Daniel J. Drake

The association of BMI and Braden total score on the occurrence of pressure ulcers.

PURPOSE: We compared pressure ulcer (PU) prevalence patients with a body mass index (BMI) of 40 or more, and Braden Scale scores of 16 or more to patients with lower BMI. METHODS A cross-sectional study by using existing data was conducted combining patient skin status with BMI. Subjects underwent skin assessment for evidence of skin breakdown by nurses trained in PU assessment. Data from this assessment were combined with historic data gathered from review of medical records and BMI. SUBJECTS AND SETTING: The study was carried out in a tertiary medical center in Eastern North Carolina. Three hundred sixty-two patients were included in the prevalence study. RESULTS: Fourteen percent of all patients had at least 1 PU. The prevalence among patients with a BMI of less than 40 was 12.5% as compared to 26% in patients with a BMI of more than 40 (P 5 .01). When controlling for the effects of BMI, patients with a Braden Scale score of 16 or less were almost 6 times more likely to have a PU as compared to those with Braden Scale scores of more than 16 (P, .001). Body mass index had an independent association with the probability of PU occurrence. Patients with BMIs of more than 40 were almost 3 times more likely to have a PU compared to those with BMIs of 40 or less, after controlling for Braden risk (P 5 .01). CONCLUSION: A BMI of more than 40 and Braden Scale score of 16 or less were found to have an independent and statistically significant association with PU occurrence. Future studies should investigate the predictive validity of BMI along with individual Braden subscales.

Caring for morbidly obese patients: safety considerations for nurse administrators.

The publication of the Institute of Medicines To Err Is Human: Building a Safer Health System in 1999 and Patient Safety: Achieving a New Standard of Care in 2003 sparked the development of patient safety indicators, the establishment of safety goals as part of the accreditation process, and improvement in reporting systems.1-3 While these efforts have been directed at safety in general, little attention has been paid to safety considerations in the care of hospitalized patients who are morbidly obese. Yet these patients are seen with increasing frequency in hospitals. They may be under care for bariatric surgery, treatment of comorbidities, or other unrelated conditions such as childbirth or trauma. Whatever their reason for entering the healthcare system, these patients may be at increased risk for falls and other adverse reactions or near misses due to their large body mass. In addition, some evidence suggests that nurses themselves are at heightened risk for injury when caring for morbidly obese patients.