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Implementation of a guideline for pressure ulcer prevention in home care: pretest-posttest study

Louis Paquay, Sabine Verstraete, Renild Wouters, Frank Buntinx, Katrien Vanderwee UGent, Tom Defloor UGent and Hendrik Van Gansbeke (2010) JOURNAL OF CLINICAL NURSING. 19(13-14). p.1803-1811
abstract
Aims and objectives: To investigate the effect of the implementation of a patient and family education programme for pressure ulcer prevention in an organisation for home care nursing on guideline adherence and on prevalence and severity of pressure ulcers and to examine the determining factors for the application of measures for pressure ulcer prevention. Background: Quality improvement programmes in pressure ulcer prevention are not always successful. Design: Implementation study using a pretest-post-test design. Data were collected in three probability samples. The first post-test data collection was held after six months, the second after 18 months. Method: Statistical analysis was used, comparing the pretest sample and the second post-test sample. Results: After 18 months, the proportion of subjects with adherent measures had increased from 10 center dot 4-13 center dot 9%, the proportion of subjects with non-adherent measures decreased from 45 center dot 7-36 center dot 0%, the proportion of subjects without pressure ulcer prevention increased from 43 center dot 9-50 center dot 1% (p < 0 center dot 0001, Chi-square test). Sub-analysis revealed that a positive change in guideline adherence was observed principally in the group at risk. Better process-of-care indicators were associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses' judgement of a patient risk status was the most important factor for applying preventive measures. Furthermore, application of pressure ulcer prevention was determined by higher age (from the age category of 70-79 years), higher dependency for the activities of daily living, higher than baseline mobility score and the presence of a pressure ulcer. Conclusions: Guideline adherence in pressure ulcer prevention changed significantly after implementation of the education programme. There might have been inconsistencies in the nurses' risk judgement. Relevance to clinical practice: Quality of pressure ulcer prevention improved, but several items for improvement remain. Adaptation of risk assessment procedures is needed.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
programme evaluation, pressure ulcer, patient education, home nursing, guideline adherence, caregiver, QUALITY-ASSURANCE, NURSING-HOME, FEEDBACK, PROJECT
journal title
JOURNAL OF CLINICAL NURSING
J. Clin. Nurs.
volume
19
issue
13-14
pages
1803 - 1811
Web of Science type
Article
Web of Science id
000278802400005
JCR category
NURSING
JCR impact factor
1.228 (2010)
JCR rank
23/85 (2010)
JCR quartile
2 (2010)
ISSN
0962-1067
DOI
10.1111/j.1365-2702.2009.03170.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
836235
handle
http://hdl.handle.net/1854/LU-836235
date created
2010-01-25 10:41:46
date last changed
2015-06-17 11:20:36
@article{836235,
  abstract     = {Aims and objectives: To investigate the effect of the implementation of a patient and family education programme for pressure ulcer prevention in an organisation for home care nursing on guideline adherence and on prevalence and severity of pressure ulcers and to examine the determining factors for the application of measures for pressure ulcer prevention.
Background: Quality improvement programmes in pressure ulcer prevention are not always successful.
Design: Implementation study using a pretest-post-test design. Data were collected in three probability samples. The first post-test data collection was held after six months, the second after 18 months.
Method: Statistical analysis was used, comparing the pretest sample and the second post-test sample.
Results: After 18 months, the proportion of subjects with adherent measures had increased from 10 center dot 4-13 center dot 9\%, the proportion of subjects with non-adherent measures decreased from 45 center dot 7-36 center dot 0\%, the proportion of subjects without pressure ulcer prevention increased from 43 center dot 9-50 center dot 1\% (p {\textlangle} 0 center dot 0001, Chi-square test). Sub-analysis revealed that a positive change in guideline adherence was observed principally in the group at risk. Better process-of-care indicators were associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses' judgement of a patient risk status was the most important factor for applying preventive measures. Furthermore, application of pressure ulcer prevention was determined by higher age (from the age category of 70-79 years), higher dependency for the activities of daily living, higher than baseline mobility score and the presence of a pressure ulcer.
Conclusions: Guideline adherence in pressure ulcer prevention changed significantly after implementation of the education programme. There might have been inconsistencies in the nurses' risk judgement.
Relevance to clinical practice: Quality of pressure ulcer prevention improved, but several items for improvement remain. Adaptation of risk assessment procedures is needed.},
  author       = {Paquay, Louis and Verstraete, Sabine and Wouters, Renild and Buntinx, Frank and Vanderwee, Katrien and Defloor, Tom and Van Gansbeke, Hendrik},
  issn         = {0962-1067},
  journal      = {JOURNAL OF CLINICAL NURSING},
  keyword      = {programme evaluation,pressure ulcer,patient education,home nursing,guideline adherence,caregiver,QUALITY-ASSURANCE,NURSING-HOME,FEEDBACK,PROJECT},
  language     = {eng},
  number       = {13-14},
  pages        = {1803--1811},
  title        = {Implementation of a guideline for pressure ulcer prevention in home care: pretest-posttest study},
  url          = {http://dx.doi.org/10.1111/j.1365-2702.2009.03170.x},
  volume       = {19},
  year         = {2010},
}

Chicago
Paquay, Louis, Sabine Verstraete, Renild Wouters, Frank Buntinx, Katrien Vanderwee, Tom Defloor, and Hendrik Van Gansbeke. 2010. “Implementation of a Guideline for Pressure Ulcer Prevention in Home Care: Pretest-posttest Study.” Journal of Clinical Nursing 19 (13-14): 1803–1811.
APA
Paquay, Louis, Verstraete, S., Wouters, R., Buntinx, F., Vanderwee, K., Defloor, T., & Van Gansbeke, H. (2010). Implementation of a guideline for pressure ulcer prevention in home care: pretest-posttest study. JOURNAL OF CLINICAL NURSING, 19(13-14), 1803–1811.
Vancouver
1.
Paquay L, Verstraete S, Wouters R, Buntinx F, Vanderwee K, Defloor T, et al. Implementation of a guideline for pressure ulcer prevention in home care: pretest-posttest study. JOURNAL OF CLINICAL NURSING. 2010;19(13-14):1803–11.
MLA
Paquay, Louis, Sabine Verstraete, Renild Wouters, et al. “Implementation of a Guideline for Pressure Ulcer Prevention in Home Care: Pretest-posttest Study.” JOURNAL OF CLINICAL NURSING 19.13-14 (2010): 1803–1811. Print.