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Nursing home quality and pressure ulcer prevention and management practices
Deidre D Wipke-Tevis1, Donna A Williams, Marilyn J Rantz
1MU Sinclair School of Nursing, University of Missouri-Columbia, 65211, USA. wipke-tevisd@missouri.edu
Objectives:
To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs).
Design:
Retrospective analysis of a large data set and comparative survey.
Setting:
LTCFs in Missouri.
Participants:
Three hundred sixty-two LTCFs participated in the survey. Three hundred twenty-one facilities had pressure ulcer QI scores between April 1 and September 30, 1999.
Measurements:
Pressure ulcer QI scores, Pressure Ulcer Prevention & Treatment Practices Survey.
Results:
The mean+/-standard deviation pressure ulcer QI score was 10.9+/-6.2%, with a risk-adjusted score of 15.7+/-8.9% for high-risk residents and 3.1+/-3.6% for low-risk residents. Minimizing head-of-bed elevation to less than 30 degrees was used by fewer than 20% of facilities. More than 40% of facilities used a risk assessment tool that was not evidence based. Fewer than 13% of facilities used the Agency for Health Care Policy and Research pressure ulcer prevention and treatment guidelines. No relationship was found between the number of prevention strategies (P=.892) or the number of treatment strategies (P=.921) and the pressure ulcer QI scores.
Conclusion:
Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment guidelines appear to be rarely implemented. This study provides a basis for developing educational and quality improvement programs and future research related to pressure ulcer prevention and treatment in LTCFs.