Background: Pressure Injury (PI) development is a devastating complication with literature reporting prevalence rates of up to 30% amongst palliative care and hospice populations, attracting condemnation from clinical peers and patient family/advocates who equate PI development with poor care. Financial penalties now apply when patients develop a severe Hospital Acquired Pressure Injury. (HAPI) However, the National Pressure Ulcer Advisory Panel (NPUAP) acknowledges that PI development in “terminally ill” individuals is not always avoidable.
Objective: To determine the incidence and prevalence of Pressure Injury (PI) development among Palliative Care Unit (PCU) inpatients and analyse associated risk factors/characteristics, explore the concept of un-avoidable PI and the impact of PIs on survival.
Methods: Setting: 16 bed specialised PCU within 630 bed public tertiary hospital. A retrospective clinical audit and data analysis of all patient admissions (n = 468) with a PI between August 2017 and August 2018.
Results: 66 PIs recorded in 44 patients. The period incidence and prevalence rates calculated were 2.5% and 9.4 % respectively. These results weren’t significant in comparison to the hospital’s incidence of 3% and prevalence rate of 6%. The rate of PIs on admission for this study 6.8% was significantly higher p = 0.02 than the hospitals rate of 3%. A Kapler- Meier Model Analysis found the comparison of survival time for patients with PIs (25.8 days) or without (mean 27.89 days) wasn't significant. Conversely, a trend towards shorter survival time from admission to death was found for patients with severe PIs – 10.44 days (p= 0.272). Biomarkers for haemoglobin (p=0.026) and albumin (p=<0.01) were significantly lower in patients with PIs than standard reference ranges.
Conclusion: In this study, PCU inpatients have comparable rates of PI incidence and prevalence to other hospitalised patients. The incident and prevalence findings were lower than previous study findings for palliative care populations. The survival rate from admission to discharge for palliative care inpatients with or without PIs was comparable. Patients with severe PIs could potentially survive for a shorter period of time than those without. Patients with anaemia, hypoalbuminemia, renal and liver impairment may be more predisposed to PI development.