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Overview

A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated (National Pressure Ulcer Advisory Panel et al, 2014). Pressure ulcers cause considerable harm to patients, hindering functional recovery, frequently causing pain and the development of serious infections. Pressure ulcers have also been associated with an extended length of stay, sepsis, and mortality (IHI, Pressure Ulcers). Accreditation Canada recognizes the importance of effective prevention strategies in the reduction of pressure ulcers and has identified pressure ulcer prevention as a Required Organizational Practices (ROP) (Accreditation Canada).

Implications

Pressure ulcers continue to be a significant health concern as the population ages and the complexity of care increases across all care settings (RNAO, 2011). A literature review done in Canada in 2004 found that the overall prevalence of pressure ulcers across all institutions studied was 26 per cent. Although 50 per cent of these were Stage 1 ulcers, this data is still disturbing (Woodbury & Houghton, 2004). Pressure ulcer incidence rates vary considerably by clinical setting — ranging in the Unites States from 0.4 per cent to 38 per cent in acute care, from 2.2 per cent to 23.9 per cent in long-term care, and from 0 per cent to 17 per cent in home care. It is estimated that pressure ulcer prevalence (the percentage of patients with pressure ulcers at any one point in time) in acute care is 15 per cent, while incidence (the rate at which new cases occur in a population over a given time period) in acute care is seven per cent. It is estimated that 2.5 million patients are treated for pressure ulcers in U.S. acute healthcare facilities each year. The estimated cost of managing a single full thickness pressure ulcer is as high as $70,000, and the total cost for treatment of pressure ulcers in the U.S. is estimated at $11 billion per year (IHI, 2011).

Goal

To reduce the incidence of pressure ulcers.