Report on the prevalence of skin ulcers in a home health agency population

Advances in Wound Care,  Nov/Dec 1999  by Meehan, Marge,  O'Hara, Lucy,  Morrison, Yolanda M

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The assessment of ulcer origin indicated that a total of 35% (n = 878) of all ulcers found were nosohusial and reported to have occurred after admission to the HHA, The remaining 65% (n = 1648) of ulcers were charted as being present on admission to the HHA. The most frequent sites for nosohusial ulcers were the buttocks (44%; 195 of 443 ulcers documented for the site). The sacral nosohusial ulcers represented 36% of ulcers documented for the site (173/476).

A variety of interventions were used to manage all stages of pressure ulcers (Table 4). Evaluation of the use of therapeutic support surfaces revealed that a total of 28% of patients with skin breakdown (n = 402) were on some form of pressure-reducing device. Of the 126 patients on specialty beds-including air fluidized, low-air loss, and lateral rotation-73% (n = 93) had full-thickness Stage III or Stage IV ulcers.

All home care patients included in the pressure ulcer prevalence survey were evaluated for level of risk for skin breakdown using the Braden Scale. The Braden Scale score ranges used for reporting this analysis were based on the findings of Ramundo in a study evaluating the reliability and validity of the Braden Scale in the home setting.9 Scores between 6 and 12 were defined as high risk; scores of 13 to 14 were moderate risk; scores of 15 to 16 were low risk; scores of 17 to 18 were considered a possible risk for pressure ulcers; and scores between 19 and 24 were considered not at risk. The overwhelming number of individuals evaluated-15,161 (70%)-were found not to be at risk for pressure ulcers, with Braden Scale scores between 19 and 23. Of those patients, 3% (n = 462) were found to have ulcers. Of the remaining patients, 12% (n = 2503) scored in the low-to moderate-risk range (risk scores between 13 and 16), and 2% (n = 419) presented with ulcers. A total of 13% (n = 2738) of patients scored in the possible pressure ulcer risk range (scores between 17 and 18), and 9% (n = 222) of this group presented with skin breakdown. Patients assessed to be within the high-risk range (5%, n = 1127) included 352 (31 %) with pressure ulcers (Figure 1).

Among patients with pressure ulcers, 38% (n = 563) were found to be incontinent of both urine and stool, 20% (n = 296) were incontinent of urine only, 3% (n = 43) were fecally incontinent only, and 39% (n = 563) were fully continent. Responses regarding diagnosis were received on 1324 (91%) of the 1455 patients found to have pressure ulcers. The primary reason for admission of those patients to the participating HHAs was, not surprisingly, pressure ulcers. Diabetes mellitus was recorded as a coexisting condition in 278 (9.6%) of the 2904 coexisting conditions listed on individuals found to have skin breakdown (Figure 2).

Among patients for whom the information was recorded (1450), 30% (n = 437) of those with ulcers had their spouse/partner as their primary caregiver. Responses were received from 95% (n = 1376) of the pressure ulcer population regarding age of the identified caregiver population: 62% (n = 859) were over age 50.