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Introduction: Hospital acquired pressure ulcers continue to pose a significant health problem in the US, affecting up to 3 million adults in acute care facilities at a cost of up to $11 billion annually. Surgical patients are at elevated risk for pressure ulcer development due to a combination of physiological, non-physiological, and surgical/anesthesia related factors.
Identification of the problem: The Braden Score (BrS) is well accepted as a predictor of pressure ulcer risk; however, the preoperative BrS may not accurately reflect postoperative risk. The Scott TriggersTM (ST) scale shows great potential as a preoperative predictor of postoperative pressure ulcer (PPU) risk, but has not been tested for predictive capacity.
Methodology: A retrospective, exploratory research design using electronic medical record abstraction was used. A purposive convenience sample of medical records of all adult patients (> 18 years of age) undergoing any in-patient surgical procedure over a 1 year period was included.
Results: Data from 15,500 charts were abstracted. ST and first postoperative BrS were significantly correlated (r=-0.48, p<.01). Three of the 4 ST factors (age, ASA score, surgery duration) were predictive of a change in BrS from preoperative to postoperative assessment (p < 0.01 for each). Preoperative albumin level was not evaluated due to a lack of data. Results also showed increased pressure ulcer risk (p<0.01) with any surgery.
Conclusion: Three of the ST triggers are predictive of PPU risk.
Implications for future research: Further research as to the interaction of other perioperative factors to PPU risk is indicated. Implementation of a simple, preoperative PPU risk assessment tool with strong predictive metrics will enable peri-anesthesia nurses to work proactively in implementing preventative interventions to reduce PPU risk in the surgical population. Such interventions should contribute to reduced healthcare costs and significantly improved patient outcomes.