Fiona Coyer1, Sandra Miles2, Sandra Gosley3, Paul Fulbrook4, Kirstine Sketcher-Baker5, Jane-Louise Cook6, Jacqueline Whitmore7. 1. School of Nursing, Queensland University of Technology, QLD Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Health Service District, QLD Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK. Electronic address: f.coyer@qut.edu.au. 2. Nursing and Research Practice Development Centre, The Prince Charles Hospital, Metro North Health Service District, QLD Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Australian Catholic University, QLD Australia. Electronic address: sandra.miles@acu.edu.au. 3. RBWH Safety and Quality Unit, Royal Brisbane and Women's Hospital, QLD Australia. Electronic address: Sandra.Gosley@health.qld.gov.au. 4. Nursing and Research Practice Development Centre, The Prince Charles Hospital, Metro North Health Service District, QLD Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Australian Catholic University, QLD Australia; School of Health Sciences, University of Tasmania, Australia. Electronic address: paul.fulbrook@acu.edu.au. 5. Patient Safety and Quality Improvement Service, Clinical Excellence Division, Queensland Health, Herston, QLD Australia. Electronic address: Kirstine.Sketcher-Baker@health.qld.gov.au. 6. School of Nursing, Queensland University of Technology, QLD Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, QLD Australia. Electronic address: janelouise.cook@qut.edu.au. 7. Patient Safety and Quality Improvement Service, Clinical Excellence Division, Queensland Health, Herston, QLD Australia. Electronic address: Jacqueline.Whitmore@health.qld.gov.au.
Abstract
BACKGROUND: Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. OBJECTIVE: To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards. METHOD: The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The sample included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units. RESULTS: Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22%; non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients. CONCLUSION: There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets.
BACKGROUND: Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. OBJECTIVE: To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards. METHOD: The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The sample included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units. RESULTS: Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22%; non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients. CONCLUSION: There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets.