Consistent practice for pressure ulcer prevention in long‐term older people care: A quasi‐experimental intervention study

Abstract

Background Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long‐term older people care. Aim To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long‐term older people care. Design A quasi‐experimental intervention study. Methods Two long‐term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence‐Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument. Results In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure‐relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices. Conclusions The results of this study support the implementation of PU prevention guidelines in long‐term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care.

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross‐sectional study

“…This result is in line with two previous studies in which skin assessment and skin care as a PU prevention practice in long‐term care facilities were also found to be mainly sufficient. 18 , 23 The other PU prevention methods described as being used frequently by the participating nurses were pressure relief devices and documentation. The use of pressure relief devices, such as specialist mattresses, is one of the key PU prevention practices in PU prevention guidelines 3 even though the evidence is somewhat uncertain about the differences in the effects of these devices.…”

“…Each item has a scale from 1 to 4: 1 = never; 2 = sometimes; 3 = often; and 4 = always. Each item also includes an option “cannot say.” In addition, participants were asked to answer whether there is agreement in their unit on consistent PU prevention practices by answering either “yes” or “no.” The instrument was previously used in two studies 18 , 23 and showed mainly moderate to good internal consistency. The instrument was further developed for this study based on the previous research findings.…”

“… 17 However, the consistency in the PU prevention practices among nursing staff may be improved with the implementation of evidence‐based PU prevention practices. 18 …”

Health Value of China’s Long-term Care Insurance in Older Disabled People: Role of Institutional Care

“…Repeated episodes of pneumonia can be avoided by prevention of aspiration, timely sputum suction, suitable oral health care, gastroesophageal re ux management, and a head-up position during the night [26, 27,28]. Pressure ulcers are frequent complications of disabled patients and are generally connected with poor prognosis [29,30]. Therefore, their early risk assessment and management such as identi cation of malnutrition and nutritional supplementation, effective skincare (creams, dressings, and management of incontinence), various support surfaces, and regular turning strategies, are important for disabled people [29,30,31].…”

“…Pressure ulcers are frequent complications of disabled patients and are generally connected with poor prognosis [29,30]. Therefore, their early risk assessment and management such as identi cation of malnutrition and nutritional supplementation, effective skincare (creams, dressings, and management of incontinence), various support surfaces, and regular turning strategies, are important for disabled people [29,30,31]. With the substitution effect of the LTCI policy, patients with institutional care could have obtained better disease management and individualized disability care plans, leading to an improved quality of life (QoL).…”