A Continuous Bedside Pressure Mapping System for Prevention of Pressure Ulcer Development in the Medical ICU: A Retrospective Analysis
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Index: WOUNDS. 2013;25(12):333-339.
Abstract: Objective. Patient repositioning to offload high-pressure areas is an essential component of pressure ulcer prevention for bed-bound patients. In most settings, the quantity and quality of offloading and repositioning are difficult to measure. Real-time continuous bedside pressure mapping (CBPM) offers an opportunity to do so. Material and Methods. Data was collected on 627 patients being treated in a medical intensive care unit (MICU): 307 patients placed on beds with a CBPM system and 320 historical controls placed on the same beds without the CBPM system 1 year prior to the study participants. A pressure ulcer prevention bundle was enhanced by the addition of a CBPM system that provides real-time digital imaging of the patient on the support surface to National Pressure Ulcer Advisory Panel guidelines. Results. During the 2-month study period, 1 (0.3%) patient in the CBPM cohort developed a pressure ulcer compared with 16 (5%) patients in the historical cohort (P = 0.001). In a survey of the MICU care providers, 90% of respondents reported that the CBPM contributed to improved pressure detection and relief, 88% indicated the CBPM assisted them with repositioning protocols, and 84% reported the pressure map provided for more efficient and effective patient repositioning. Conclusion. Real-time, ongoing pressure measurement using a pressure-sensing mat may be a useful tool to help care providers effectively reposition patients within the context of existing standardized protocols for the prevention and minimization of pressure ulcers.
Key words: pressure ulcer, decubitus ulcer, prevention, pressure mapping
The International Pressure Ulcer Prevalence Survey has estimated the prevalence of hospital-acquired pressure ulcers at 5% annually.1 In that survey, hospital-acquired pressure ulcer prevalence was highest in adult intensive care units (ICUs), ranging from 9.2% in cardiac ICUs to 12.1% in medical ICUs (MICUs). It is estimated that pressure ulcer care accounts for $2.41 billion in excess health care costs in the United States.2 The additional care required for pressure ulcers and associated complications (such as infection) also contributes to increased length of hospital stay and mortality.3,4
Preventing the development of pressures ulcers in health care settings has become increasingly important. Research and innovation presently focuses on pressure ulcer pathophysiology and factors contributing to their development. Furthermore, as of October 2008, acute care hospitals in the United States have financial incentives to prevent hospital-acquired pressure ulcers. The Center for Medicare and Medicaid Services (CMS) no longer reimburses hospitals at a higher rate for the care of hospital-acquired stage III and stage IV pressure ulcers billed as a secondary diagnosis.5,6 Numerous evidence-based guidelines and protocols exist for pressure ulcer intervention.7 Today, most hospital facilities assess pressure ulcer risk within 24 hours of a patient’s admission (followed by periodic reassessments) to determine individualized care plans for patients at risk for developing a pressure ulcer.