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. 


Decubitus ulcers are a real problem and have been known to exist since ancient Egyptian times (Moore et al, 2004). However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Decubitus ulcers can lead to very serious medical consequences for no ambulatory people who have impaired sensation. If it is associated with medical treatment, it can be extremely expensive.


Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. However, many nurses in Indonesia do not realize the problems and do not put the risks for decubitus ulcer as their nursing intervention priority. Nurses may already know about nursing interventions that can prevent decubitus ulcers. In reality, they do not implement that intervention plans to the patients before the early signs of decubitus ulcers, such as skin redness, are shown. What is the most effective and efficient ways to improve the patient safety and prevent decubitus ulcers?


Please read this following good references:


Abruzzese 2008. The Knoll Assessment Tool for Pressure Ulcer Potential, Institute for Algorithmic Medicine, Houston, USA. Retrieved May 16, 2008 from


Arief, I 2007. Kesehatan Adiyuswa. Retrieved May 14, 2008 from


Bansal, C; Scott, R; Stewart, D; Cockerell, C, J 2005. Decubitus Ulcers: A Review of The Literature, International Jurnal of Dermatology, Volume 44, page 805-810. Retrieved May 14, 2008 from


Beitz, J, M; Fey, J & Brien, D, O 1998. Perceived Need For Education Vs. Actual Knowledge Of Pressure Ulcer Care In A Hospital Nursing Staff, BNet. Retrieved May 13, 2008 from


Guideline for Prevention and Management of Pressure Ulcers, 2008. AHRQ. Retrieved May 28, 2008 from


Hiatt, J, M 2007. “ADKAR” – A Model for Change Management.  Retrieved May 26, 2008 from

Moore, Z & Price, P 2004. Nurses’ Attitudes, Behaviors and Perceived Barriers Towards Pressure Ulcer Prevention, Journal of Clinical Nursing, Volume 13, Issue 8, Page: 942-951. Retrieved May 14, 2008 from


Pershall, L 2006. Explanation Of Decubitus Ulcers Or Pressure Sores. Retrieved May 14, 2008 from

Ramanujam, R; Abrahamson, K & Anderson, J, G 2008. Influence of Workplace Demands on Nurses’ Perception of Patient Safety, Nursing & Health Sciences, Volume 10, Issue 2, Page: 144-150. Retrieved May 15, 2008 from 


Reddy, M; Gill, S, S & Rochon, P, A 2006. Preventing Pressure Ulcers: A Systematic Review, JAMA, Volume 296, Page: 974-984. Retrieved May 15, 2008 from &


Spilsbury, K; Nelson, A; Cullum, N; Iglesias, C; Nixon, J & Mason, S 2007. Pressure Ulcers and Their Treatment and Effects on Quality of Life: Hospital Inpatient Perspectives, Journal of Advanced Nursing, Volume 57, Issue 5, Page: 494-504. Retrieved May 14, 2008 from


Vanderwee, K; Grypdonck, M, H, F; Bacquer, D, D & Defloor, T 2007. Effectiveness of Turning with Unequal Time Intervals on the Incidence of Pressure Ulcer Lesions, Journal of Advanced Nursing, Volume 57, Issue 1, Page: 59-68. Retrieved May 15, 2008 from   


Yahya, A, A 2006. Konsep dan Program “Patient Safety“. Retrieved May 13, 2008 from


Zhan, C; Friedman, B; Mosso, A & Pronovost, P 2006. Medicare Payment for Selected Adverse Events: Building the Business Case for Investing In Patient Safety. Retrieved May 14, 2008 from