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A root-cause analysis of hospital-acquired pressure ulcers (HAPUs) at a Midwest level one trauma center revealed 69% of patients who developed HAPUs had surgery during their stay. Staff in the perioperative area indicated that pressure ulcer risk assessment was not routinely performed on patients undergoing surgery. A review of the literature and an IRRB approved chart audit of surgical patients revealed risk factors in those who developed HAPUs: Age 70 or older, Diabetes, Braden Score of 16 or less, prolonged surgical time (>= 50), multiple surgeries during the same admission, and pre-existing pressure ulcer. These factors were incorporated into a perioperative risk assessment tool. Patients with one risk factor were considered at risk for tissue breakdown. A total of 699 surgical in-patients were enrolled in the study. The control group of 350 patients was randomly selected prior to the implimentation of the protocol. The treatment group of 349 surgical patients was screened for pressure ulcer risk using the protocol.
There were statistically significant differences between the control and treatment groups. Treatment group subjects were older (t(590)=7.338, p=< .001), more likely to have diabetes (x2(1)=16.51, p=<= .001) and had longer surgical times, (t(694)=-10.134, p<= .001). Control group subjects had prior surgery (x2(1)=47.217, p<= .001) and lower Braden scores (t(570)=-4.179, p< .001). There were statistically significanly fewer pressure ulcers in the treatment group (1.7%, 6/349) verses the control group (4.3%, 15/350) (x2(1)=3.950, p=.047).
It is estimated that 5% of patients admitted to the acute care setting develop HAPUs with rates increasing to 45% if the patient undergoes surgery.1 Utilization of this tool can aid in implementation of prevention measures prior to, during and after surgery, thereby reducing the incidence of HAPUs in surgical patients.