[For discussion: Quality assurance in medical care - is PKMS the right way to go?]. / Zur Diskussion: Qualitätssicherung in der Pflege - mit PKMS auf dem richtigen Weg?

Hospitals are legally obliged to take part in external comparative quality assurance programs. Quality indicators for pressure ulcer prevention are among the most widely used for geriatric clinical institutions. To enable more precise risk adjustment established risk factors are employed in conjunction with the OPS 9-200. Using a PKMS case to produce an OPS 9-200 is far too heterogeneous, sketchy and vague to create an accurate and satisfactory pressure ulcer risk assessment for patients with varied and individual case factors. Therefore we propose to include risk factors which, according to experts, are clearly and specifically related to pressure ulcers (e.g. immobility and incontinence) and matched by unique ICD codes.

Basic geriatric assessment does not predict in-hospital mortality after PEG placement.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. METHODS: All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. RESULTS: A total of 1232 patients (60.4% women) with a median age of 82 years (range 60 to 99 years) were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664), with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%). In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.003-1.056), male sex (OR 1.741, 95% CI 1.216-2.493), and pneumonia (OR 2.641, 95% CI 1.457-4.792) or the diagnosis group 'miscellaneous disease' (OR 1.864, 95% CI 1.224-2.839) were identified as statistical risk factors for in-hospital death. Cognitive status did not have an influence on mortality (OR 0.447, CI 95% 0.248-1.650). CONCLUSION: In a nationwide geriatric database, no component of the basic geriatric assessment emerged as a significant risk factor for mortality after PEG placement, emphasizing individual decision-making.