden participated in the study. In each participating hospital, teams of two trained nurses who collected the data on the wards were established. All patients admitted before midnight on the day of the survey and older than 18 years were included.
Results The data collection instrument and study procedure of the survey were found to be effective by all participants. 5947 patients were surveyed in 25 hospitals in five European countries. The pressure ulcer prevalence (grade 1–4) was 18.1% and if grade 1 ulcers were excluded, it was 10.5%. The sacrum and heels were the most affected locations. Only 9.7% of the patients in need of prevention received fully adequate preventive care.
Conclusion The methodology is sufficiently robust to measure and compare pressure ulcer prevalence in different countries. The pressure ulcer prevalence was higher than expected and relatively few patients received adequate prevention. This indicates that more attention to prevention is needed in Europe.
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TL;DR: Early evidence is provided that adverse events due to medical care represent a major source of morbidity and mortality globally, and the importance of critically evaluating the quality and safety of the care provided once a person accesses health services is suggested.
Abstract: Objective To contextualise the degree of harm that comes from unsafe medical care compared with individual health conditions using the global burden of disease (GBD), a metric to determine how much suffering is caused by individual diseases. Design Analytic modelling of observational studies investigating unsafe medical care in countries’ inpatient care settings, stratified by national income, to identify incidence of seven adverse events for GBD modelling. Observational studies were generated through a comprehensive search of over 16 000 articles written in English after 1976, of which over 4000 were appropriate for full text review. Results The incidence, clinical outcomes, demographics and costs for each of the seven adverse events were collected from each publication when available. We used disability-adjusted life years (DALYs) lost as a standardised metric to measure morbidity and mortality due to specific adverse events. We estimate that there are 421 million hospitalisations in the world annually, and approximately 42.7 million adverse events. These adverse events result in 23 million DALYs lost per year. Approximately two-thirds of all adverse events, and the DALYs lost from them, occurred in lowincome and middle-income countries. Conclusions This study provides early evidence that adverse events due to medical care represent a major source of morbidity and mortality globally. Though suffering related to the lack of access to care in many countries remains, these findings suggest the importance of critically evaluating the quality and safety of the care provided once a person accesses health services. While further refinements of the estimates are needed, these data should be a call to global health policymakers to make patient safety an international priority.
390 citations
TL;DR: The estimates reported here provide a basis for assessment of the cost-effectiveness of measures to reduce the incidence of hospital-acquired ulcers, both to patients and to health-care providers.
Abstract: Objective: To provide an estimate of the costs of treating pressure ulcers in the UK at August 2011 prices, as a means of highlighting the importance of pressure ulcer prevention. Method: Resource use was derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice, with prices reflecting costs to the health and social care system in the UK. This approach was used to estimate treatment costs per episode of care and per patient for ulcers of different severity and level of complications. Results: The cost of treating a pressure ulcer varies from £1214 (category 1) to £14 108 (category IV). Costs increase with ulcer severity because the time to heal is longer and the incidence of complications is higher in more severe cases. Conclusion: Pressure ulcers represent a significant cost burden in the UK, both to patients and to health-care providers. Without concerted effort, this cost is likely to increase in the future as the populati...
369 citations
TL;DR: The clinical complexity of chronic wounds is discussed and the best currently available models for investigating chronic wound pathology are described, to assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.
Abstract: The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.
355 citations
TL;DR: Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations, so wound care is unlikely to be a management priority.
Abstract: Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations. Until this information is available, wound care is unlikely to be a management priority.
310 citations
TL;DR: Although the cost to provide pressure ulcer prevention to patients at risk can importantly impact health care services' budgets, the costs to treat a severe pressure ulcers were found to be substantially higher.
307 citations
References
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TL;DR: To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a significant threat to healthcare providers in the UK, as it is in the USA.
Abstract: Objective: to estimate the annual cost of treating pressure ulcers in the UK. Design: costs were derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reXecting good clinical practice. Setting: health and social care system in the UK. Subjects: patients developing a pressure ulcer. Methods: a bottom-up costing approach is used to estimate treatment cost per episode of care and per patient for ulcers of different grades and level of complications. Also, total treatment cost to the health and social care system in the UK. Results: the cost of treating a pressure ulcer varies from £1,064 (Grade 1) to £10,551 (Grade 4). Costs increase with ulcer grade because the time to heal is longer and because the incidence of complications is higher in more severe cases. The total cost in the UK is £1.4–£2.1 billion annually (4% of total NHS expenditure). Most of this cost is nurse time. Conclusions: pressure ulcers represent a very signiWcant cost burden in the UK. Without concerted effort this cost is likely to increase in the future as the population ages. To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a signiWcant threat to healthcare providers in the UK, as it is in the USA.
