Why do I need to do a Prevalence/Incidence study?
The facility needs to establish a baseline or benchmark prior to making any changes in protocols for prevention and treatment of pressure ulcers (or any condition the facility is trying to manage). The best way to monitor and evaluate the effectiveness of newly implemented protocols is to perform another prevalence/incidence study a year after the
protocols were established to see if there is a change in the number and stage of the ulcers.
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What am I assessing?
Pressure ulcers stage I - IV and intact skin. When assessing the prevalence of pressure ulcers, the bony prominence and other areas that receive pressures are assessed.
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Is there a charge to participate in this study?
No. However, there is the facility personnel and time to collect the data.
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What is Prevalence?
Prevalence is the representation of the number of patients within a given facility that have pressure ulcers at a specific point in time (usually 24 hours). Prevalence - using the day’s census, skin assess all patients.
P= number of patients with ulcers
Number of patients (assessed) in the sample x 100
The census is the number of patients that need to be assessed; however, the actual number assessed may differ. Patients can refuse to participate, be out of the room or not be available during the study time period. Those patients not assessed should be subtracted from the total. Census - patients not assessed = number of patients (assessed) in sample. This applies to prevalence and incidence.
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What is Incidence?
Incidence is the percentage of patients that did not have pressure ulcers in the prevalence study but developed one or more during the time Period between the prevalence and incidence study. The number of patients that were intact on the day of the Prevalence Study.
I = number of patients with ulcers (new ulcers)
Number of patients (assessed) in the sample X 100
(Patients still in the facility, that were intact during the prevalence study)
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Is there another way to determine Incidence?
Some researchers check the chart during the Prevalence study, and any ulcer not documented on admission is considered Incidence. This assumes the documentation in the facility is flawless. This method will tell you if there is a problem with documentation.
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What units in the facility are to be included?
In order to maintain standardization for this study, only units with similar lengths of stay are included. These units should include Medical, Surgical and ICU units. For this study, units such as OB, Nursery or Rehab will not be included in the aggregate results because their lengths of stay vary and would skew the study results.
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How do I choose the Prevalence date?
Choose a day to assess all patients in the above units within a 24-hour period. Note: If you are participating in a larger “national” study, then you will have to choose a date within a specified time period. Please contact your KCI Representative if you are unsure about this.
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How do I calculate the Incidence date?
Once you have determined the length of stay for the medical, surgical and critical care units as described above, you will then add that number to the date of the Prevalence Study. That will give you your date for Incidence. Example: 4 days LOS, Prevalence Study February 1st, Incidence Study February 5th.
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How is this study different from other Prevalence studies?
This study will include “Incidence” – your second observation of patients who developed nosocomial pressure ulcers (facility acquired ulcers).
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Who can be on the data collection teams?
Skin assessment is part of standard nursing care; however, if you plan to have anyone other than facility personnel assist, it is advised that they be placed as temporary staff for the day, a patient consent form be signed by each patient or check with the risk manager/legal advisor about patient privacy, confidentiality and liability. This is a learning experience for the facility. The study can identify CQI/CQP issues such as charting, assessment, equipment use, faulty equipment, adherence to protocols and knowledge deficits. Facility staff should do the actual assessments. This ensures the accuracy of the information. If the numbers are questioned, the staff member that collected the data can verify the collected information.
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Will I receive any educational tools from KCI?
Yes. Education is available at http://www.kci1.com/969.asp.
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How do I know the data collectors are reliable?
Prior to the study, the data collectors should view the online education provided on staging pressure ulcers, or a qualified instructor may teach staging. The participants should be tested to determine if they can adequately stage pressure ulcers.
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How many data collectors will I need?
Normally each team of two can see about 25-40 patients in an eight-hour period. More time will be necessary for the higher acuity patients. Be sure to assign specific areas accordingly.
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How do I let the staff know about the study and ensure their cooperation?
Memos with the date, time and what the teams will be doing and what they won’t be doing (assessing patients, removing dressings, but not replacing them, and not cleaning incontinent patients) should be sent out to the staff, physicians, administration, physical therapy and anyone involved with patient care prior to the study date. Posters, newsletters and staff meetings are also good ways to reinforce the information about the study.
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How long does the study take?
This is a “Point Prevalence and Incidence Study”, each study day should be completed within 24 hours.
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What is the role of the “Study Director”?
The Study Director acts as the study director and is responsible for coordinating the education and study teams. They are responsible for checking the forms for accuracy before sending them into KCI for processing.
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I’ve completed the study and verified the forms. Where do I send them?
Make copies of the forms. Send the originals to KCI via trackable service (Fed Ex, UPS, Airborne) attn: P & I Study, 8023 Vantage Dr, San Antonio, TX 78230.
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Will I get a report for my facility?
Yes. Each facility will receive a report analyzing the data collected for the specific facility as well as an aggregate report for all facilities participating in the study.
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How do I compare last year’s study to this year’s?
Your KCI Representative is available to help you interpret your data; however, here are some basic guidelines. First of all, compare the overall numbers i.e. Prevalence and Incidence. Then look at the report for the field “ Skin Breakdown on Admission?.” This field is intended to give you information on the number of pressure ulcer that were or were not noted on the nursing admission assessment or note. Have these numbers increased or decreased? Then ask yourself why, you know your environment better than anyone. Has there been a change in the patient population? Then you can look at more specific information: If the stage I’s and II’s increase, the staff may be more aware and are finding the ulcers earlier due to the education. Have the III’s and IV’s increased or decreased?
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Who do I contact for help?
KCI Corporate at Phone: 1-800-275-4524 Robin Briones (ext 56332) or Deb Wight (56380)
Or you can call your KCI Representative.
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When filling out forms, should I fill out forms for all patients on the units?
No. Although you will assess all patients, only complete forms for patients with ulcers.
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How do I interpret the data?
How do I compare this study to next year? If the stage I’s and II’s increase, ask yourself why. The staff may be more aware now and are finding the ulcers. Has there been a change in the population? Did you use a validated risk assessment tool or validate the tool you used? Have the III’s and IV’s decreased? If you buy therapeutic mattresses for your beds, the study should be done prior to their use and then a year after they are put into use. This will allow you to assess the effectiveness of the mattresses. If your studies were not done the same way, they cannot be compared in most cases.
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What patients in the facility are to be included?
Adult Patients in the Medical, Surgical and Critical Care units of the facility are considered to be “at risk” for this study.
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How do I determine Length of Stay?
Length of stay (LOS): The average number of days a patient stays in a particular unit. For this study, the units included are the adult medical, surgical and critical care units in the facility. The Incidence study date is calculated by using the length of stay number. In order to ensure the accuracy of data collected on Incidence study day, it is imperative that the length of stay be correct.
Note: Extended care units are not included in this study. However, if data is collected in these units, the results will be reported separately.
Example: Medical Unit LOS = 4 days, Surgical Unit LOS = 5 days. The calculated length of stay for this study would be 4 days.
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