-Abstract-
Background : A pressure sore was defined as any skin lesion caused by unrelieved
pressure and resulting in damage to underlying tissue. The health care institutions in
the United States were reported the incident rate of pressure sores ranging from 6 to
14%. Intensive Care Unit needed highest quality of care has been found over 40%
incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores
in patients in the United States have been estimated to be $7.5 billion; furthermore, 50
percent more nursing time is required to care for patients with pressure sore in
comparison to the time needed to implement preventive measures against pressure sore
formation. However, In Korea, there were little reliable reports, or researches, about
incidence rates of pressure sore in health care institution including intensive care unit
and about the integrated approach like CQI action team for risk assessment, prevention
and treatment of pressure ulcers. Therefore, this study was to develop pressure sore
risk assessment tool and the protocol for prevention of pressure sore formation through
CQI action team activities, to monitor incident rate of pressure sore and the length of
sore formation for patients at high risk, and to approximately estimate nursing time for
sore dressing during research period as the effect of CQI action team.
Method : CQI action team in intensive care unit, launched since early 1996, reviewed
the literature for the standardized risk assessment tool, developed the pressure sore
assessment tool based on the Braden Scale, tested its validity, compared on statistics
including incidence rate of pressure sore for patients at high risk. Throughout these
activities, CQI action team was developed the protocol, called as St. Marys hospital
Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment
to wound prevention. After applied the protocol to patients at high risk, the incident rate
and the period of prevention against pressure development were tested with those for
patients who received care before implementation of protocol by Chi-square and
Kaplan-Meier Method of Survival Analysis.
Result : The CQI action team found that there was significant difference of incidence
rate of pressure sores between patients at high risk (control group) who received care
before implementation of protocol (p<.05). 25% possibility of pressure sore formation
was shown for the patients with 6th hospital day in ICU in control group. In
experimental group, the patients with 10th hospital day had 10% possibility of pressure
sore. Therefore, there was significant difference(p<.05) in survival rate between two
groups. Also, nursing time for dressing on pressure sore in experimental group was
decreased as much as 50% of it in control group.
Conclusion : The collaborative team effort led to reduced incidence, increased the
length of prevention against pressure sore, and declined nursing care times for sore
dressing. However, there have had several suggestions for future study. The preventive
care system for pressure sore should be applied to patients at moderate, or low risk
throughout continuous CQI team activities based on Bad Sore Indicator Fact Sheet.
Hospital-wide supports, such as incentives, would be offered to participants for keeping,
strong commitment to CQI team. Also, Quality Information System monitoring incidents
and estimating cost of poor quality, like workload(full time equivalence) or financial loss,
regularly in a hospital-wide QI implementation. Being several limitations, this study
would be one of the report cards for the CQI team activities in intensive care unit of an
acute hospital and a trial of quality improvement of health care in Korea.
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