Looking for the Unavoidable Pressure Ulcer: urban vs. rural

Looking for the unavoidable Deep Tissue Injury: Urban vs Rural

Purpose: To compare the Deep Tissue Injuries from a large urban community system-based hospital to a small rural free-standing hospital.  As Pressure Ulcer prevention programs become more robust and electronic documentation becomes more available, the question of avoidable vs. unavoidable becomes approachable.

Methods:

A robust pressure ulcer prevention program was foundational to explore nosocomial ulcers.  WOCN nursing developed prevention programs in each respective hospital.  Each hospital monitored its nosocomial PrU and identified DTIs.  Because DTI literature remains sparse, simple data collection seemed feasible.  Through WOCN collaboration two hospitals agreed to compare findings from January through July 2012.

 Results:

14 urban and 12 rural Deep Tissue injuries were identified, during this seven month time span. Some of the results were expected and some were quite surprising.  

 The urban average admitting Braden score was 13.5, while the rural was 12.9. Urban average age was 70, while rural was 81 years with all patients. The urban DTI discovery happened on the 11^th day after admission vs. Rural at 7.9 days Urban DTI injuries were divided into 8 heels and 5 buttocks/sacrum/ coccyx and the lateral side of a foot; while rural had 5 heels and 7 sacrum. The average low diastolic blood pressure in the urban patient was 43 and the rural 39.5 mmHg.

The most surprising results were the urban and rural DTIs that developed in the ICU happened on the buttock/sacrum/coccyx and these patients expired; 4/5 urban on the average of 13 days and 3/7 of rural expired on average of 2 days. Non ICU rural and urban heel DTIs survived to be discharged.

Conclusion:

Robust prevention, reporting processes, and data tracking are making it possible to begin to separate the avoidable from the unavoidable ulcer.