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Advisor(s)
Abstract(s)
Apesar das úlceras de pressão serem um problema de saúde frequente quer em
institucionalizados, quer em domiciliados, ainda existem poucos dados sistematizados
em Portugal que nos possam dar uma visão da sua dimensão e evolução. Desta
constatação se viu a necessidade de um estudo de prevalência para investigar aspetos
chave na prática corrente da prevenção de úlceras de pressão, nomeadamente através da
análise dos eventuais fatores de risco. Assim, o objetivo específico deste trabalho foi
conhecer a prevalência de úlceras de pressão e condições associadas em hospitais da
região norte de Portugal.
Foi realizado um estudo transversal, onde se colheram dados dos 673 doentes
internados no Hospital Pedro Hispano (401) e no Hospital São João (272), nos dias 1 de
Março e 30 de Agosto de 2011. Foi utilizado um inquérito que inclui a caracterização do
doente (idade e sexo), a Escala de Braden (com a adição de uma pergunta sobre
incontinência), a categoria e a localização da úlcera mais grave, a presença de
equipamento de prevenção na cama e na cadeira, o reposicionamento na cama e na
cadeira, o local onde foi adquirida a úlcera de pressão e a localização anatómica e
categoria de todas as úlceras.
Dos resultados há a salientar que a prevalência encontrada foi de 16,5%, com
27,42% das úlceras de pressão na categoria I, 28,7% na categoria II, 24,9% na categoria
III e 18,9% na categoria IV, principalmente localizadas no sacrum (19,8%), calcâneo
esquerdo (10,7%), calcâneo direito (9,1%) e região occipital (6,2%). Relativamente à
Escala de Braden, 56% apresentam baixo risco e 44% alto risco de desenvolverem
úlceras de pressão. Contudo, 47,4% estão acamados/sentados e 36,4% completamente
imobilizados/muito limitados. É nos serviços de Medicina Interna e Urgência que se
encontram doentes em maior risco com um score médio segundo a Escala de Braden de
aproximadamente 12. Relativamente à prevenção, 55,2% possuíam equipamento na
cama, mas na cadeira só 32,1%; contudo não são reposicionados 82,9% dos doentes na
cama, e na cadeira 85,9%. Por fim, 62,2% das úlceras foi adquirida no domicílio. Não
foi verificada uma diferença relevante entre a prevalência no Inverno (53,2%) e no
Verão (46,8%).
Verifica-se que a situação nos hospitais estudados se mantém sensivelmente
idêntica comparada com outros estudos nacionais, podendo afirmar-se apenas que a
prevalência obtida neste estudo é ligeiramente superior à obtida em 2004, que foi de
11,5%.
Como conclusão poderá afirmar-se que apesar de já muitas instituições terem
implementado o uso de escalas de avaliação de risco, é necessário agir de acordo com os
resultados obtidos e utilizar da melhor forma os recursos existentes. Contudo, não
devemos basear nelas todas as decisões clínicas, pois para cada doente existem fatores
de risco específicos, sendo que alguns podem não estar contemplados nestas escalas.
