An Evaluation of Pressure Ulcer Risk Variables

Pressure ulcers are a significant and costly health care problem. The key to preventing pressure ulcers is early identification of patients at risk and implementation of appropriate interventions. The Department of Defense has implemented managed care program, an approach for delivering quality health care within a cost-containment environment. An earlier prevalence study at the facility where this study will be conducted identified a pressure ulcer prevalence rate almost twice the national average. In today's economic situation, it is imperative that a method of assessing pressure ulcer risk be devised to provide efficacious and cost-effective quality patient care to military beneficiaries.

The specific aims of this study are to: 1) evaluate the Braden Scale's accuracy in predicting the development of pressure sores in acute care patients, and 2) identify specific variables most highly correlated with the development of pressure ulcers. The study's aims will be investigated under the rubric of Braden's Conceptual Schema. The study is a prospective correlational descriptive design. For this study, the dependent variable is the presence, stage and severity of pressure ulcers. Independent study variables are as follows: Braden Risk Score, albumin, total lymphocyte count, tissue oxygenation, age, length of hospital stay, length of surgical procedure, diastolic blood pressure, smoking, and patient acuity.

A power analysis based on previous studies and adjusted for the facility's prevalence rate determined 300 subjects will be needed. Subjects meeting study criteria will be evaluated for risk for pressure ulcers using the Braden Scale within 24 hours of admission. Demographic and baseline data will be obtained on admission. Using a repeated measures design, subjects will be assessed for pressure ulcer formation. The relationship between the risk of pressure ulcers, quantitative physiological variables, and pressure ulcer formation will be explored using correlational statistics. Understanding the risk factors associated with pressure ulcer development will provide the foundation for the selection of subsequent interventions.

This study has potential for clinical application to assist in the determination of predictive risk factors for pressure ulcer development. Prevention of pressure ulcers is cost effective compared to the price of treating them. It is essential that patients at high risk for pressure ulcers be appropriately identified so judicial decision making can be utilized for prevention therapies such as support surfaces. The long term goal is to be able to recommend variables for the development of a more specific risk assessment tool for the prediction of pressure ulcers in the acute care population.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013104...