主管:国家卫生健康委员会
主办:国家卫生健康委医院管理研究所
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重症监护与非重症监护患者的压力性损伤患病率:全州范围的比较

Fiona Coyer Sandra Miles Sandra Gosley Paul Fulbrook Kirstine Sketcher-Baker Jane-Louise Cook Jacqueline Whitmore   

  1. 昆士兰科技大学护理学院,澳大利亚(Fiona Coyer,Jane-Louise Cook);Metro北卫生服务区Brisbane皇家妇女医院重症监护室,澳大利亚(Fiona Coyer);Metro北卫生服务区查尔斯亲王医院护理和研究实践发展中心,澳大利亚天主教大学助产和医辅护理学院Brisbane校区(Sandra Miles,Paul Fulbrook);Huddersfield大学皮肤完整和感染预防研究所,英国(Fiona Coyer);Brisbane皇家妇女医院RBWH安全和质量单位,澳大利亚(Sandra Gosley);临床护理中心(Jane-Louise Cook);Tasmania 大学健康科学学院,澳大利亚(Paul Fulbrook);Herston昆士兰健康卓越临床部患者安全和质量改善服务,澳大利亚(Kirstine Sketcher-Baker,Jacqueline Whitmore)
  • 出版日期:2017-09-25 发布日期:2017-09-25

Pressure injury prevalence in intensive care versus non-intensive care patients: a state-wide comparison

  • Online:2017-09-25 Published:2017-09-25

摘要: 背景:医院获得性压力性损伤(HAPI)与患病率和病死率的增加有关,被认为在很大程度上是可以预防的。压力性损伤的患病率被视为反映卫生保健质量的一项指标。目的:在全州范围内,比较重症监护室(ICU)患者和非ICU患者的压力性损伤的患病率、严重程度和发生部位。方法:本研究采用二次数据分析设计,从昆士兰州所有拥有Ⅰ-Ⅲ级重症监护室,并参与了2012-2014年昆士兰床旁审计的卫生医院,提取和分析去识别化处理的压力性损伤数据。样本涵盖所有成人ICU患者和非ICU患者,患者均同意参与昆士兰床旁审计。精神卫生单位除外。结果:除压力性损伤Ⅰ期外,2012-2014年间,ICU患者HAPI的总患病率为11%,非ICU患者为3%;住院期间,ICU患者发展为压力性损伤的可能性是非ICU患者的3.8倍(RR的95%可信区间为2.7~5.4)。对所有患者来说,骶骨/尾骨都是HAPI最常见的部位(ICU患者为22%,非ICU患者为35%)。然而,ICU患者黏膜压力性损伤的比例(22%)显著高于非ICU患者(2%)。压力性损伤Ⅱ期是HAPI患病率最高的阶段,ICU患者为53%,非ICU患者为63%。

Abstract: Background: Hospital-acquired pressure injury is associated with increased morbidity and mortality and considered to be largely preventable. Pressure injury prevalence is regarded as a marker of health care quality. Objective: To compare the state-wide prevalence, severity and location of pressure injuries of intensive care unit patients compared to patients in non-intensive care wards. Methods: The study employed a secondary data analysis design to extract and analyse de-identified pressure injury data from all Queensland Health hospitals with level I-III intensive care facilities that participated in Queensland Bedside Audits between 2012-2014. The sample included all adult ICU and non-ICU patients that provided consent for the Queensland Bedside Audits, excluding those in mental health units. Results: Excluding Stage I, overall hospital-acquired pressure injury prevalence from 2012 to 2014 was 11% for intensive care patients and 3% for non-intensive care patients. Intensive care patients were 3.8 times more likely (RR 2.7-5.4, 95% CI) than non-intensive care patients to develop a pressure injury whilst in hospital. The sacrum/coccyx was the most common site of hospital-acquired pressure injury in all patients (intensive care patients 22%; non-intensive care patients 35%) however, mucosal pressure injury proportion was significantly higher in intensive care patients (22%) than in non-intensive care patients (2%). Stage II HAPI prevalence was the most common stage reported, 53% for intensive care patients compared to 63% for non-intensive care patients. Conclusion: There are significant differences in hospital-acquired pressure injury prevalence by stage and location between intensive care and non-intensive care patients reflecting the possible impact of critical illness on the development of skin injury. This has implications for resource funding for pressure injury prevention and the imposition of government initiated financial penalties for hospital-acquired pressure injury. For future comparisons to be effective between intensive care units, benchmarking partners should share similar characteristics and relevant targets.