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Abstract
Patients with a hip fracture often have a poor nutritional status that is associated
with increased risk of complications, morbidity and mortality. The aim of this study
was to investigate the effects of an improved care intervention in relation to nutritional
status and pressure ulcers. An intervention of best practices for patients with hip
fracture was introduced, using the available resources effectively and efficiently
with a not too complicated or expensive intervention.
A quasi-experimental study of 478 patients consecutively included between April 1,
2003 and March 31, 2004. A new evidence-based clinical pathway was introduced on October
1, 2003. The results from the first 210 patients in the control group and the last
210 patients in the intervention group are presented in this article.
The total number of patients with a hospital-acquired pressure ulcer was in the intervention
group, 19 patients, and in the control group, 39 patients (p = 0.007). No patient
younger than 65 years developed a pressure ulcer. There were no statistical significant
differences between the groups with respect to blood biochemical variables at inclusion.
Patients in the control group had higher arm muscle circumference (AMC) (p = 0.05),
calf circumference (CC) (p = 0.038) and body mass index (BMI) (p = 0.043) values.
Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) <10th percentile and
AMC <10th percentile were found in 12 patients in the control group and in 4 patients
in the intervention group. None of the 4 patients in the intervention group developed
pressure ulcers. However, 2 of the 12 patients in the control group were affected.
It is possible to reduce the development of hospital-acquired pressure ulcers among
elderly patients with a hip fracture even though they have poor prefracture nutritional
status. Results in this study indicate the value of the new clinical pathway, as number
of patients who have developed pressure ulcers during their stay in hospital has been
reduced by 50%.