Pressure Ulcer Prevention in Elderly Nursing Home Residents

Introduction:  Elderly nursing home (NH) residents are at risk for pressure ulcers (PUs). Therefore, PU prevention interventions (PUPIs) are important but little is known about PU prevention in NH residents.

 Purpose: To describe the PUPIs ordered for older people admitted to NHs

 Methods:  The study had a descriptive design. Most PUPIs in NHs require a practitioner (physician and nurse practitioner) order (POs). More than 2 million POs for 42,893 older (65+ years) people admitted to NHs, free of a PU and incontinence, three-years (2000-2002) were reviewed and coded for evidence of PUPIs using electronic and manual text-search methods.  POs were reviewed at admission until a PU was identified in the “perineal” body area (sacrum, hips and other body areas exposed to incontinence), a resident’s POs ended or the study period ended.  Residents were in one of 446 proprietary NHs in 27 states.  PUPIs were defined using a literature review, national guidelines, and consultation with certified WOC nurses. Analyses included frequencies, percentages, means(sds) and chi-square tests.

 Results: 10% (4,319/42,893) of NH residents received PUPIs and were 70% female, aged 81(7) years (mean(sd). The most common PUPIs ordered were skin assessment (31% (1,341/4,319 residents), nutritional supplementation with vitamins (14%) or calorie enhancers (4%), applying a skin protectant (12%), off- loading by turning/repositioning in bed (6%), air mattresses, or (2%) foam mattresses (2%), and incontinence behavioral interventions (4%). PU risk assessment occurred in only 0.5% residents. PUPIs were initiated after incontinence developed in 93% of residents receiving them. More residents receiving PUPIs developed a perineal PU (8%) than were expected (5%, p<.01).

 Conclusions: PU prevention orders generally followed recommended interventions but were uncommon in NH residents and usually instituted after incontinence developed.  Results support the need for PU risk assessment, earlier institution of PU prevention, and/or better incontinence management.