Una aproximación al impacto del coste económico del tratamiento de las úlceras por presión en España

Algorithm for the differential diagnosis between dependence-related skin injuries and severe life-threatening skin injuries

AIM

To develop a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable).

METHOD

A nominal group technique was used. Six experts with extensive knowledge of these types of injuries were selected for the group. All were nurses with a PhD in wound research and had more than 15 years of experience in wound care. The experts were asked only one question: In your opinion, what are the basic and indispensable aspects to differentiate a dependence-related skin injury (DR-SI) from a severe life-threatening skin injury (SLT-SI)?

RESULTS

The experts identified three basic elements to differentiate DL-SI and SLT-SI (clinical situation, provision of care, and clinical characteristics of the lesions). A diagnostic algorithm was developed to differentiate the two types of skin lesions using the three basic elements identified, a literature review, and what was published in the two articles that define DR-SI and STL-SI.

CONCLUSION

We developed a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). The algorithm also facilitates the identification of the subtypes of these injuries, depending on its location and characteristics.

Design and Development of a Methodology Based on Expert Systems, Applied to the Treatment of Pressure Ulcers

The medical treatment of chronic wounds, pressure ulcers in particular, burdens healthcare systems nowadays with high expenses that result mainly from their monitoring and assessment stages. Decision support systems applied within the 'remote medicine' framework may be of help, not only to the process of monitoring the evolution of chronic wounds under treatment, but also to facilitate the prevention and early detection of potential risk conditions in the affected patients. In this paper, the design and definition of a new decision-support methodology to be applied to the monitoring and assessment stages of the medical treatment process for pressure ulcers is proposed. Built upon the use and development of expert systems, the methodology makes it possible to generate alerts derived from the evolution of a patient's chronic wound, by means of the interpretation and combination of data coming from both an image of the wound, and the considerations of a healthcare professional with expertise in the subject matter. Some positive results are already shown regarding the determination of the ulcer's status in the tests that have been carried out so far. Therefore, it is considered that the proposed methodology might lead to substantial improvements regarding both the treatment's efficiency and cost savings.

[Impact of interventions in the pressure ulcer rate]

OBJECTIVE

To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU).

MATERIAL AND METHODS

A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact.

RESULTS

Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program.

CONCLUSIONS

The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%.

Ongoing nursing training influence on the completion of electronic pressure ulcer records

INTRODUCTION

Pressure ulcer (PU) care in nursing at the Hospital Clínico Universitario de Valladolid (HCUV) in Spain includes basic care and its registration through the electronic GACELA Care tool. To assess and evaluate the nursing intervention in PU evolution, a training programme was carried out to unify criteria on PU assessment, treatment, evaluation and monitoring.

OBJECTIVE

To assess the influence of training on the completion of PU records in the GACELA Care application, and identify the level of satisfaction of the nurses after its use.

MATERIALS AND METHODS

A quasi-experimental prospective study consisting of a specific training programme assessed pre- and post-training was carried out on the records of PU documentation at the HCUV. The PU records included in the study were collected using the electronic nursing healthcare management computer tool GACELA Care and belonged to patients admitted for >48h, excluding venous, arterial and stage I PUs. The pre-training sample consisted of 65 records collected between 1 April and 30 June 2014, and there were 57 post-training records, completed from 1 January to 31 March 2015. The training programme consisted of thirty-minute theoretical and practice training sessions. The study variables were ulcer type, location, stage, length and diameter, perilesional skin, cure type, products used and cure frequency, in addition to the number of actions taken in the records in correlation to the days of hospitalisation. To identify the nurses' opinions, a satisfaction survey about the management platform of ongoing Castilla y León training was administered.

RESULTS

The variations from the pre- to the post-training PU-sample completion rates were the following: from 23% to 40% for PU diameter, from 11% to 38% for PU length and from 57% to 79% for perilesional skin condition records. There was also a significant increase in the number of form updates after the training activity. The nurses' level of satisfaction with the training activity showed a positive outcome, with an average score of 8.84 over 10.

CONCLUSION

The training activity improved PU record completion significantly and was deemed positive by the nurses, mainly for its applicability in clinical practice.