705 citations
TL;DR: The pilot raised a number of fundamental issues related to the process of conducting a large-scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on 'gatekeepers'.
Abstract: The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey
Background. In many research papers, pilot studies are only reported as a means of justifying the methods. This justification might refer to the overall research design, or simply to the validity and reliability of the research tools. It is unusual for reports of pilot studies to include practical problems faced by the researcher(s). Pilot studies are relevant to best practice in research, but their potential for other researchers appears to be ignored.
Objective. The primary aim of this study was to identify the most appropriate method for conducting a national survey of maternity care.
Methods. Pilot studies were conducted in five hospitals to establish the best of four possible methods of approaching women, distributing questionnaires and encouraging the return of these questionnaires. Variations in the pilot studies included (a) whether or not the questionnaires were anonymous, (b) the staff involved in distributing the questionnaires and (c) whether questionnaires were distributed via central or local processes. For this purpose, five maternity hospitals of different sizes in Scotland were included.
Results. Problems in contacting women as a result of changes in the Data Protection Act (1998) required us to rely heavily on service providers. However, this resulted in a number of difficulties. These included poor distribution rates in areas where distribution relied upon service providers, unauthorized changes to the study protocol and limited or inaccurate information regarding the numbers of questionnaires distributed.
Conclusions. The pilot raised a number of fundamental issues related to the process of conducting a large-scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on ‘gatekeepers’. This paper highlights the lessons learned as well as the balancing act of using research methods in the most optimal way under the combined pressure of time, ethical considerations and the influences of stakeholders. Reporting the kinds of practical issues that occur during pilot studies might help others avoid similar pitfalls and mistakes.
418 citations
TL;DR: Turning every 4 h on a VE mattress resulted in a significant reduction in the number of pressure ulcer lesions and makes turning a feasible preventive method in terms of effort and cost.
282 citations
TL;DR: A standardized methodology for prevalence and incidence study data collection/reporting has been developed and used in successive studies and years and provides a tool to help health care organizations measure the effectiveness of interventions, improve patient outcomes on an ongoing basis, and begin trending analysis.
Abstract: Objective To provide health care organizations with a benchmark to measure pressure ulcer prevalence and incidence. Subjects Medical, surgical, and intensive care unit patients at participating health care organizations. Design Pressure ulcer prevalence was measured during a predetermined 24-hour period at each participating health care organization, using a standardized data collection form. Incidence was measured over the average length of stay determined for each participating health care organization. Patient demographics, pressure ulcer stages, pressure ulcer locations, and contributing factors were collected during the study. Collected data forms were audited prior to being submitted to a central site for database entry, analysis, and report generation. Results Pressure ulcer prevalence ranged from a low of 14% (2001 and 2002) to a high of 17% (1999). Incidence ranged from a low of 7% (2001, 2003, 2004) to a high of 9% (2000). Comprehensive reports were delivered to the participating health care organizations, with each health care organization's data compiled to create a comparison database. Conclusion A standardized methodology for prevalence and incidence study data collection/reporting has been developed and used in successive studies and years. This provides a tool to help health care organizations measure the effectiveness of interventions, improve patient outcomes on an ongoing basis, and begin trending analysis.
265 citations
TL;DR: The predictive validity of the Braden Scale and the timing of assessment for optimal prediction of pressure sore development were studied in a nursing home population.
Abstract: The predictive validity of the Braden Scale and the timing of assessment for optimal prediction of pressure sore development (PS) were studied in a nursing home population. Subjects (N = 102) over age 19, free of PS and admitted within the previous 72 hr, were randomly selected from consecutive admissions to a skilled nursing facility. Subjects were assessed for risk and skin condition every 48 to 72 hr for 4 weeks. Twenty-eight subjects (27.5%) developed a PS. A cut score of 18 used at the observation prior to the first recorded PS maximized prediction, producing a sensitivity of 79%, a specificity of 74%, a 54% predictive value of a positive test, 90% predictive value of a negative test, and 75% correct classification rate.
223 citations