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ABSTRACT: Although guidelines for the management of pressure sores are widely available, their implementation is not always easy and sometimes does not produce the desired changes.
To describe the results of a clinical audit aiming at assessing the appropriate use of medications for pressure sores, after the implementation of guidelines.
The audit group, with an expert in assessment, a nurse expert in pressure sores, a microbiologist, a dermatologist and a chemist analysed the clinical and nursing records of all the patients with a pressure sore, discharged during the first trimester of 2005 and 2006, after the implementation of the guidelines, from wards with higher prevalence of pressure sores: geriatric, medical, intensive care, rehabilitation and post acute wards. Each documented treatment was classified as appropriate, not appropriate or "grey area", treatments inappropriate according to guidelines but not according to expert or current knowledge (e.g. poliurethane medications for heel pressure sores). After each stage, the results were returned and discussed with the involved wards.
One hundred 74 patients were surveyed in 2005 and 199 in 2006, with a total of respectively 287 and 326 sores. The percentage of inappropriate treatments was 20% in 2005 and 12.8% in 2006 (OR 1.79 I.C. 95% 1.10- 2.91), while an increase of treatments considered grey area (from 7% to 13.5%) was observed. The medium number of medications used was 17.3 per lesion, in 2005 and 16.4 in 2006 with a cost respectively of 83.6 and 67.35 per lesion, but the two populations were not strictly comparable.
Clinical audit is a strategy that involving doctors and nurses, may promote positive changes. The rate of inappropriate treatments (higher in areas with high turnover of nurses) can be improved with educational interventions. The identification of treatments of the grey area highlights the need of periodically revising guidelines to update their contents according to new knowledge and technologies.
Assistenza infermieristica e ricerca: AIR 25(4):214-9. · 0.40 Impact Factor