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Short Papers
24
Journal of Tissue Viability 1998 Vol 8 No 2
SHORT PAPERS Pressure Sore Incidence at St George's Healthcare NHS Trust Introduction Pressure sore incidence data has been collected at St George's Healthcare NHS Trust for three years now, using a methodology which has been described previously!. The data is collected for a number of reasons: to fulfil our contractual obligations to our purchasers, to monitor the size of the problem and to identify problem areas for targeting equipment and educational initiatives and to inform whether this targeting is effective.
Results The overall results are given in table 1. There has been an overall reduction in the number of patients suffering from pressure sores although this has not been consistent throughout all specialties. In 1997 reduction in numbers did not result in a lower incidence. This is likely to be a consequence of some wards not submitting audit returns during that year. There has been a reduction in the numbers and incidence in those specialties (general hospital elderly care, neuro-science, cardia-thoracic and intensive therapy) where changes have been instigated in the supply and management of pressure relieving equipment.
Discussion This methodology, while useful for the observation of broad changes, does not allow detailed analysis of change or to determine the causes of this change. Nor does it permit determination of whether small changes are clinically significant or not. Predominantly, this is due to the incidence being calculated as a percentage of all admissions and no allowance being made for variations in numbers of susceptible patients, which makes it virtually impossible to compare between wards/departments and to identify examples of good practice. While the method could be adapted to collect data on risk score of all patients admitted, in a trust of this size (16,000 admissions per annum in the monitored specialties) this would be a very large and costly exercise. The method suggested by Healey2 , while elegant, similarly would be unlikely to succeed without extensive monitoring. The most viable proposal is to include pressure sore risk assessment data as part of the computerised patient admission data base. We will be striving towards that goal this year. KS Gebhardt, CNC Pressure Sore Prevention, St George's Healthcare NHS Trust, London.
Address for Correspondence Surgical and Clinical Support Services, Ground Floor, St James' Wing, St George's Hospital, Blackshaw Road, London SW17 OQT.
References 1
2
St Clair M, Cooper S, Gebhardt KS. A three month study to measure the incidence of pressure sores in patients admitted to acute wards of a large general hospital. Nursing Standard 1995; 9(19): 50-51. Healey F. Using incidence data to improve risk assessment. Journal of Tissue Viability 1996; 6(1): 3-9.
Table 1. Number and (incidence) of patients who acquired pressure sores in hospital. Specialty
1995
1996
Community
57
39
Elderly Care General Hospital
78
66
65
Orthopaedics
113
83
74
General Surgery
77
86
91
Neuroscience
51
35
27
Cardiathoracic
63
72
57
Medical
84
77
53
Intensive Therapy Unit
28
35
21
4
5
2
Elderly Care
Hospital
Gynaecology
Obstetrics
50
2
Paediatrics TOTAL (1)
1997
14
14
555
498
440
(2.0%)
(1 .8%)
(1.8%)
1. excluding obstetrics and paediatrics
Journal of Tissue Viability 1998 Vol 8 No 2
SHORT PAPERS Pressure Sore Incidence at St George's Healthcare NHS Trust Introduction Pressure sore incidence data has been collected at St George's Healthcare NHS Trust for three years now, using a methodology which has been described previously!. The data is collected for a number of reasons: to fulfil our contractual obligations to our purchasers, to monitor the size of the problem and to identify problem areas for targeting equipment and educational initiatives and to inform whether this targeting is effective.
Results The overall results are given in table 1. There has been an overall reduction in the number of patients suffering from pressure sores although this has not been consistent throughout all specialties. In 1997 reduction in numbers did not result in a lower incidence. This is likely to be a consequence of some wards not submitting audit returns during that year. There has been a reduction in the numbers and incidence in those specialties (general hospital elderly care, neuro-science, cardia-thoracic and intensive therapy) where changes have been instigated in the supply and management of pressure relieving equipment.
Discussion This methodology, while useful for the observation of broad changes, does not allow detailed analysis of change or to determine the causes of this change. Nor does it permit determination of whether small changes are clinically significant or not. Predominantly, this is due to the incidence being calculated as a percentage of all admissions and no allowance being made for variations in numbers of susceptible patients, which makes it virtually impossible to compare between wards/departments and to identify examples of good practice. While the method could be adapted to collect data on risk score of all patients admitted, in a trust of this size (16,000 admissions per annum in the monitored specialties) this would be a very large and costly exercise. The method suggested by Healey2 , while elegant, similarly would be unlikely to succeed without extensive monitoring. The most viable proposal is to include pressure sore risk assessment data as part of the computerised patient admission data base. We will be striving towards that goal this year. KS Gebhardt, CNC Pressure Sore Prevention, St George's Healthcare NHS Trust, London.
Address for Correspondence Surgical and Clinical Support Services, Ground Floor, St James' Wing, St George's Hospital, Blackshaw Road, London SW17 OQT.
References 1
2
St Clair M, Cooper S, Gebhardt KS. A three month study to measure the incidence of pressure sores in patients admitted to acute wards of a large general hospital. Nursing Standard 1995; 9(19): 50-51. Healey F. Using incidence data to improve risk assessment. Journal of Tissue Viability 1996; 6(1): 3-9.
Table 1. Number and (incidence) of patients who acquired pressure sores in hospital. Specialty
1995
1996
Community
57
39
Elderly Care General Hospital
78
66
65
Orthopaedics
113
83
74
General Surgery
77
86
91
Neuroscience
51
35
27
Cardiathoracic
63
72
57
Medical
84
77
53
Intensive Therapy Unit
28
35
21
4
5
2
Elderly Care
Hospital
Gynaecology
Obstetrics
50
2
Paediatrics TOTAL (1)
1997
14
14
555
498
440
(2.0%)
(1 .8%)
(1.8%)
1. excluding obstetrics and paediatrics