12/21/2023 0 Comments Rule 34 hapu9 The Braden scale is able to demonstrate at least 70% sensitivity and specificity for identifying inpatients at risk of pressure ulcers. A lower total Braden scale score indicates a higher risk of developing pressure ulcers. The Braden scale is a generic pressure ulcer risk assessment tool that consists of six subscales that evaluate a patient's sensory perception, activity level, mobility, and nutrition status and the skin's exposure to moisture, friction, and shear forces. The pressure ulcer risk assessment is usually conducted on the day before surgery or postoperatively, depending on the type of admission, that is, elective or emergency operation. Currently, we use the Braden scale to assess pressure ulcer risk for both medical and surgical patients. An estimated 47 000 surgeries are performed annually in SGH across the different surgical disciplines, including orthopaedics, urology, hepatobiliary, and surgical oncology. Singapore General Hospital (SGH) is one of the oldest and largest acute care hospitals in Singapore. 7 Notably, patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with the home. The prevalence of HAPU among surgical patients is about 8.5% or higher depending on the type and the duration of the surgery. Preventing HAPU involves accurate and ongoing risk assessments so that preventive measures can be implemented as early as possible and carried out throughout the period of immobility. It is well recognised that HAPU is avoidable. 5 Similarly, in Singapore, patients with HAPU had higher hospitalisation costs and lengths of hospitalisation. 3, 4 In the United States, patients with hospital-acquired pressure ulcers (HAPU) had a longer length of stay, higher total hospitalisation costs, and greater odds of readmissions compared with patients with no HAPU. 1, 2 It is well-recognised that pressure ulcers are a significant cause of morbidity and lead to a lower quality of life for both patients and their carers. Surgical patients are at a higher risk of developing pressure ulcers because of many factors such as a prolonged period of immobility, surgical/anaesthesia-related factors, and pre-existing medical conditions. SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval : 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. A total of 80 HAPU cases and 189 controls were analysed. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. Therefore, a better prediction tool is needed to predict risk using preoperative data. Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU).
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