EUROPEAN PRESSURE ULCER ADVISORY PANEL

2.3 Phase 3: Passive hospital patient chart review to identify patients with PU cases, 1994

Over a three-month period in 1994, a retrospective passive PU surveillance was conducted in seven hospitals that participated in the COMAC/HSR programme and in which hospital management actively sought quality improvements in PU prevention and treatment. All hospitals were either county or city hospitals with more than 1,000, in some cases with more than 2,000 beds. Across these seven hospitals, 1,200 consecutive adult in-patient records were reviewed. The sample was composed of 1,200 adult in-patients (over 18 years of age) discharged from the participating hospitals after 1 January 1994. Within each centre, the audit concentrated upon departments that cared predominantly for the elderly. One nurse from each hospital collected PU data from the participating department(s) based upon the available medical records. Of the 1,200 patients, 271 (22.6%) experienced PU during their stay, with 551 individual ulcers recorded (2.03 PU per patient). In the survey PU located in the same anatomic site, but located on the left or right side of the body were counted as two PU’s. In order to standardise the data collection and the quality of collected data, training and consultations, a detailed data collection protocol and data collection forms were provided to the PU nurses.

The main objective of Phase 3 was not considered to be affected by the non-random basis of hospital department participation. This phase held one key objective: to reveal the large variation among hospitals regarding their current nursing practices and the documentation of PU at both hospital and national level.

Nursing practice varied between departments and hospitals. In an extreme example of inappropriate practice, in one hospital, an anti PU powder (Crupodex - Dextranomer) was spread on the bed-sheet and then the patient was rolled up in the sheet! While this is an extreme example no protocols, guidelines or standards were used to define appropriate practices. Due to this lack of a definition of what was appropriate practice it was not possible to discuss the observed practices and explore how these diverged from accepted norms. In general PU preventive care, where present, was not undertaken in any systematic fashion.

The second part of this extensive series of pressure ulcer studies along with the study conclusions will be published in the next issue of the EPUAP Review.

References:

• Clark M, Watts S (1991) The incidence of pressure ulcers within a National Health Service Trust hospital during 1991, J-Adv-Nurs. 20, 1, 33–6.
• Gulácsi L, Jakab Zs, Szloboda I (1993) Pressure Scores; A quality circle investigation, Health Management Review 31, 5, 425–449.
• Haalboom JRE, van Everdingen JEE, Cullum N (1997) Incidence, prevalence and classification, In: Jakab Zs, Gulácsi L (1993a) Prevention and Treatment of Bed Ulcers, Nursing Care 2, 6, 20–28.
• Jakab Zs, Gulácsi L (1993b) Prevention and Treatment of Bed Ulcers in a Group of Hungarian Hospitals, The Nurse 5, 6, 33–59.
• Klazinga N (1994) Concerted Action Programme on Quality Assurance in Hospitals 1990–1993 (COMAC/HSR/QA), Global Results of the Evaluation, International Journal in Health Care 6, 3, 219–230.

Part II will appear in issue 3/2.

Table 2. Quality assurance related to prevention and treatment of PU in Hungarian hospitals participating in the European Concerted Action Programme on Quality Assurance in Hospitals.

(*) Participating countires and number of hospitals (COMAC/HASR/QA): Austria: 14 hospitals; Belgium 42 hospitals; Demark: 30 hospitals; France: 11 hospitals; Germany: 11 hospitals; Greece: 8 hospitals; Ireland: 5 hospitals; Israel: 17 hospitals; Italy: 14 hospitals; The Netherlands: 15 hospitals; Portugal: 11 hospitals; Russia: 11 hospitals; Spain: 82 hospitals; United Kingdom: 7 hospitals; Hungary: 17 hospitals; Poland 40 hospitals.
(**) Participating countires and number of hospitals (BIOMED/PECO): Denmark: 4 hospitals; France: 5 hospitals; Germany: 15 hospitals; Greece: 1 hospital; Hungary: 20 hospitals; Italy: 11 hospitals; Ireland: 21 hospitals; Israel: 7 hospitals; The Netherlands: 6 hospitals; Poland: 27 hospitals; Portugal: 8 hospitals; Russia: 14 hospitals; Slovak Republic: 2 hospitals; Spain: 50 hospitals; Switzerland: 4 hospitals; United Kingdom: 3 hospitals.

Sources: 1) Qualiy Assurance in European Hospitals, results of the assessment phase of a concerted action programme covering 262 hospitals in 15 countries, CBO, September 1992; 2) Quality Assurance in European Hospitals, results of the evaluation phase, CBO, December 1993.
C7 - Altogether seven large county hospitals (C7) participated through the whole duration of the programme, representing 37% of the county hospitals.