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482 An Analysis of Patient Level Risk Factors for Healthcare Associated Pressure Ulcer Development

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Caroline Geremakis, MPH , Saint Louis University School of Public Health, Saint Louis, MO
Angela Recktenwald, MPH , BJC Healthcare, St. Louis, MO
Mary Patt Matt, RN, MSN, CIC , BJC Healthcare, St. Louis, MO
Debbie M. Nihill, RN, MS, CIC , BJC HealthCare, Saint Louis, MO
Keith Woeltje, MD, PhD , Washington University School of Medicine, St. Louis, MO
Background: In 2009, BJC HealthCare committed to reducing their 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 understand 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 PrU prevention strategies used in the operating room.