Pressure Ulcer Research Paper

In the United States pressure ulcers affect 3 million adults across the health care setting. Pressure ulcers have a major impact on quality of life, health status, and the cost of health care. The Centers for Medicare and Medicaid Services announced that they will not pay for additional costs due incurred for hospital-acquired pressure ulcers. They consider pressure ulcers acquired after admission to be preventable and will not reimburse hospitals for pressure ulcer treatment, these are considered secondary diagnoses and not their main reason for admission.1 Patients that are non-ambulatory due to physical or medical reasons are at a high risk for developing pressure ulcers with the highest incidence being in the ICU setting because
of the severity of the patients' illness and the patients' lack of mobility.
The research question addressed in this study is, how to prevent hospital-acquired heel pressure ulcers by the use of a pressure relieving device in non-ambulatory patients. In this case, the pressure relieving device used was the Mepilex Border heel dressing.
This paper is a review of an article published in the Journal of Wound Care, Volume 24 Issue 8, November 26, 2014 entitled "Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial", conducted at the Royal Melbourne Hospital, Australia.
The article references the study of one hundred and fifty (150) critically ill and trauma patients admitted to the Emergency Department of the Royal Melbourne Hospital and then later transferred to the Intensive Care Unit (ICU). These patients were fitted with pressure relieving boots to determine the boots effectiveness in preventing hospital-acquired pressure ulcers of the heels. The Border II patients were fitted with Mepilex Border Heel dressing (produced by Mölnlycke Healthcare AB, Göteborg Sweden)
The control group for the Border II trail were one hundred and fifty-two (152) critically ill and trauma patients from a previously conducted trial, which was known as, and here after referred to as, the Border I trial. The patients in the Border I trial control group received standard pressure ulcers prevention care only.
Based on commonly accepted mathematical criteria, the above numbers are adequate to provide an 80% confidence interval in the findings.
These numbers for the study were intentionally chosen to be statistically significant, yet small enough to be adequately monitored.
Patients having severe spinal injuries which prevented them from being repositioned, patients with existing heel pressure ulcers, or under the age of 18 were purposefully excluded from this study. The remaining trauma and critically ill patients admitted to the hospital were the pool from which the study participants were selected.
The data collected for this study includes patient physiological variables, the reason for admission, comorbidities, the patients' length of stay in the emergency department, operating room, and intensive care unit (in hours). Monitoring of patient Braden scores daily and examination of patients heels every 24 hours for the length of the study were conducted by research team members. Inter-rater reliability testing was done on all members of the research team prior to the implementation of this study.
The limitations in this study could be that the control group and the study group came from two (2) separate studies that were conducted at different times. Another limitation to be considered was that this study was only conducted at the Royal Melbourne
Hospital.
During the course of this study, no patients developed a hospital-acquired heel pressure ulcer. By contrast, the control group developed nineteen (19) heel pressure ulcers during the course of their study. Based on the aforementioned results, it was determined that the use of a pressure relieving devices can significantly reduce the numbers of hospital-acquired heel pressure ulcers. Constant monitoring and early intervention are critical to the prevention of hospital-acquired pressure ulcers.
This study indicates that with the correct application by nursing staff of prophylactic pressure relieving devices could significantly lower the incidence of hospital-acquired pressure ulcers.
While this study is significant, further studies with multiple facilities need to be conducted to authenticate the findings.