Journal_1_2014_final_WEB

Science, Practice and Education
Any patient can develop a PU dependent on its individual
comorbidity, the performed procedures and the intensity
of nursing care. An American analysis on changes in the
percentage of licensed nursing staff in Pennsylvanian hospitals
between 1991 and 1997 led to the conclusion that
almost all complications are seen more often in hospitals
with fewer licensed nursing staff, in particular pressure ulcers
and pneumonia 14 . A Swedish group who examined the
problem of pressure ulcers in intensive care wards reported
that 58 % of nursing staff think lack of time was a significant
factor whenever pressure ulcer risk was not properly
evaluated or aid devices were employed either inadequately
or not at all 15 . For Germany, our analyses indicate that a
low number of full-time employees in nursing homes had
an influence on the incidence of pressure ulcers both as
primary and as secondary diagnosis 16 .
There is no predominant principal diagnosis which is
associated with a relevant number of PUs. Older people
having PU documented as an additional diagnosis in Germany
in 2005 had femur fracture in 6.9 %, heart failure
in 5.4 % and pneumonia in 5.2 % as the most frequent
principal diagnosis 4 . It remains unclear if there is a specific
risk associated with these diseases if it is just a selection of
old and immobile patients. In contrast in those presenting
with PU as the principal diagnosis the classical risk
factors faecal and urinary incontinence seem to have a
relevant impact either on the development of PU or on
the admission to hospital. These patterns of comorbidity
did not change in the period from 2005 to 2011 as we
did not expect it to change 17,18 .
Limitations
Although routine data in the electronic patient record are
frequently used for secondary purposes, there is currently
no systematic analysis of coding quality in Germany 10 .
Whether coding matches reality as a prerequisite for further
use of the data in medicine and health politics has
to be investigated in controlled trials. Thus, we cannot
estimate the rate of wrong coding of the grades or the
localizations of pressure ulcers.
In conclusion, in Germany the rate of cases hospitalized
with the principal diagnosis PU did not increase whereas
the rate of PU documented in hospitalized patients increased
from 2005 to 2011. Thus, PU is still a relevant
problem. This analysis pointed out some specific aspects
in PU localization and comorbidity that show the multidimensional
dimension of the problem.
m
Acknowledgement
We thank Referat VIII A 1 from the Federal Statistical Office
for extracting and providing the data from the DRG-Statistik.
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EWMA Journal 2014 vol 14 no 1