Title: Predicting pressure injury risk among a homeless population in the District of Columbia
Williams, A1. BSN, WCC, Estelle, C1. RN-WCCF, Edwards, M1. MSN, RN, Mavin, S1., MS, RN, Evers-Manly, S2. PhD, RN, FAAN
1Howard University Hospital, USA
2All Health Care/Imani’s, USA
Abstract: The cost of treating an acquired pressure injury could be as high as $100,000, if the skin injury progresses to stage 4 and has complications (Leaf Healthcare, 2016). In a 2014 study, Aydin et al. (2014) discovered that hospitals across the US had a monthly Hospital Acquired Pressure Ulcer (HAPU) rate of 2.7% in medical units. Howard University Hospital (HUH) averaged 4.7% HAPUs from June 2017 to December 2017 within the medical and ICU units. Of more concern, chronic wounds affect approximately 8.2 million Medicare recipients annually, more important, the incidence of chronic wounds is anticipated to rise about 2% annually. Yearly, more than 305 million acute, traumatic and burn wounds are recorded and treated globally. As of January 2018, approximately 6,904 individuals and families were experiencing homelessness in the District of Columbia (DHS, 2018). Homeless persons are exposed to harsh conditions as many live outside in extreme cold and hot weather. Consequently, prolonged exposure to the severe environment has a detrimental effect on skin. Predicting skin injury using the Braden Scale alone, (1987), (Scale) in this population was not successful. We reviewed 100 medical records of patients with a hospital acquired skin injury between June -December 2017. Approximately 80% of the pressure injuries from our review were found in chronically ill homeless patients. While these patients scored low risk for developing a skin injury, based on the Scale, they developed a skin injury, leading to longer length of stay in the hospital. We added a subscale including seven variables: activity tolerance, chronic medical condition, homelessness, medications, substance abuse, and history of a previous pressure injury. The new tool classifies risk for acquiring a pressure injury from mild to severe. The higher the number, the greater the risk. Each item was scored between 1 and 4, accompanied by a descriptor. The total accumulated points are as follows: 7-10 mild risk, 11-15 moderate risk, 16-19 high risk, and 20-23 severe risk. From June 2017 to December 2017, there was an average of 4.7 patients a month per 300 admissions to the medical and intensive care units at HUH who acquired a pressure injury. After implementing the HUH tool, we were able to better predict skin injury in the homeless population. Patients, who were at high to severe risk, received a substantial increase in preventive measures which included specialty beds and offloading devices. Adding the variables in the seven sub-scale in conjunction with the Braden tool allowed better prediction of hospital acquired injuries among the homeless population with chronic illness. The number of hospital acquired pressure injuries was reduced form 4.7 patients a month per 300 admissions to one patient a month per 300 admitted patients during January 2018 to June 2018. In addition to using the tool, the wound care team provided real time education on how to use the tool and shared strategies to prevent and reduce the incidence of hospital acquired pressure injuries.
Audience Take Away: The audience will learn build advanced clinical knowledge that leads to long-lasting benefits – for themselves and their patients. The presentation will provide practical knowledge that can be used in the acute care setting to better predict risk of pressure injury among vulnerable populations, prolonged hospitalizations and readmissions.
- Discuss current multidisciplinary care approaches to wound care.
- Discuss components required for accurate wound assessment.
- Select treatment options based upon wound assessment, etiology, and goal of wound care.
- Discuss the legal ramifications of wound care.
Shirley Evers-Manly, PhD, RN, FAAN is the President and Founder of All Health Care Imani’s in Oakland, California. She has 35 years of experience developing and implementing clinical, academic, and community-based health promotion and prevention programs, working with vulnerable populations and speaking about diversity in health care locally and abroad. She has won numerous prestigious awards for her accomplishments and contributions and was awarded Congressional Recognition for Outstanding Community Service by the California State Senate and United States Congress. Dr. Evers-Manly is an internationally recognized expert in oncology and health disparities throughout the life span. She has made significant contributions in advocating to eliminate health disparities and inequities throughout the world. She gives voice to those who feel they have no voice.