Developing and implementing a pressure ulcer prevention strategy: protocol of a quasi-experimental study in Slovakia

Pressure ulcers (PUs) are a health complication that is largely preventable (80-95%) and which has a physical, psychological and socioeconomic impact on the individual and on their family. The worldwide prevalence is between 5-27% and the cost of treatment is more than twice the cost of prevention. Due to the inconsistency of preventive measures at the national level, Louis Pasteur University Hospital in Košice, the second largest university hospital in Slovakia, in cooperation with the Department of Nursing, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, is implementing a PU prevention strategy, and undertaking data collection and identification of gaps to address PUs.

This protocol describes the development of a PU prevention strategy (PUPS) by clinicians and academics from the two institutions, using the EPUAP/NPIAP/PPPIA 2019 international guideline, and its planned implementation into clinical practice.

The preliminary testing of PUPs involved 60 patients, of whom 28 were at very high risk of PU development, positively correlating with age (p=0.002). Patients at very high-risk were found to receive care more consistently compared to high- and medium-risk patients. In the planned research, demographic data and sample characteristics in relation to the level of risk and the performed/missed preventive measures will be statistically analysed and evaluated. The success of the prevention strategy will be evaluated based on hospital-acquired pressure ulcer (HAPU) statistics, and characteristics before and after the implementation of PUPS.

PUPS is the result of a collaboration between the academic institution and the hospital that integrates and links education, research, evidence and practice to improve outcomes for patients, and streamline the work of healthcare professionals. In view of the results of the strategy's pre-testing, it is believed that the planned research will reveal the shortcomings of implementing preventive strategies in detail, and allow those responsible to focus specifically on the improvement plan. In addition, the electronic format of the PUPS will be used to collect and summarise statistical data on HAPUs, which is lacking in Slovakia. This strategy has the potential to improve standards of PU prevention and quality of care assessment, based on the principles of evidence-based practice at the national level in Slovakia. Systematic prevention strategies lead to satisfactory outcomes in the context of targeting deficiencies, managing workload, reducing PUs and costs, improving quality and safety of care, and increasing patient satisfaction. The implementation of an easy-to-use protocol is a pilot project at national level. The aim is to incorporate the strategy into national standards and potentially recommend it at international level.