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Hip fracture care clinical care standard indicators: 5c-Proportion of patients with a hip fracture experiencing a new Stage II or higher pressure injury during their hospital stay

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this term Indicator 5c-Proportion of patients with a hip fracture experiencing a new Stage II or higher pressure injury during their hospital stay
METeOR identifier:Help on this term628233
Registration status:Help on this termHealth, Standard 12/09/2016
Description:Help on this term

Proportion of patients with a hip fracture experiencing a new Stage II or higher pressure injury during their hospital stay.

Rationale:Help on this term

Pressure injuries are common but potentially preventable complications following hip fracture (Baumgarten et al. 2003; Reddy et al. 2006). They can have substantial negative effects in terms of pain, quality of life, length of hospital stay, cost of care, medical complications, and mortality (Baumgarten et al. 2003; Reddy et al. 2006).

Indicator set:Help on this termClinical care standard indicators: hip fracture Health, Standard 12/09/2016
Australian Commission on Safety and Quality in Health Care, Superseded 18/06/2018
Outcome area:Help on this termMobilisation and weight-bearing Health, Standard 12/09/2016

Collection and usage attributes

Computation description:Help on this term

The numerator includes patients with a hip fracture with a new pressure injury(s) acquired during their stay in hospital for the treatment of their hip fracture.

Pressure injuries are as per ICD-10-AM classification, where Episode of care—additional diagnosis, code (ICD-10-AM 9th edn) ANN{.N[N]} is one of the codes in the table below, and Episode of admitted patient care—condition onset flag, code N = 1 Condition with onset during the episode of admitted patient care.

Pressure injuries included in the numerator
ICD-10-AM code  [1] Title Description
L89.1x Pressure injury, stage II

Partial thickness loss of dermis presenting as a shallow, open wound with a red-pink wound bed, without slough.

L89.2x Pressure injury, stage III Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunnelling.
L89.3x Pressure injury, stage IV Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed.
L89.4x Pressure injury, unstageable, so stated Purple or maroon localised area or discoloured, intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.
L89.5x Suspected deep tissue injury, depth unknown, so stated Full thickness tissue loss in which the base of the pressure injury is covered by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the presuure injury bed.

Note that Stage I pressure injury: non-blanchable erythema (where Episode of care—additional diagnosis, code (ICD-10-AM 9th edn) ANN{.N[N]} is L89.0x) is excluded from the numerator. This is where the skin is intact, with non-blanchable redness of a localised area, usually over a bony prominence.

Where there is more than one pressure injury, count the one at the highest stage.

Presented as a percentage.


[1] Where 'x' indicates that all fifth character codes following the three-digit rubric and fourth character are included in the definition. The fifth character in this code set indicates the site of the pressure ulcer.

 

Computation:Help on this term

(Numerator ÷ denominator) x 100

Numerator:Help on this term

Number of patients admitted to hospital with a hip fracture acquiring a Stage II or higher pressure injury during their stay in hospital for the treatment of their hip fracture.

Denominator:Help on this term

Number of patients admitted to hospital with a hip fracture.

Comments:Help on this term

For hospitals collecting the Australian and New Zealand Hip Fracture Registry (ANZHFR) data set (ANZHFR Steering Group 2013), the variable New pressure ulcers can be used for the numerator of this indicator.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termService event
Format:Help on this term

N[NN]

Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

ANZHFR (Australian and New Zealand Hip Fracture Registry) Steering Group 2013. Data dictionary. Sydney: ANZHFR. Viewed 5 May 2016, http://www.anzhfr.org/images/resources/Data%20/> Dictionary%20v8%
20Dec%202013.pdf
.

Baumgarten M et al. 2003. Risk factors for pressure ulcers among elderly hip fracture patients. Wound repair and regeneration: official publication of the Wound Healing Society [and] the Europe Tissue Repair Society 11(2):96-103.

Reddy M, Gill SS & Rochon PA 2006. Preventing pressure ulcers: a systematic review. JAMA: The Journal of the American Medical Association 296(8):974-84.

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