A Study Of Acute Pressure Ulcer Assessment On Tumor Patients With Surgery

ObjectiveThe objectives of this study are to explore the risk factors of acute pressure ulcer after surgery. To construct the evaluation system of acute pressure ulcer by using the Delphi methods and establish the RAS of cancer patients. Meanwhile, this study also planed to compare the predictive value of this new scale with Waterlow’s scale, then provide evidence for the measurements of preventing acute pressure ulcer.MethodThe present study consists of two sections.In the first section, we reviewed related literatures and summarized the risk factors reported in the previous studies. Then, we used the Delphi method to establish the dimensions and items of acute pressure ulcer appraisal scale. This process involved20experts specializing in operation room nursing management, nursing quality management, and ICU nusing quality management, etc. Experts distributing in Hongkong, Tianjin and Beijing were consulted through emails or letters. After first round of consultation, comments on this scale were exposed to each expert anonymously. Finally, agreement was achieved on each item through a second round of consultation. The reliability and representativeness were examined by four indexes: the experts’coefficient, the concentration of expert opinion, the positive coefficient of experts and the consistency of expert opinion.In the second section of this study, we collected290patients data from a major hospital related to both the new scale and Waterlow scale from January2012to December2013. During the preoperative visit, two trained registered nurses independently evaluated each patient under the natural light. Meanwhile, the new scale and Waterlow scale were scored respectively. The incidence of pressure ulcer was recorded immediately after operation. Two additional nurses imput data into SPSS19.0. The sensitivity and specificity of these two scales were tested through Logistic regression for binary data and ROC under curve area.Result1The results deriving from literature reviews showed that the risk factors of pressure ulcer includes exogenous factors:operative position, local pressure, moisture of skin, surgery and anesthesia, hemodynamic change; and endogenous factors:age, weight, temperature and nutritious situation etc.2After the first round of consultant from experts, we got19responses from20experts, the response rate is95%. During the second round consultation,19experts were involved and the response rate is100%. The mean coefficient of experts is0.79, medium value is0.80. After the first round consultation, the minimum value of importance is2.58, maximum value is4.74, and mean is3.87. For the second round of this values are3.21,4.74,4.74respectively.The expert harmony coefficient is0.419for the first round consultation and0.495for the second round consultation. The variable coefficients for the two round consultation are0.25,0.24respectively.3For the new scale for risk assessment of acute pressure ulcer after surgery, four dimensions involving15items were established by the present study:general condition, nutritional status, disease condition and operative factors.4Of290participants,68cases presented different stages of pressure ulcer. Based on the study data, the incidence rate of pressure ulcer related to surgery is23.3%.56cases exhibited stage Ⅰ pressure ulcer with the manifestation of red spot in the apophysis site of the body which comprises82.4%of all the cases with pressure ulcer.5Four variables come into the logistic regression equation:operative position, alteration of operative position, moisture of skin and the hypotension during surgery. The Receiver operating characteristic (ROC) showed a larger Area under Curve (AUC) in new scale (AUC=0.701) than in Waterlow scale(AUC=0.615). A score of18was indentified as the critical value of predicting the incidence of acute pressure ulcer after surgery by using the new scale.Conclusion1Lots of factors could result in acute pressure ulcer related to surgery. Through the review of literature, Delphi methods and factor correlation analysis, the present study established an scale for evaluating the risks of acute pressure ulcer related to surgery.15high risk variables were included in this scale:age, preoperative mobility, types of skin, BMI, prealbumin, diabetes, peripheral vascular diseases, anemia, duration of surgery, operative position, bleeding volume, intra operative hypotension, moisture of skin, externally applied forces and alteration of operative position.2The results of Delphi methods showed a higher expert coefficient, consistency of opinion and positive attitude of participation which also means a high attention of experts to this issue.3The result also supported the new scale has a better prediction of pressure ulcer than Waterlow’s scale. The implement of this new scale is also simple and convenient. By using this new scale for the assessment of high risk of pressure ulcer, clinicians could find the risk factors of patients then formulate optimal measures to prevent and reduce the occurrence of pressure ulcer.4The prevention and care of pressure ulcer has been the difficulties and hot issues in the nursing field. It has been agreed both home and abroad that risk assessment scale is the hinge measures of prevention and monitoring the incident of pressure ulcer. Various scales are applied in the assessment of pressure ulcer with different limitations and ranges of application. Our study developed a new scale to assess the risk of postoperative pressure ulcer and also calculated the therehold of18points. The using of this new scale could assess the risk of pressure ulcer more scientifically, accurately and rationally. It may reduce or avoid the occurrence of operative pressure ulcer thus protect the patients. It’s also the focal part of operative room nursing care.