Assessing the adequacy of pressure ulcer prevention in hospitals: A nationwide prevalence survey

Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, UZ Blok A-2nd floor, De Pintelaan 185, Gent 9000, Belgium.
BMJ quality & safety (Impact Factor: 3.99). 03/2011; 20(3):260-7. DOI: 10.1136/bmjqs.2010.043125
Source: PubMed


The development of a pressure ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the pressure ulcer preventive interventions used in hospitals.
The aim of this study was to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals.
A cross-sectional, multi-centre pressure ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure pressure ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention.
The total sample consisted of 19,968 patients. The overall prevalence of pressure ulcers Category I-IV was 12.1%. Only 10.8% of the patients at risk received fully adequate prevention in bed and while sitting. More than 70% of the patients not at risk received some pressure ulcer prevention while lying or sitting.
Generally, there is a limited use of adequate preventive interventions for pressure ulcers in hospitals, which reflects a rather low quality of preventive care. The implementation of pressure ulcer guidelines requires more attention. The pressure ulcer prevention used in practice should be re-evaluated on a regular basis.

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    • "Despite differences regarding some preventive measures and the claimed level of their evidence, all the guidelines have recommended the same preventive interventions (Shahin et al. 2009). Although the guidelines have been in existence for a number of years, the results of several studies demonstrated that the guidelines regarding prevention of pressure ulcers were not fully implemented in clinical practice and nursing actions that are not viewed as recommended practice or included in the guidelines continue to be in use (Gunningberg et al. 2001, € Ozdemir & Karadag 2008, Paquay et al. 2008, Vanderwee et al. 2011, Halfens et al. 2013). There is limited information on nurses' practice in pressure ulcer prevention and adherence to the recommendations of the German National Expert Standard in general hospital wards in Germany. "
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    ABSTRACT: The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. A nonparticipant observational descriptive design was used. A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were ‘cleaning the patients’ skin’ and ‘minimizing exposure to moisture’ that were undertaken in more than 90% of all patients. The least frequent measures were ‘patient and relative education’, ‘assessment and recording of nutritional status’. This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.
    Journal of Clinical Nursing 11/2014; 24(11-12). DOI:10.1111/jocn.12723 · 1.26 Impact Factor
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    • "We also wanted to ensure measures had face validity with clinicians and produced data which were concordant with epidemiological studies. Research suggests a hospital prevalence figure for pressure ulcers of 10.2% (categories 1–4) [23]. The NHS Safety Thermometer has recorded an overall prevalence of 7.4% (categories 2–4) across all settings. "
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    ABSTRACT: Quality issueResearch indicates that 10% of patients are harmed by healthcare but data that can be used in real time to improve safety are not routinely available.Initial assessmentWe identified the need for a prospective safety measurement system that healthcare professionals can use to improve safety locally, regionally and nationally.Choice of solutionWe designed, developed and implemented a national tool, named the NHS Safety Thermometer (NHS ST) with the goal of measuring the prevalence of harm from pressure ulcers, falls, urinary tract infection in patients with catheters and venous thromboembolism on one day each month for all NHS patients.ImplementationThe NHS ST survey instrument was developed in a learning collaborative involving 161 organizations (e.g. hospitals and other delivery organizations) using a Plan, Do, Study, Act method.EvaluationTesting of operational definitions, technical capability and use were conducted and feedback systems were established by site coordinators in each participating organization. During the 17-month pilot, site coordinators reported a total of 73 651 patient entries.Lessons learnedIt is feasible to obtain national data through standardized reporting by site coordinators at the point of care. Some caution is required in interpreting data and work is required locally to ensure data collection systems are robust and data collectors were trained. Sampling is an important strategy to optimize efficiency and reduce the burden of measurement.
    International Journal for Quality in Health Care 04/2014; 26(3). DOI:10.1093/intqhc/mzu043 · 1.76 Impact Factor
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    • "A 2002 crosssectional , multi-centre study in European hospitals showed that only 10% of the patients at risk received fully adequate prevention (Vanderwee et al., 2007). Similar results were found in a 2008 cross-sectional study including 19,968 patients (admitted to 84 hospitals) in Belgium (Vanderwee et al., 2011). The latter found that only 10.8% of the patients at risk received fully adequate prevention in bed and when seated. "
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    ABSTRACT: BACKGROUND: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. OBJECTIVES: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. DESIGN: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). SETTING: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. PARTICIPANTS: In total, 464 nursing home residents and 118 healthcare professionals participated. METHODS: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30min group lecture. RESULTS: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F=15.12, P<0.001). CONCLUSION: The intervention was only partially successful to improve the primary outcome. Attitudes improved significantly while the knowledge of the healthcare workers remained unsatisfactorily low. Further research should focus on the underlying reasons for these findings.
    International journal of nursing studies 10/2012; 50(4). DOI:10.1016/j.ijnurstu.2012.09.007 · 2.90 Impact Factor
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