Pressure ulcer prevalence and incidence rates are highest in those receiving palliative/ hospice care, spinal cord injuries, critical care and in long term care. Recent research suggests that pressure ulcer incidence in acute care hospitals may have a different etiology than those pressure ulcers that occur at home or in long term care. It is important to distinguish pressure ulcers that are present on admission from those pressure ulcers that have been hospital acquired (HAPU/I). A plethora of research is available on HAPU/I, however, scant research has investigated the community acquired pressure ulcer/injuries (CAPU/I) and the impact of CAPU/I on acute care hospitals.
Methods:
The setting for this study was a 620 bed academic medical center on the west coast of the United States. The sources used for data collection were the electronic medical record (EMR), the incident reporting system (IR), and the quarterly surveys (CALNOC, NDNQI).
We established a process in the EMR, to have a best practice alert (BPA) added to the EMR admission process in order to identify patients who were admitted with pressure ulcers. Once the nurse clicks on yes, they then have a drop down staging photo to match to the patient pressure ulcer.
We collected the data for all patients in the hospital quarterly survey. While nurses were visually assessing each patient at the bedside for the NDNQI survey, the EMR collected the data points on every patient to define whether a pressure ulcer was a HAPU/I or a CAPU/I, age of the patient and length of stay.
A pressure ulcer registry was created from the EMR and the IR system in order to measure and compare the HAPU/I (not included in this study) to the CAPU/I. We measured CAPU/I: length of stay, origin of admission (home, SNF), ED visits, stage of pressure ulcer /injury, and the number of encounters per quarter.
Results:
The reported pressure ulcers “present on admission” was 35-60 pressure ulcers/week in the EMR.
The CAPU/I point prevalence ranged from 3.9% to 7.9% over 3 years of data collection at the quarterly survey.
The IR system had 70-90 reports for CAPU/I per month reported. The patients who arrived from a skilled nursing facility had fewer hospital encounters (114 ED visits and admissions) than those patients who arrived from home (298 ED visits and admissions) within the two quarters measured.
Conclusion:
The measurement of the prevalence and incidence of HAPU/I and CAPU/I enables organizations to monitor patient outcomes for comparison over time and between institutions. Using the EMR and the IR system to create a pressure ulcer registry for data collection along with the quarterly surveys (NDNQI, CalNOC surveys) enhances the validity and reliability of the measurement of HAPU/I and CAPU/I.