Abstract: Risk Factors Associated with Heel Pressure Ulcers in Hospitalized Patients (45th Annual Conference (June 22-26, 2013 ))

Sunday, June 23, 2013: 1:51 PM

Barbara Delmore, PhD, RN, CWCN, DAPWCA, NYU Langone Medical Center, Nurse Specialist, New York, NY, Sarah Lebovits, RN, MSN, ANP-BC, CWOCN, DAPWCA, NYU Langone Medical Center, Wound and Ostomy Nurse Practitioner, New York, NY, Barbara Suggs, BSN, RN, NYU Langone Medical Center, Senior Nurse Clinician; Adjunct Instructor, New York, NY, Linda Rolnitzky, MS, New York University School of Medicine, Division of Biostatistics, Research Scientist, New, NY, Philip Baldock, RN, NYU Langone Medical Center, Nursing Quality Specialist, New York, NY and Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN, The John A. Hartford Institute for Geriatric Nursing, New York University College of Nursing, Senior Advisor, New York, NY

Purpose: Heel pressure ulcers (HPUs) are increasing at an alarming rate. The purpose of this research is to develop and validate a method of predicting whether a patient admitted to a hospital is at high risk of developing a HPU during their stay.

Methodology: This two-phase project uses retrospective case-control data with cases (patients who developed HPU) and controls (patients who did not) selected at the ratio of 1:2, respectively. Research and literature review revealed 13 factors that appear to influence HPU development: Diabetes, Vascular , Neuropathy, Braden Scale score 18 or less, 70 years or greater, immobility, perfusion issues, obesity, cachexia, surgery 3 or more hours, ICU stay >3 days, ventilator >3 days, and activity status.

Phase 1 data was collected on 150 patients with HPUs and 300 without. To validate the method in Phase 2, data was collected on 102 patients, 34 with HPUs and 68 without HPUs.

Statistics: Chi-square analysis was used to study the association of each variable with HPUs. Univariate analyses identified patient characteristics and hospital conditions significantly associated with HPUs. These variables were used in a multiple logistic regression modeling to develop a score to identify high-risk patients. ROC curves are currently being used to select the cutpoint for this score with the best overall sensitivity and specificity.

Results: Chi-square analysis in Phase I showed that Vascular disease (OR=4.421, 95% CI, 2.573-7.595, X²=.000), Diabetes (OR=2.557, 95% CI, 1.652-3.958, X²=.000), immobility (OR=16.491, 95% CI, 8.821-30.828, X²=.000), and Braden Scale score (18 or less) (OR=9.5, 95% CI, 5.3,17.2) have a strong influence on HPU development. Phase 2 (validation) analysis is currently being conducted and is demonstrating consistency with Phase I findings.

Conclusion: Targeting certain hospitalized populations who are deemed more at-risk for HPUs, will allow implementation of appropriate prevention measures.

1303 Risk Factors Associated with Heel Pressure Ulcers in Hospitalized Patients