title: Never say never: a descriptive study of hospital-acquired pressure ulcers in a hospital setting.
abstract: OBJECTIVE
  The purposes of this study were to describe the characteristics of patients who experienced hospital-acquired pressure ulcers (HAPUs); explore risk factors with these patients, including comorbid conditions; and describe risk-reduction measures in patients who developed HAPUs.
  
  
  METHODS
  Eighty-two patients with at least 1 HAPU were identified at an urban Midwestern trauma center over 1 year.
  
  
  METHODS
  A prospective study was conducted that included chart review and patient assessment.
  
  
  METHODS
  Assessment criteria for the data collection form were obtained from the literature. The novel instrument was designed to capture intrinsic conditions, for example, medical diagnoses; extrinsic conditions, such as microclimate factors; and organ failure. Characteristics of all patients with at least 1 HAPU were collected by a certified wound care nurse. Data were analyzed using descriptive statistics.
  
  
  RESULTS
  Most patients who developed HAPUs were ill enough to require extended hospital stays and discharged to extended care facilities. All patients with HAPUs had multiple risk factors, categorized as intrinsic, extrinsic, or organ failures, yet nearly one-quarter were identified by current standards as "low-risk." Many of the measured variables are well-established risk factors, but several were comorbid diagnoses that are not assessed on the Braden Scale for Pressure Sore Risk. Eighty percent of subjects had 6 or more risk factors associated with an increased risk for PU development (mean = 9.2). Two-thirds of the sample group experienced failure of at least 1 organ system. Data on the use of 5 preventive interventions was tallied. A vast majority of patients (84.1%) were using 4 or 5 (mean = 4.3, SD = 1.0) of the interventions prior to the occurrence of the HAPU.
  
  
  CONCLUSIONS
  Current risk assessment methods do not assess organ failures and the effect of multiple comorbid associated with HAPU occurrence. Current risk prevention methods may not be sufficient to prevent HAPUs in all patients.
authors.affiliation: Mount Sinai Hospital, Chicago, Illinois 60608, USA. Karen.Bry@sinai.org
authors.forename: Karen E
authors.initials: KE
authors.lastname: Bry
authors.forename: Diannalyn
authors.initials: D
authors.lastname: Buescher
authors.forename: Mary
authors.initials: M
authors.lastname: Sandrik
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014193:Trauma Centers; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult