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Vol. 70 2016. Supl. 1 Zagreb Vol. 70 2016. Supl. 1 Zagreb UDC 61 • AMCREF 70 (Supl. 1) 1−116 (2016) ISSN 1330-0164 AMC65-1 korice.indd 1 31.3.2011 15:24:09 ACTA MEDICA CROATICA GLASILO AKADEMIJE MEDICINSKIH ZNANOSTI HRVATSKE Journal of the Academy of Medical Sciences of Croatia, Pra{ka 2/III 10000 Zagreb Croatia Urednica – Editor-in-Chief NASTJA KUČIŠEC-TEPEŠ Tajnik – Editorial Assistant ILIJA KUZMAN Tehnička urednica – Editor DUNJA BERITIĆ-STAHULJAK Urednički odbor – Section Editors Iva Alajbeg, Marko Banić, Nikolina Bašić Jukić, Iva Dekaris, Marko Duvnjak, Josip Djelmiš, Alenka Gagro, Josipa Kern, Petar Kes, Dragutin Košuta, Ratko Matijević, Zvonko Rumboldt, Adriana Vince Predsjednica Uredničkog savjeta – Chief Council JASNA LIPOZENČIĆ Urednički savjet – Editorial Council Mladen BeliczaMladen (Zagreb), Belicza Theodor (Zagreb), Dürrigl Theodor (Zagreb), Dürrigl Vladimir (Zagreb), Goldner Vladimir (Zagreb), Goldner Olga (Zagreb), Jelić (Slavonski Brod), HansTatjana Georg Jeren Fassbender (Zagreb), (Mainz), Vjekoslav Olga Jerolimov Jelić (Slavonski (Zagreb), Brod), Anica Tatjana Jušić Jeren(Zagreb), (Zagreb),Vjekoslav Eduard Klain (Zagreb), Jerolimov Vasilije Nikolić(Zagreb), (Zagreb), Anica M. WilliamJušić (Zagreb), Novick (Memphis),Eduard Klain Vlado (Zagreb), Oberiter Jan (Zagreb), Murker (München), Željko Reiner (Zagreb), Vasilije NikolićDanijel (Zagreb), Rukavina M. (Rijeka),William NovickMelita Valentić-Peruzović(Memphis), Vlado Oberiter (Zagreb), (Zagreb), Pietro Vajro Željko (Napoli), Reiner (Zagreb), DanijelJohn Rukavina Wallwork (Rijeka), (Cambridge), Melita LjiljanaValentić-Peruzović Zergollern-Čupak (Zagreb), (Zagreb), Pietro VajloŽeljko (Napoli), Zupančić John (Zagreb) Wallwork (Cambridge), Ljiljana Zergollern-Čupak (Zagreb), Željko Zupančić (Zagreb) Adresa Uredništva – Address of the Editorial Board ACTA MEDICA CROATICA Akademija medicinskih znanosti Hrvatske Pra{ka 2/III 10000 Zagreb, Hrvatska Tel/fax: +385 1 46 40 586; E-mail: [email protected] Časopis se tiska pet puta godišnje. Naručuje se neposredno od Uredništva. Godišnja pretplata u zemlji iznosi za ustanove 500,00 kn, za pojedince 150,00 kn, a uplaćuje se naIBAN HR5423600001101481831. Pretplata u inozemstvu iznosi protuvrijednost US $ 150.- koju treba uplatiti na račun Privredna banka Zagreb, d.d. No. 70310998200-137182; Akademija medicinskih znanosti Hrvatske, 10 000 Zagreb, Praška 2/III, Hrvatska (za Acta Medica Croatica). The Journal is published five times a year. Orders can be placed directly to our Editorial Office. The annual sub- scription in the country for institutions 500.00 kn, for individuals 150.00 kn to be paid to the account No. 2360000- 1101481831; abroad: the equivalent of US $150.- to be paid to our foreign currency bank account „Privredna banka Zagreb, d.d.“ No. 703109982800-137182; Akademija medicinskih znanosti Hrvatske, 10 000 Zagreb, Praška 2/III, Hrvatska (for Acta Medica Croatica). Lektor – Lector Antonija Redovniković Omotna stranica – Cover design Ivan Picelj Tisak – Printed by GradskaABF tiskara Group, Osijek 10000 d.d., Zagreb, 31000 Croatia Osijek, Croatia TiskaTiska sese uu 500500 primjerakaprimjeraka –− Printed Printed in in 500 500 copies copies Tiskanje časopisa potpomognuto je fi nancijskim sredstvima Ministarstva znanosti, obrazovanja i športa Republike Hrvatske. The printing of the Journal is subsidized by the Ministry of Science, Education and Sports of the Republic of Croatia. AMC65-1 korice.indd 2 31.3.2011 15:24:09 AMC65-1 korice.indd 2 31.3.2011 15:24:09 acta medica croatica Časopis Akademije medicinskih znanosti Hrvatske Acta Med Croatica • Vol. 70 (Supl. 1) • Str. 1-116 • Zagreb, listopad 2016. The Journal of the Academy of Medical Sciences of Croatia IX. SIMPOZIJ S MEĐUNARODNIM SUDJELOVANJEM Dekubitus - što je novo Indexed/abstracted in: Biosis Previews Cancerlit Embase/Excerpta Medica Health Planning and Administration Medline/Index Medicus Toxline EBSCO Acta Med Croatica, 70 (2016) (Supl. 1) 3-10 Leading Article PRESSURE ULCER PREVENTION: FUNDAMENTALS FOR BEST PRACTICE MARK COLLIER Nurse/Consultant – Tissue Viability United Lincolnshire Hospitals NHS Trust c/o Pilgrim Hospital, Boston, Lincolnshire, UK This introduction has highlighted both the complex nature of the aetiology of pressure ulcer development and the complex nature of the assessment process intended to identify those patients who are or might be at an enhanced risk of pressure ulcer development. The latter statement assumes that all patients cared for in any healthcare setting are vulnerable to pressure ulcer development. Whilst it is acknowledged that the use of a risk assessment tool can be important in an overall pressure ulcer prevention strategy, it is important that the limitations of these tools are acknowledged and that they are not an fi