246346 An analysis of patient level risk factors for healthcare associated pressure ulcer development

Tuesday, November 1, 2011

Caroline Geremakis, MPH , School of Public Health, Saint Louis University, Saint Louis, MO
Angela Recktenwald, MPH , Headquarters, Nurses for Newborns Foundation, St. Louis, MO
Mary Patt Matt, RN, MSN, CIC , Center for Clinical Excellence, BJC Healthcare, Saint Louis, MO
Debbie M. Nihill, RN, MS, CIC , Center for Clinical Excellence, BJC HealthCare, Saint Louis, MO
Keith Woeltje, MD, PhD , Washington University School of Medicine, Saint Louis, MO
Background: In 2009, BJC HealthCare committed to reducing their healthcare associated (HA-PrU) by 75% by 2012. Currently, we utilize standard pressure ulcer risk assessments, skin inspections and prevention efforts as part of quality management for patient care. Despite these efforts, we have not seen a sufficient decrease in our HA-PrU rate. To become better equipped to design and implement effective intervention strategies, we performed a patient level risk factor assessment.

Objective: To assess and identify the patient level HA-PrU risk factors and use this information to develop intervention strategies. Methods: We utilized data from 3 hospitals to conduct a case-control study. We matched cases and controls 3 to 1 by hospital and age within 5 years. We analyzed data using descriptive statistics and binary analysis to identify actionable risk factors for intervention consideration. Regression modeling was also conducted to develop predictive models for pressure ulcers.

Results: Our analysis found several significant risk factors for HA-PrU; BMI <18.5 (OR=4.1, p<0.05), mechanical ventilation (OR=6.4, p<0.001), edema (OR= 8.7, p<0.001), incontinence (OR= 3.9, p<0.001), surgery (OR= 3.89, p<0.001), and no food by mouth for three or more days (NPO) (OR= 5.4, p<0.001), renal insufficiency (OR=2.0, p<0.05), non-pressure ulcer skin lesions (OR=5.4, p<0.01) and at least one episode of low diastolic blood pressure (OR=18.3, p<0.01). Our best predictive model (R2=0.40) included edema, surgery, NPO, BMI and number of low diastolic blood pressure days.

Conclusions: This information, in conjunction with current risk assessments, can be used to better identify patients at increased risk for pressure ulcers and the implementation of aggressive and early intervention. Utilizing this data, BJC HealthCare is examining modification of our current risk assessment processes, as well as evaluating and enhancing the pressure ulcer prevention strategies used in the operating room.

Learning Areas:
Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Identify patient level risk factors for healthcare associated pressure ulcers.

Keywords: Quality Improvement, Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student working in health outcomes reasearch, the abstract is a reflection of the work that was part of my masters practical experience and internship.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.