The Unavoidable Pressure Ulcer: A Retrospective Case Series

This article was published in Journal of Clinical Outcomes Management 2009 Aug;16(8):359-363 

To identify medical conditions related to pressure ulcer occurrence when at-risk status is appropriately assessed and preventive measures are in place we did a retrospectice chart review in an acute care hospital. Charts were reviewed for past medical history, activities of daily living, comorbid illness, and physiologic parameters at the time of ulcer discovery.   20 patients met the inclusion criteria.  Average age was 69.2 years and 80% were male.  All pressure ulcers were discovered at an early stage. 100% had hypoalbuminemia, 75% had respiratory failure with endotracheal intubation, 70% had anemia, 70% were hypoxic, and 65% were hypotensive at the time of ulcer discovery. Of the patients who were hypotensive, nearly all (92.3%) were on pressor agents. 55% had either infection or sepsis, 50% had malignancy, 50% had diabetes mellitus, and 40% had either acute or chronic renal failure or both. 30% had a clinical diagnosis of congestive heart failure. 30% had undergone a major operative procedure prior to ulcer discovery.

Conclusion: Pressure ulcers remain an important indicator of quality; however, there is a subset of patients where skin breakdown is unavoidable with current prevention technologies. 

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Dr. Jeffrey M. Levine has authored numerous articles on topics related to healthcare of the elderly. These include medical history, prevention and treatment of chronic wounds such as pressure ulcers, elder neglect and abuse, and physical restraints. He has also edited a book on legal and regulatory aspects of nursing homes.