nite assessment in themselves and that they should be used by a practitioner with a fundamental breadth of relevant knowledge and an appreciation of the range of appropriate preventative equipment/techniques available and the role of the multi-disciplinary team in the prevention of all avoidable pressure ulcers. KEY WORDS: pressure ulcer, prevention, best practice ADDRESS FOR CORRESPONDENCE: Mark Collier United Linkolnshire Hospitals NHS Trust c/o Pilgrim Hospital Sibsey Road Boston, Linkolnshire, PE21 9QS E-mail: [email protected] INTRODUCTION Table 1. In view of an increasingly ageing population and the Prevalence of pressure ulceration by county involved in study (ibid) associated demographic changes throughout Europe, Belgium 21% it could be argued that the need for all clinicians to Italy 8% be both aware of the Aetiology of Pressure Ulceration Portugal 12% and a variety of Prevention Techniques is paramount Sweden 23% for the delivery of evidence based practice by all mem- United Kingdom 22% bers of the multi-disciplinary team - for the benefi t of all of our patients. Th is is in spite of the fact that there Note: A total of 5,947 patients were included in the study across fi ve countries and identifi ed percentages have been rounded to the nearest have been an increased number of articles/copy pages whole fi gure. It is also important to note that this study was a pilot project in journals and other publications that have been de- to test methods for measuring prevalence across healthcare boundaries. dicated to issues relevant to the prevention of pressure ulceration, especially during the past decade. Previous More recently, it has been reported that at least 500,000 prevalence studies undertaken throughout Europe (1) patients a year will develop at least one pressure ulcer indicate that there is still much work to be undertaken whilst in the care of the National Health Service (NHS – and that pressure ulceration is a real problem both for United Kingdom) and that one in twenty patients (5%) patients and the healthcare systems in which those pa- who are admitted to hospital with an acute illness thro- tients are being cared for (table 1). ugh an Accident and Emergency Department will also develop a pressure ulcer. Th is incidence fi gure rises to as much as 99% of patients admitted through Accident and ACTA MEDICA CROATICA 3 M. Collier. Pressure Ulcer prevention: Fundamentals for best practice. Acta Med Croatica, 70 (2016) (Supl. 1) 3-10 Emergency Departments who are acutely ill and who Pressure reduction is the constant reduction in the have been kept within the A&E department for over two amount of external pressure being exerted on a pa- hours prior to transfer to another clinical setting (2). tient’s anatomy whilst at rest, whereas pressure relief is the intermittent lowering of the external pressure being Furthermore the cost of managing a pressure ulcer and exerted on the patient’s anatomy (10). the eff ects on both the patient and healthcare setting can be summarised as follows; • Additional treatment / management costs asso- PRESSURE DEFINED ciated with a patient with one Category 4 Pres- sure Ulcer equals…up to £40,000 (€46,170) (3) Bennett and Lee defi ned pressure as a perpendicular • from £1,214 (€1,402) Category 1 to £14,108 load or force exerted on a unit of area such as the sa- (€16,296) Cat 4 (4) crum (11). Th is gravitational force is also oft en referred to as compression. Th e average pressure exerted on the Additional ‘hidden costs’ that can be incurred by the skin can be calculated using the following formula: healthcare system can be summarised as; • Cost of treatment is 3.6 times more expensive Body weight Pressure = than prevention (5) - think cost eff ectiveness be- Skin contact area fore all of your actions/interventions! • Additional resource burdens for Healthcare or by the use of pressure sensitive equipment (7). setting? Increased staffi ng and treatment costs / extended length of stay / dissatisfaction of pa- In addition to the overall concept of pressure, other di- tients / eff ects on staff morale. ff ering forms of pressure have also been highlighted - • Increased incidence of Wound Infections -> those of shear and friction. Gangrene -> Septicaemia -> Amputation -> Death, resulting in increased pharmacological / Shear: (A stretching force). A mechanical stress that is product and surgical costs, as well as increased parallel to a plane of interest (11). When a high level of mortality and associated litigation costs! shear is present, then the amount of external pressure necessary to produce vascular occlusion is only about Th e eff ects on a patient’s Health Related Quality of Life half the amount when shear is not present (12). When (HRQoL) have been previously summarised as; trying
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