The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents
The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents
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DOI：
10.1111/j.1532-5415.2004.52106.x
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发表时间：
2004-03-01
影响因子：
6.3
通讯作者：
Voss, AC
中科院分区：
文献类型：
--
作者：
Horn, SD;Bender, SA;Voss, AC
目的：确定与长期护理居民压疮（PU）发展相关的住院医师、治疗和设施特征。设计：采用方便抽样的回顾性队列研究。背景：全美95家长期护理机构参与了全国压疮长期护理研究。参与者：共有1524名18岁及以上的居民，停留时间为14天或更长，他们没有现有的PU，但有发展PU的风险，根据布雷登量表预测压疮风险评分为17或更低，在研究开始时。测量：在12周的时间内收集的每位居民的数据包括居民特征(例如，人口统计学、病史、疾病严重程度（使用综合严重程度指数、布雷登量表评分）、治疗特征（营养干预、压力管理策略、失禁治疗、药物）、人员比例和其他设施特征，以及结果（研究期间PU的发展）。数据来自医疗记录、最小数据集和其他书面记录（如医嘱、用药日志）。结果：71%的受试者（n=1,081）在12周的研究期间没有发生PU；其余29%的居民（n=443）发展了新的PU。住院、治疗和设施特征与发生I至IV期PU的可能性较大相关，包括较高的初始疾病严重程度、近期PU病史、显著体重减轻、口腔进食问题、使用导尿管和使用定位装置。与发生I至IV期PU可能性降低相关的特征包括新住院患者、营养干预（例如，使用口服医疗营养补充剂和管饲100至21天）、使用抗抑郁药、使用一次性短裤超过14天、每位住院患者每天注册护士工作时间为0.25小时或更长、每位住院患者每天护士助理工作时间为2小时或更长、执业护士流失率低于25%。当I期脓肿被排除在分析之外时，同样的变量是显著的，增加液体顺序与降低发生脓肿的可能性相关。结论：营养干预、液体医嘱、药物治疗和人员配置模式等多种因素与长期护理患者脓毒症的预防有关。需要制定基于研究的PU预防方案，其中包括这些因素和减少风险因素的目标干预措施。
OBJECTIVES: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long-term care residents.DESIGN: Retrospective cohort study with convenience sampling.SETTING: Ninety-five long-term care facilities participating in the National Pressure Ulcer Long-Term Care Study throughout the United States.PARTICIPANTS: A total of 1,524 residents aged 18 and older, with length of stay of 14 days or longer, who did not have an existing PU but were at risk of developing a PU, as defined by a Braden Scale for Predicting Pressure Sore Risk score of 17 or less, on study entry.MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics (e.g., demographics, medical history, severity of illness using the Comprehensive Severity Index, Braden Scale scores, nutritional factors), treatment characteristics (nutritional interventions, pressure management strategies, incontinence treatments, medications), staffing ratios and other facility characteristics, and outcome (PU development during study period). Data were obtained from medical records, Minimum Data Set, and other written records (e.g., physician orders, medication logs).RESULTS: Seventy-one percent of subjects (n=1,081) did not develop a PU during the 12-week study period; the remaining 29% of residents (n=443) developed a new PU. Resident, treatment, and facility characteristics associated with greater likelihood of developing a Stage I to IV PU included higher initial severity of illness, history of recent PU, significant weight loss, oral eating problems, use of catheters, and use of positioning devices. Characteristics associated with decreased likelihood of developing a Stage I to IV PU included new resident, nutritional intervention (e.g., use of oral medical nutritional supplements and tube feeding for >21 days), antidepressant use, use of disposable briefs for more than 14 days, registered nurse hours of 0.25 hours per resident per day or more, nurses' aide hours of 2 hours per resident per day or more, and licensed practical nurse turnover rate of less than 25%. When Stage I PUs were excluded from the analyses, the same variables were significant, with the addition of fluid orders associated with decreased likelihood of developing a PU.CONCLUSION: A broad range of factors, including nutritional interventions, fluid orders, medications, and staffing patterns, are associated with prevention of PUs in long-term care residents. Research-based PU prevention protocols need to be developed that include these factors and target interventions for reducing risk factors.