Reliability of Pressure Ulcer Staging A Review of Literature and 1 Institution's Strategy
Reliability of Pressure Ulcer Staging A Review of Literature and 1 Institution's Strategy
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DOI：
10.1097/cnq.0b013e31823b1f22
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发表时间：
2012-01-01
影响因子：
1.4
通讯作者：
Gombert, Jan
中科院分区：
文献类型：
--
作者：
Bruce, Tracey A.;Shever, Leah L.;Gombert, Jan
压疮是一个日益严重的医疗保健问题。压疮的准确识别和分类会影响患者的预后、医疗保健成本和质量倡议。确定与回答问题相关的现有证据：“床边护理人员是否准确可靠地按照他们的文件所证明的那样对压疮进行分期？”来自一个大型三级护理中心的进一步证据也被报道为压疮的识别和护士的分期。检索《护理累积索引》和《相关健康文献》和MEDLINE数据库，以确定现有证据证明护士对压疮进行分类的准确性和可靠性。两位评审员独立筛选了结果。共获得54篇全文供审阅，10篇纳入终审。此外，在一个大型三级卫生系统中，通过从1488名患者的就诊和1499名患者的评估的电子健康记录中提取数据，检查了压疮识别和分期的准确性和一致性。对压疮记录进行比较，从1名护士的评估到下一次轮班护士的评估，以及从床边护士的评估到压疮专家的评估。文献回顾显示，压疮识别和分类的可靠性是有限的，并且具有高度的变异性。文献中的一些报告表明，护士很难将压迫性溃疡与其他类型的伤口区分开来。此外，压疮记录中的错误也被发现。对一个大型三级医疗保健系统的进一步数据分析显示，压疮文件并不可靠。
Pressure ulcers are an increasing health care problem. Accurate identification and classification of pressure ulcers impacts patient outcomes, health care costs, and quality initiatives. To identify existing evidence related to answering the question "Does bedside nursing staff accurately and reliably stage pressure ulcers as evidenced in their documentation?" Further evidence from one large tertiary care center with pressure ulcer identification and staging by nurses is also reported. Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases were searched to identify existing evidence on the accuracy and reliability of pressure ulcer classification by nurses. Two reviewers independently screened results. A total of 54 full-text articles were obtained for review and 10 were included for final review. In addition, the accuracy and consistency of pressure ulcer identification and staging were examined at one large tertiary health system by extracting data from electronic health records for 1488 patient visits and assessments for 1499 patients. Comparisons were done for pressure ulcer documentation from 1 nurse's assessment to the following shift nurse's assessment and from the bedside nurse's assessment to assessments done by pressure ulcer experts. Review of the literature revealed that the reliability of pressure ulcer identification and classification is limited and highly variable. Some reports in the literature suggested nurses had difficulty distinguishing a pressure ulcer from other types of wounds. In addition, inaccuracies in pressure ulcer documentation were also identified. Further analysis of data within one large tertiary health care system revealed unreliable pressure ulcer documentation.