Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Disparities in Glycemic Control Among Hispanic Adults With Diabetes

Background/Aims: Poor glycemic control is associated with increased morbidity and mortality for adults with diabetes mellitus (DM). Little research has examined disparities in glycemic control among Hispanics with DM compared to whites. The objective of this work was to determine: 1) whether disparities in glycemic control exist among Hispanics versus whites; and 2) whether demographics, socioeconomic status, disease characteristics, health care utilization (primary care, specialty care, care management services) and treatment characteristics (oral hypoglycemic medications, insulin use) explain differences in glycemic control. Methods: Using an observational study design, we studied 29,825 adults on the Kaiser Permanente Northwest DM registry as of January 1, 2013, with a valid HbA1c test during calendar year 2013. Good glycemic control was defined as HbA1c 30 (vs. body mass index \u3c 30), Charlson comorbidity score (continuous), primary care utilization in 2013 (1+ visits vs. none), specialty care utilization (1+ visits vs. none), use of DM care management services (1+ services vs. none), use of oral hypoglycemic medications (1+ medications fills vs. none) and insulin use (any insulin use vs. none). Seven logistic models were constructed: model 1 (race/ethnicity), model 2 (model 1 + demographics), model 3 (model 2 + SES), model 4 (model 3 + disease characteristics), model 5 (model 4 + health care utilization) and model 6 (model 5 + treatment characteristics). Results: Hispanics were less likely to have good glycemic control in unadjusted models (odds ratio: 0.56, 95% confidence interval [CI]: 0.51–0.61; P\u3c0.0001). This point estimate remained consisted across all logistic models examined, even after adjusting for covariate measures (odds ratio: 0.69, 95% CI: 0.62–0.77; P\u3c0.0001). Discussion: Our findings suggest that disparities in glycemic control among Hispanics compared to whites remain even after adjusting for critical covariate measures. More work is needed to understand whether lifestyle choices and other factors explain differences and whether targeted interventions can reduce these disparities

Design and Implementation of a Clinician-Focused Intervention to Improve Diagnosis and Management of Symptomatic Vulvovaginal Atrophy in a Large Health System

Background/Aims: Nearly 50% of postmenopausal women experience symptoms related to vulvovaginal atrophy (VVA). However, despite the availability of effective treatment options, studies show that few women seek treatment for, and few providers ask women about, these symptoms. Our paired abstract describes clinician-reported barriers to diagnosis and management. Here we describe the prevalence of VVA diagnoses among women seen for well care within Kaiser Permanente Northwest (KPNW). We also describe the design of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA. Methods: Using electronic medical record (EMR) data, we identified well visits among women 55 years or older occurring within 17 KPNW primary care and OB/GYN clinics between June 2013 and May 2014. We computed the proportion of women who received a VVA-related diagnosis at the index visit. We then stratified the clinics based on visit volume and randomized them to an immediate versus delayed clinician-focused intervention. The intervention includes online and in-person education for clinicians regarding: 1) diagnosis and management of symptomatic VVA, and 2) new EMR-based clinical support tools (Smartsets and Smarttexts). Results: We identified 14,274 unique well visits over the 1-year period of time. Of these, 80.5% (11,500/14,274) occurred in primary care. Only 5.7% (769/13,544) of visits by women not already using vaginal estrogen contained a VVA-related diagnosis. There are 371 clinicians; education for those in the intervention clinics is ongoing (Fall 2014). After the education period, we’ll prospectively collect EMR data to compare groups on the following outcomes: 1) proportion of well visits with VVA diagnoses; 2) proportion of women receiving vaginal estrogen prescriptions; and 3) proportion of visits that used the clinical support tools. We will also conduct an online survey of patients to determine if women in the intervention clinics are more likely than those in the control clinics to discuss VVA symptoms with their providers and to receive education and treatment options if symptomatic. Discussion: The proportion of postmenopausal women with a VVA-related diagnosis was lower than expected. The purpose of our ongoing study is to evaluate whether active outreach to providers with education and clinical support tools leads to improved diagnosis and management of VVA

Design and Implementation of a Clinician-Focused Intervention to Improve Diagnosis and Management of Symptomatic Vulvovaginal Atrophy: Clinician-Reported Barriers

Background/Aims: Nearly 50% of postmenopausal women experience symptoms related to vulvovaginal atrophy (VVA) including vulvovaginal dryness and irritation, painful intercourse, dysuria, urinary urgency and incontinence, and recurrent urinary tract infection. Effective treatment options are available, however few women seek treatment for these symptoms and few providers ask women if they are symptomatic. As part of the development of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA among Kaiser Permanente Northwest patients, we conducted a survey of primary care and OB/GYN clinicians to assess provider knowledge about VVA and barriers to its diagnosis and treatment. Methods: We sent an email invitation to take a short online survey to all 353 Kaiser Permanente Northwest primary care and OB/GYN clinicians with valid email addresses. The survey included VVA knowledge questions related to symptoms, diagnosis and treatment, and practice assessment questions. We asked clinicians to report all potential barriers to VVA diagnosis and treatment in their practice. A list of potential barriers and an open-ended response option were provided. Results: The response rate was 34% (120/353). Knowledge about VVA was good; 67% (641/953) of responses were correct. Only 39.5% (47/119) of clinicians were likely to assess VVA in a postmenopausal patient if she did not mention symptoms. Most clinicians rated their confidence in counseling their patients as medium or less regarding menopause-related vaginal discomfort (56.1%; 67/118) and the risks/benefits of vaginal estrogen therapy (58%; 69/119). Commonly reported barriers were lack of time during the visit (75.4%; 86/114), lack of patient education materials (45.6%; 52/114) and clinical tools (18.4%; 21/114), patient discomfort with discussing vulvovaginal concerns (41.2%; 47/114), warnings about risks of estrogen medication in elderly women (36.8%; 42/114), and the clinicians’ lack of knowledge about VVA (32.5%; 37/114). Discussion: Provider knowledge about VVA symptoms and treatment is generally good. Barriers to patient care such as time, lack of clinical support tools, and patient-provider discomfort with discussion of VVA may explain why this easily treated condition is frequently underdiagnosed and undertreated. Our second abstract describes the intervention phase of our study, which includes the design and implementation of a clinician-focused intervention to improve diagnosis and management of symptomatic VVA

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat