The unavoidable pressure ulcer: A retrospective case series

• Objective: To identify medical conditions related to pressure ulcer occurrence when at-risk status is appropriately assessed and preventive measures are in place. • Design: Retrospective chart review. • Setting: Acute care hospital. • Methods: Charts were reviewed for past medical history, activities of daily living, comorbid illness, and physiologic parameters at the time of ulcer discovery. • Results: 20 patients met the inclusion criteria. Average age was 69.2 years and 80% were male. All pressure ulcers were discovered at an early stage. 100% had hypoalbuminemia, 75% had respiratory failure with endotracheal intubation, 70% had anemia, 70% were hypoxic, and 65% were hypotensive at the time of ulcer discovery. Of the patients who were hypotensive, nearly all (92.3%) were on pressor agents. 55% had either infection or sepsis, 50% had malignancy, 50% had diabetes mellitus, and 40% had either acute or chronic renal failure or both. 30% had a clinical diagnosis of congestive heart failure. 30% had undergone a major operative procedure prior to ulcer discovery. • Conclusion: Pressure ulcers remain an important indicator of quality; however, there is a subset of patients where skin breakdown is unavoidable with current prevention technologies.