Table 3.
Receipt of skin health elements by setting and PrU Risk (N=206)
| SH Elements | Total N=206 | Outpatient N=62 | Inpatient N=144 | P-Value | Low Risk of PrU N=73 |
High Risk of PrU N=133 |
P-Value |
|---|---|---|---|---|---|---|---|
| Overall completeness, percent received, mean (sd) | 75.5 (11.7) | 64.3 (9.3) | 80.3 (9.0) | <0.001 | 73.2 (12.8) | 76.8 (10.9) | 0.03 |
| Individual elements | N (%) | N (%) | N (%) | N (%) | N (%) | ||
| Medical: wound related | |||||||
| Documentation of skin integrity1 | 206 (100) | 62 (100) | 144 (100) | - | 73 (100) | 133 (100) | 0.13 |
| Documentation of treatment plan for pressure ulcer | 67 (100) | 16 (100) | 51 (100) | 0.61 | - | 67 (100) | - |
| Consult to wound care specialist# | 64 (98.5) | 13 (100) | 51 (98.1) | 0.61 | - | 64 (98.5) | - |
| Documentation of pressure ulcer measurements | 67 (91.8) | 16 (88.9) | 51 (92.7) | 0.61 | - | 67 (91.8) | - |
| Consult to plastic surgeon2 | 21 (67.7) | 1 (33.3) | 20 (71.4) | 0.18 | - | 21 (67.7) | - |
| Consult to podiatrist3 | 3 (60.0) | 1 (50.0) | 2 (66.7) | 0.71 | - | 3 (60.0) | - |
| Educated on skin breakdown procedures | 4 (2.1) | 2 (3.4) | 2 (1.5) | 0.39 | 1 (1.4) | 3 (2.4) | 0.64 |
| Equipment | |||||||
| Wheelchair evaluation | 158 (82.7) | 44 (80.0) | 114 (83.8) | 0.53 | 52 (78.8) | 106 (84.8) | 0.30 |
| Transfer equipment assessed | 145 (78.8) | 49 (92.5) | 96 (73.3) | 0.004 | 55 (82.1) | 90 (76.9) | 0.41 |
| Bathroom equipment assessed | 133 (70.0) | 39 (68.4) | 94 (70.7) | 0.76 | 44 (64.7) | 89 (73.0) | 0.23 |
| Wheelchair cushion evaluation | 112 (57.1) | 23 (41.1) | 89 (63.6) | 0.004 | 32 (47.1) | 80 (62.5) | 0.04 |
| Pressure mapping evaluation2 | 12 (32.4) | 1 (16.7) | 11 (35.5) | 0.37 | - | 12 (32.4) | - |
| Mattress evaluation | 18 (9.4) | 1 (1.7) | 17 (12.9) | 0.01 | 4 (5.6) | 14 (11.6) | 0.17 |
| Function | |||||||
| Functional assessment | 185 (91.1) | 46 (76.7) | 139 (97.2) | <0.001 | 66 (90.4) | 119 (91.5) | 0.79 |
| Assess ability to safely transfer | 171 (85.9) | 44 (75.9) | 127 (90.1) | 0.009 | 61 (87.1) | 110 (85.3) | 0.72 |
| Counseled on PrU reliefs | 150 (73.5) | 16 (26.7) | 134 (93.1) | <0.001 | 49 (68.1) | 101 (76.5) | 0.19 |
| Counseled on weight shifts | 136 (66.0) | 11 (17.7) | 125 (86.8) | <0.001 | 40 (54.8) | 96 (72.2) | 0.01 |
| Counseled on turning | 132 (64.4) | 6 (9.8) | 126 (87.5) | <0.001 | 40 (55.6) | 92 (69.2) | 0.05 |
| Psychosocial | |||||||
| Cognitive assessment* | 203 (99.0) | 61 (98.4) | 142 (99.3) | 0.54 | 72 (100) | 131 (98.5) | 0.30 |
| Support system assessed | 203 (98.5) | 60 (96.8) | 143 (99.3) | 0.16 | 71 (97.3) | 132 (99.2) | 0.26 |
| Screened for substance abuse (smoking, alcohol or drug use) | 192 (94.1) | 56 (90.3) | 136 (95.8) | 0.13 | 64 (90.1) | 128 (96.2) | 0.08 |
| Psychosocial assessment | 171 (89.1) | 39 (75.0) | 132 (94.3) | <0.001 | 61 (89.7) | 110 (88.7) | 0.83 |
| Support system addressed | 21 (87.5) | 5 (100) | 16 (84.2) | 0.34 | 5 (83.3) | 16 (88.9) | 0.72 |
| Social/vocational assessment | 151 (74.4) | 26 (41.9) | 125 (88.7) | <0.001 | 50 (71.4) | 101 (75.9) | 0.48 |
| Medical: non-wound related | |||||||
| Medication reconciliation* | 198 (99.5) | 61 (100) | 137 (99.3) | 0.51 | 71 (100) | 127 (99.2) | 0.46 |
| Co-morbid conditions reviewed* | 205 (99.5) | 61 (98.4) | 144 (100) | 0.13 | 72 (98.6) | 133 (100) | 0.18 |
| Screened for bowel incontinence | 203 (98.5) | 60 (96.8) | 143 (99.3) | 0.16 | 73 (100) | 130 (97.7) | 0.20 |
| Screened for bladder incontinence | 201 (98.0) | 59 (95.2) | 142 (99.3) | 0.05 | 73 (100) | 128 (97.0) | 0.13 |
| Nutritional intervention | 80 (95.2) | 19 (90.5) | 61 (96.8) | 0.24 | 20 (100) | 60 (93.8) | 0.25 |
| Nutritional consult | 186 (94.4) | 49 (87.5) | 137 (97.2) | 0.008 | 69 (98.6) | 117 (92.1) | 0.06 |
| Supplies reviewed and renewed1 | 115 (60.5) | 23 (37.7) | 92 (71.3) | <0.001 | 44 (62.9) | 71 (59.2) | 0.62 |
| Screen sweating/ moisture issues | 8 (3.9) | 3 (4.8) | 5 (3.5) | 0.64 | 3 (4.1) | 5 (3.8) | 0.90 |
1 Routinely addressed for all inpatients, regardless of reason for admission.
2 Eligibility for these SH elements excluded those with stage I/II wounds.
3 Eligibility for this SH element was limited to those with foot ulcers.
* Refers to items that are included on an inpatient nursing template that are done for all inpatients, not just those receiving annual evaluations.
# Limited to those patients with existing stage III/IV PrUs. Patients with stage I/II PrUs would not be routinely seen by a wound care nurse or plastic surgeon.
Bolded items remain significant after Bonferroni correction applied.