Kenji Ushizawa

Decubitus Studies After the Non-Enforcement of Bedsore Measures

Purpose: We studied how to prevent the developing of bedsore in patients by implementing a novel method. The Shounankenyukai Nagaoka hospital, a care treatment hospital was able to prevent the development of bedsores in patients, the way the hospital managed to do it was taken as the subject of an investigation. Method: As the chairman of the board of directors of this hospital was a member of the study group, the cooperation of the staff executing the study could be built by the authority. We decided to carry out the surveillance study of the present condition and to analyze it as shown below; (Breakdown: Devices to use, Body pressure dispersion, plan for prevention, enforcement of the plan, daily rehabilitation management, nourishment – organized in a chronological order of data). We reviewed all the medical examination data from June 3, 2002 to November 11, 2005. Then, we created a bedsore plan database, rehabilitation management database, and blood tests result database. Results: The patients who were in need of some degree of care made up 56% of the nursing care insurance in the hospital, while the prevalence bedsore patients was only 4.7% in 2002, 0% in 2005, and an average of 2.8% in 4 years. Three characteristic issues of the hospital became clear (i) exceptional enforcement of rehabilitation treatment by the Takizawa method based on the Degree of Care needed, (ii) making the patients position change in less than every 2 hours and the local body pressure of less than 200 mmHg according to the KOSIAK formula for the prevention of bedsores development, and (iii) concerning the nourishment management, although there were many inpatients requiring in tube feeding, to switch to oral ingestion and to individual nourishment management as soon as possible. Discussion: It was published that the bedsore prevalence in patients needing a Degree of Care is 53.6%, on average, in all Japanese hospitals and health care facilities. There is a big difference between that and the result of this study. We consider 3 points which may specifically contribute to a decrease in the generation of bedsores; (i) enforcement of the kinetic rehabilitation adapted to the level of care needed, mainly of the type of motivative exercise, such as the Takizawa method and its enforcement according to the nursing care degree, (ii) use of a cushion for the posture change a bed, which is also used in the Takizawa method of rehabilitation for keeping the sitting position and (iii) nourishment management that considers individual circumstances. It seems that the introduction of the non-enforcement of bedsore measures would enable the effective bedsore prevention in hospitals.