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Category I pressure ulcers: how reliable is clinical assessment?
Sophiahemmet University.
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2011 (English)In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 30, no 3, 194-205 p.Article in journal (Refereed) Published
Abstract [en]

finger-press tests and visual observation alone were not reliable methods to discriminate between blanching and nonblanching erythema. Forty-seven percent of the patients had a risk score 20 or fewer (high risk for pressure ulcers). Forty-four patients (56%) had pressure ulcers at discharge.

Place, publisher, year, edition, pages
2011. Vol. 30, no 3, 194-205 p.
Keyword [en]
Pressure ulcers, Assessment, Hip fractures
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-788DOI: 10.1097/NOR.0b013e318219ae77PubMedID: 21597349OAI: oai:DiVA.org:shh-788DiVA: diva2:434069
Available from: 2011-08-12 Created: 2011-08-12 Last updated: 2014-12-01Bibliographically approved
In thesis
1. Pressure ulcers - role of the nurse to improve patient safety: prevalence, risk factors, classification and documentation in patients undergoing hip surgery
Open this publication in new window or tab >>Pressure ulcers - role of the nurse to improve patient safety: prevalence, risk factors, classification and documentation in patients undergoing hip surgery
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Pressure ulcer is a common complication in hip fracture surgery and convalescence. Earlier prevalence studies have demonstrated a lower prevalence in Southern Europe than in Northern Europe. In patients with hip fractures, specific risk factors for developing pressure ulcers, apart from those included in standardised risk assessment are not fully understood. Correct classification of Category I pressure ulcers is a prerequisite for planning preventive measures. It is also mandatory for the reliability of prevalence studies. Until now subjective tests such as finger-press test and visual assessment have been utilised in clinical practice. An objective method has hitherto been lacking. Planning and delivering good nursing care to patients who are at risk of, or already have, manifest pressure ulcers should be built on proper documentation. Degree of documentation of pressure ulcer prevalence and risk factors in patients with hip fractures versus elective hip replacement surgery has hitherto not been investigated. Scrutiny of medical records for these diagnoses and identification of potential differences should therefore be of interest.Aim: - To investigate prevalence and incidence of pressure ulcers upon arrival and at discharge from hospital, and to identify potential intrinsic and extrinsic risk factors for the development of pressure ulcers in patients admitted for hip fracture surgery. To establish the inter-rater reliability between blanching and non-blanching erythema, assessed by two independent assessors. The secondary purpose was to investigate potential correlations between risk factors and pressure ulcers. - To explore if a non-invasive objective method could differentiate between blanching/nonblanching erythema in the sacral area of patients undergoing hip fracture surgery. - To investigate the degree of documentation regarding risk assessment, preventive measures taken, prevalence and severity of pressure ulcers, in patients undergoing surgery for hip fractures or elective hip replacements at admission and during hospital care at an orthopaedic unit.Results: The prevalence of pressure ulcers in Southern Europe was lower compared to Northern Europe. Specific risk factors such as dehydration (p=.005), moist skin (p=.004), pulmonary disease (p=.006) and diabetes (p=.005) were identified. The finger-press test and visual assessment of Category I pressure ulcers were both unreliable methods with low interrater reliability. The proportion of patients with persistent discoloration differed significantly between the assessors from Day 1 to Day 5 (p = .013). Reflectance spectrophotometer used was proven to deliver high precision regarding classification of non-blanchable erythema (Category I pressure ulcers). Documentation of pressure ulcers, risk assessment, body mass index and prevention at admittance was unsatisfactory in patients undergoing hip surgery.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2012. 91 p.
Keyword
Hip fracture, Pressure ulcers, Classification, Reflectance spectrophotometer, Nursing documentation
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1201 (URN)978-91-7457-690-0 (ISBN)
Public defence
2012-03-30, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Ingång R, Stockholm, 14:00
Opponent
Supervisors
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2016-06-09Bibliographically approved

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CiteExportLink to record
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Citation style
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