Figure 1. Outcome of pressure injuries acquired during admission, 2003–11. Once each report is verified, the relevant clinical nurse
managers are sent a copy of the completed first review form for pressure ulcers that are acquired during the current admission. Following review and/or comment, these are forwarded to the appropriate directorate nursing director and then the Clinical Governance Unit. The Nursing Research and Evaluation Department generates and distributes weekly review forms to ensure monitoring of progress or deterioration of all verified pressure injuries (i.e.: both those present on admission and those acquired during the current admission) until the injury heals or the patient is discharged. The outcome for each pressure injury is recorded in one of
three main categories — 'healed', 'present on discharge', or 'deceased with'. This level of detail is unique to Western Australia, and, possibly, the whole country. The process provides a data- rich environment that can be explored to help understand the incidence of pressure injuries and the factors that contribute to hospital-acquired injuries. An area that is currently being explored is the number
of patients who either present to hospital with a stage two or higher pressure injury or those that acquire one, and for whom the patient outcome is 'deceased with' [Fig 1]. Preliminary review of this data has led to a questioning of the degree to which pressure injuries are preventable and whether the proportion that may indicate skin failure at the end of life is actually larger than first expected[2]
. Analysis of each case suggest that there are a number of
patients who are not palliative when the pressure injury is reported, but tend to experience a rapid deterioration over a 10-day period, which leads to death that is unrelated to the pressure ulcer. The following questions are pertinent — how likely is it that
skin failure is the first sign of this unexpected outcome? Is it possible to prevent pressure injuries in these patients? Additional contextual information is now being collected at the first review of all hospital-acquired pressure injuries to investigate further exactly which pressure ulcers are potentially preventable.
A preliminary review of this data, collected over a 12-month
period, suggests that at least 50% of the hospital-acquired pressure injuries may actually be considered unavoidable, as the care that has been given to the patient prior to the development of the injury reflects current best practice. This result was higher than expected and exceeded the proportion of patients who deceased with pressure injuries. The Nursing Research department, therefore, intends to continue to collect and explore this type of data as it suggests that despite the numerous resources and articles available at the local and international level, our understanding of pressure injury prevention is still incomplete. Joanne Hardy is Nurse Manager; Sunita McGowan is Nurs- ing Director; Aileen Hulbert is Nurse Manager — all at the Nursing Research and Evaluation department, Fremantle Hospital, Australia
1. Bergstrom N, Braden B, Kemp M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden
Scale.Nurs Research. 1998; 47(5): 261–69
2. Black JM, Edsberg LE, Baharestani MM, Langemo D, NPUAP, et al. Pressure ulcers: avoidable or unavoidable? Results of the NPUAP Consensus Conference.Ostomy Wound Manage. 2011; 57(2): 24–37
STOP Pressure Ulcer Day, 16 November, 2012
Spanish, Portuguese and Italian speaking countries have set aside one day each year to promote pressure ulcer prevention
O
www.woundsinternational.com 11
ver the past few years, several wound and pressure ulcer organisations located in
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