Many kinds of medicines, diagnostic tests, procedures, the number of patients and staff in hospitals can be a potential risk for errors. These errors can produce problems, injury or trauma to the patients. Thus, “safety is a fundamental principle of patient care and a critical component of quality management” (World Alliance for Patient Safety, Forward Programme WHO, 2004 cited in Yahya, 2006).
One of the biggest patient safety issues in health care is decubitus ulcer. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) has identified decubitus ulcer as one of the adverse events during hospitalization (Zhan, 2006). In USA at present, decubitus ulcer occurs 474,692 per year or 54 per hour. In developing countries, the incidence rate of decubitus ulcer was 11% in the two weeks of treatment (Arief, 2007).
Decubitus ulcers, also known as bedsores, pressure ulcers and pressure sores, are caused by impaired blood supply and tissue malnutrition owing to prolonged pressure over skin, soft tissue, muscle, and/or bone (Bansal et al, 2005). Bansal et al also explained that susceptibility to pressure ulcers comes from a combination of external factors (such as: pressure, friction, shear force, and moisture) and internal factors (for instance: fever, malnutrition, anemia, and endothelial dysfunction).
Moreover, Bansal et al said that patient with normal sensitivity, mobility, and mental faculty, decubitus ulcers usually do not occur. Patients with the following conditions are most susceptible: neurological disease, cardiovascular disease, prolonged anesthesia, dehydration and malnutrition, hypotension and surgical patients. Two-thirds of decubitus ulcers occur in patients aged more than seventy years. Thus, decubitus ulcers occur most often in aged, incontinent, debilitated, paralyzed, and unconscious patients.
Spilsbury et al (2007) have done a research which focussed on the complexities impact of decubitus ulcers. Spilsbury et al found that patient got emotional, mental, physical and social effects because of the decubitus ulcer and its treatments. Patients also gave their suggestions on the causes of their decubitus ulcer and descriptions of pain, appearance, smell and fluid leakage. Additionally, patients described amounts and quality of care that they received, including comfort levels of dressings and pressure relieving equipment, also the timing of interventions. Besides that, patients were largely dependent on others to treat, manage and care for their ulcer, but indicated that the pain, discomfort and distress of pressure ulcers were not acknowledged by nursing staff. Based on this research, nurses should provide preventive interventions and understand the importance of comfort for patients.