The Pressure Ulcer Clinical Indicator Data Set

Page content: Background Information | Data set | 1. Hospital-acquired ulcers | 2. Risk assessment | List of data fields

Background Information and Purpose of Collection-Summary

As an internationally acknowledged patient safety problem, pressure ulcers are increasingly recognised as an indicator of the quality of care provided. Pressure ulcers are a largely preventable adverse outcome of a healthcare admission. In the third Pressure Ulcer Point Prevalence Survey (PUPPS3) Victoria’s statewide prevalence was found to be 17.6%.

The Pressure Ulcer Clinical Indicator Data Set has been created to support ongoing surveillance of pressure ulcer occurrence. The data collection is based on recommendations resulting from PUPPS3 and consultation undertaken with health service representatives.

The Pressure Ulcer Clinical Indicator Data Set focuses on two key areas; number and severity of hospital-acquired ulcers and risk assessment of patients. These were chosen to provide the greatest value in a sustainable, relevant and achievable counting strategy.

Data set

The measures are broken into two groups: outcome measures (number and severity of ulcers) and a process measure (risk assessment).

The measures have been selected with the aim of being meaningful, sustainable and relevant while imposing the minimum data collection burden. Both ‘absolute numbers of patients/ulcers’ and ‘improving risk assessment’ were identified as being two of the most important areas for attention.

The definitions of the individual data items are contained in the Pressure Ulcers Clinical Indicators Data Set: Specification of Data Elements (2007-08) (454kb, pdf).

1. Hospital-acquired ulcers:

Outcome measures seek to represent measures of health improvement or deterioration that are attributable to health care. ‘Number of patients with ulcers’ gives a clear indication of the scale of the problem. Use of the ‘number of ulcers’ in each category of ulcer severity provides an ongoing picture of the severity of the pressure ulcer problem.

Indicators

• Number of admitted patients who develop at least one Stage 1 (and 2, 3, 4) pressure ulcer during their episode of care in the reporting quarter (numerator)
• The total number of admitted patients who developed at least one pressure ulcer during their episode of care (numerator)
• Total number of occupied bed days, for overnight and multi-day patients, during the reporting quarter for all admitted episodes of care (denominator)

Classification of pressure ulcer severity is based on the Australian Wound Management Association (AWMA) guidelines.

Stage 1 pressure ulcer

Observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area of the body may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel) and/or sensation (pain, itching).

The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues.

Stage 2

Partial thickness skin loss involving epidermis and/or dermis.  The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.      

Stage 3

Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia.  The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4

Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule).  Undermining and sinus tracts may also be associated with Stage 4 pressure ulcers.

2. Risk assessment

Process indicators represent measures of the delivery of appropriate health care to the relevant population at risk. In this case the population is patients admitted to hospital and the appropriate care is assessing patients for risk of developing a pressure ulcer.

Indicators

• The number of audited patient histories with a documented pressure ulcer risk assessment (numerator).
• Number of patient histories audited=30 (denominator).

Sampling methods (patient record audits) are being used to gather the rates of risk assessments performed. In this case a sample of 30 sequential patient records is to be audited per quarter. This method balances the collection’s value against the burden of data collection. As an indication of current performance the Victorian results show that 66% of patients surveyed in PUPPS3 had a completed risk assessment.

Although measuring the number of completed risk assessments does not address the quality of the risk assessments performed or the linking to care plans, the completion of a risk assessment is the first step in ensuring the other steps do occur. Also it is a pure number that is not subjective or open to interpretation.
All Victorian Health Services are required to submit data for all fields on a quarterly basis. The collection will be reviewed at three years (2010).

The first data is due by 30 April 2008 for the collection period 1 January-31 March 2008. Submission will be via an electronic form that is available at: Pressure Ulcer Clinical Indicator data submission

List of data fields for the ‘Pressure Ulcer Clinical Indicator Data Set’

A comprehensive data dictionary has been prepared and will be available at:

Pressure Ulcers Clinical Indicators Data Set: Specification of Data Elements (2007-08) (454kb, pdf)

Organisation Details

• Health Service (Drop down list)
• Campus / Hospital Name (Drop down list)
• Campus Code (Self generating)

Contact person details

(to enable follow-up or confirmation where required)

• Family Name
• First Name
• Position
• Email Address (a record of the submission will be mailed to this address.)

Reporting Period

• Financial Year (Drop down list)
• Reporting Quarter (Drop down list)

Outcome Measures

• Stage 1 pressure ulcer patients (hospital-acquired)
• Stage 2 pressure ulcer patients (hospital-acquired)
• Stage 3 pressure ulcer patients (hospital-acquired)
• Stage 4 pressure ulcer patients (hospital-acquired)
• Total pressure ulcer patients (hospital-acquired)
• Bed days total (to be entered centrally at DHS)

Process Measure

• Number of risk-assessments documented
• Number of medical records audited (30)

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