MANAGEMENT of A Protocol for the PREVENTION of Pressure Ulcers IN A Private HOSPITAL SÃo Paulo – Brazil

Introduction: Pressure Ulcer (PU) is an adverse event, justifying its management by specific protocol^(1-3). Our Goal is to describe the impact of restructuring of a protocol for management of PU.Method: Descriptive study conducted from Jan/2008 to Jan/2010 in a hospital in São Paulo City, encompassing all adult patients. In Sep/2008 the protocol was reviewed, emphasizing prevention, in Jan/2009 new revision and nutritional adjustments. The PU index ([(events number / patients-day number)*1,000]) was monitored from a control chart. The patient risk classification was made by the Braden scale and events severity by the NPUAP - National Pressure Ulcer Advisory Panel Scale. Results: For the restructuring of the protocol was considered the recommendations of the MEDLINE database and consensus NPUAP and EPUAP – European Pressure Ulcer  Advisory Panel (especially the nutritional recommendations); actions involving preventive, therapeutic and recommended staff training. The average rate in 2008 was 3.25 to 3.76  in 2009 and 4.20 in 2010  PU/1.000 patient-days. The prevalence of patients at high risk was 7.2% in 2008 and  5.4% in 2009 to 9.3% in 2010 (72% increase). Of the 412 new cases of PU recorded during the study period, 96% (n=395) were incontinent and of these, 75% had IAD (incontinence associated dermatitis) n=296 pacientes. The prevalence of more severe events  (stage III and IV PU) in 2008 decreased 24.7%, 16.5% in 2009 and 6.8% in 2010. Conclusion: The protocol with emphasis on prevention, combined with correct training and guidance to patients at risk, has helped reduce the occurrence of PU, bringing practical benefits to care.