title: Pressure ulcer preventive device use among elderly patients early in the hospital stay.
abstract: BACKGROUND
  Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies.
  
  
  OBJECTIVE
  The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record.
  
  
  METHODS
  This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction.
  
  
  RESULTS
  Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score < or =14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination.
  
  
  CONCLUSIONS
  Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD 21201, USA.
authors.forename: Shayna E
authors.initials: SE
authors.lastname: Rich
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.forename: David
authors.initials: D
authors.lastname: Margolis
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001513:Beds / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004282:Documentation; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009737:Nursing Records; D009989:Orthotic Devices / Q000706:statistics & numerical data*; D015143:Philadelphia; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors