Nancy Sullivan, BA; Karen M. Schoelles, MD, SM
Note: The AHRQ reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the AHRQ before submission of the manuscript.
Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of ECRI Institute, the AHRQ, or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Allison Gross, MS, LIS, for performing the literature searches; Lydia Dharia and Katherine Donahue for preparing the manuscript for publication; and Paul G. Shekelle, MD, PhD, for his review and suggestions on earlier versions of the manuscript.
Financial Support: From the AHRQ, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Ms. Sullivan: None disclosed. Dr. Schoelles: Support for travel to meetings for the study or other purposes (money to institution): RAND Corporation; Other (money to institution): work done by several ECRI staff on Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices for the AHRQ supported by RAND. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2655.
Requests for Single Reprints: Nancy Sullivan, BA, ECRI Institute Evidence-based Practice Center, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Sullivan and Dr. Schoelles: ECRI Institute Evidence-based Practice Center, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Author Contributions: Conception and design: N. Sullivan, K.M. Schoelles.
Analysis and interpretation of the data: N. Sullivan, K.M. Schoelles.
Drafting of the article: N. Sullivan.
Critical revision of the article for important intellectual content: N. Sullivan, K.M. Schoelles.
Final approval of the article: K.M. Schoelles.
Obtaining of funding: K.M. Schoelles.
Administrative, technical, or logistic support: N. Sullivan, K.M. Schoelles.
Collection and assembly of data: N. Sullivan, K.M. Schoelles.
Sullivan N, Schoelles KM. Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:410-416. doi: 10.7326/0003-4819-158-5-201303051-00008
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Published: Ann Intern Med. 2013;158(5_Part_2):410-416.
Complications from hospital-acquired pressure ulcers cause 60 000 deaths and significant morbidity annually in the United States. The objective of this systematic review is to review evidence regarding multicomponent strategies for preventing pressure ulcers and to examine the importance of contextual aspects of programs that aim to reduce facility-acquired pressure ulcers. CINAHL, the Cochrane Library, EMBASE, MEDLINE, and PreMEDLINE were searched for articles published from 2000 to 2012. Studies (any design) that implemented multicomponent initiatives to prevent pressure ulcers in adults in U.S. acute and long-term care settings and that reported pressure ulcer rates at least 6 months after implementation were selected. Two reviewers extracted study data and rated quality of evidence. Findings from 26 implementation studies (moderate strength of evidence) suggested that the integration of several core components improved processes of care and reduced pressure ulcer rates. Key components included the simplification and standardization of pressure ulcer–specific interventions and documentation, involvement of multidisciplinary teams and leadership, use of designated skin champions, ongoing staff education, and sustained audit and feedback.
Appendix Table 1. Components of Pressure Ulcer Prevention Studies in U.S. Hospitals, 2000–2012
Appendix Table 2. Components of Pressure Ulcer Prevention Studies of Long-Term Care, 2000–2012
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