Despite of being a very common health issue, both in in-patients and in households, pressure ulcers still have very little systematic data in Portugal that could give us a glance on its dimension and evolution. Therefore, we considered relevant a prevalence study to establish key patterns in the current practice of pressure ulcers’ prevention, mainly through the analysis of the possible risk factors. Thus, the specific purpose of this dissertation was to get to know the pressure ulcers’ prevalence and its associated conditions in hospitals of the northern region of Portugal. A horizontal study was performed, in which the data of the 673 in-patients of the Pedro Hispano Hospital (401) and of the São João Hospital (272) were taken, on the 1st of March and on the 30th of August 2011. An enquiry was performed which also included the in-patient profiling (age and gender), the Braden Scale (adding a question on incontinence), the stage and location of the most severe ulcer, the existence of prevention equipment both in bed and in chair, the re-position both in bed and in chair, the location where the pressure ulcers appeared and the anatomic location and stage of all of the ulcers. From the results, we point out that the prevalence was of 16,5%, with 27,42% of the pressure ulcers in grade I; 28,7% in grade II; 24,9% in grade III and 18,9% in grade IV, mainly located on the sacrum (19,8%), left heel (10,7%), right heel (9,1%) and in the occipital region (6,2%). Regarding Braden scale, 56% scored low risk and 44% high risk of getting pressure ulcers. However, 47,4% are in bed/in chair and 36,4% completely immobile/very limited mobility. Both in Internal Medicine and in Urgency services, we found patients in a higher risk with a medium score according to the Braden Scale of approximately 12. Regarding prevention, 55,2% had a pressure redistribution device in bed, but only 32,1% had one in use on the chair. However, 82,9% of the patients are not repositioned in bed and 85,9% on the chair. At last, 62,2% of the pressure ulcers appeared in household. There isn’t a relevant difference between Winter prevalence (53,2%) and Summer prevalence (46,8%). We established that the situation on the studied hospitals is slightly identical to others national studies; we can only point out that the prevalence shown in this dissertation is a little higher to the one we got in 2004 which was of 11,5%. As a conclusion, we can say that despite many institutions already have implemented the use of risk assessment scales, it is necessary to act according to the results shown and use in a better way all existing resources. However, we shall not base on them all of the clinical decisions as there are for each patient specific risk factors and some of them may not be considered in those scales.
Despite of being a very common health issue, both in in-patients and in households, pressure ulcers still have very little systematic data in Portugal that could give us a glance on its dimension and evolution. Therefore, we considered relevant a prevalence study to establish key patterns in the current practice of pressure ulcers’ prevention, mainly through the analysis of the possible risk factors. Thus, the specific purpose of this dissertation was to get to know the pressure ulcers’ prevalence and its associated conditions in hospitals of the northern region of Portugal. A horizontal study was performed, in which the data of the 673 in-patients of the Pedro Hispano Hospital (401) and of the São João Hospital (272) were taken, on the 1st of March and on the 30th of August 2011. An enquiry was performed which also included the in-patient profiling (age and gender), the Braden Scale (adding a question on incontinence), the stage and location of the most severe ulcer, the existence of prevention equipment both in bed and in chair, the re-position both in bed and in chair, the location where the pressure ulcers appeared and the anatomic location and stage of all of the ulcers. From the results, we point out that the prevalence was of 16,5%, with 27,42% of the pressure ulcers in grade I; 28,7% in grade II; 24,9% in grade III and 18,9% in grade IV, mainly located on the sacrum (19,8%), left heel (10,7%), right heel (9,1%) and in the occipital region (6,2%). Regarding Braden scale, 56% scored low risk and 44% high risk of getting pressure ulcers. However, 47,4% are in bed/in chair and 36,4% completely immobile/very limited mobility. Both in Internal Medicine and in Urgency services, we found patients in a higher risk with a medium score according to the Braden Scale of approximately 12. Regarding prevention, 55,2% had a pressure redistribution device in bed, but only 32,1% had one in use on the chair. However, 82,9% of the patients are not repositioned in bed and 85,9% on the chair. At last, 62,2% of the pressure ulcers appeared in household. There isn’t a relevant difference between Winter prevalence (53,2%) and Summer prevalence (46,8%). We established that the situation on the studied hospitals is slightly identical to others national studies; we can only point out that the prevalence shown in this dissertation is a little higher to the one we got in 2004 which was of 11,5%. As a conclusion, we can say that despite many institutions already have implemented the use of risk assessment scales, it is necessary to act according to the results shown and use in a better way all existing resources. However, we shall not base on them all of the clinical decisions as there are for each patient specific risk factors and some of them may not be considered in those scales.
Description
Keywords
Úlcera de pressão Prevalência Fatores de risco Prevenção Pressure ulcer Prevalence Risk assessement Prevention