EUROPEAN PRESSURE ULCER ADVISORY PANEL

PREVENTION OF PRESSURE ULCERS IN PATIENTS WITH HIP FRACTURES. DEFINITION, MEASUREMENT AND IMPROVEMENT OF THE QUALITY OF CARE
Lena Gunningberg, Department of Public Health and Caring Sciences,
Section of Caring Sciences, Uppsala University, Sweden

The aims of the present thesis were to survey the prevalence and incidence of pressure ulcers in patients with hip fractures and to investigate nursing staff knowledge and documentation regarding pressure ulcer prevention for the same patient group. Another aim was to test the effect of three preventive interventions; risk assessment and pressure ulcer grading, a pressure-reducing mattress and an educational programme. Experimental, comparative and descriptive designs were used and quality improvement philosophy guided the research. In 1997 and 1999, a total of 124 and 101 patients > 65 years with hip fractures were included and followed with risk assessment and skin observation. Audit of patient records, a questionnaire to nursing staff and a focus group interview were also employed.

The findings from the first studies showed that 20% of the patients had pressure ulcers on arrival at the hospital. During the hospital stay 55% developed new pressure ulcers. Nursing staff knowledge and documentation regarding pressure ulcer prevention was unsatisfactory. An extensive educational programme was developed and conducted in 1998. Twenty-five registered nurses participated from the hospital and the community setting.

There were no significant differences in the prevalence/incidence of pressure ulcers between the experimental and control groups in the two experimental studies. However, there was a significant reduction of the incidence of pressure ulcers between 1997 and 1999 (from 55% to 29%). The focus group indicated that since 1997 there had been changes in nursing and treatment routines in the Accident and Emergency Department and in the orthopaedic wards.

Extract from her thesis, printed with kind permission of Lena Gunningberg, Department of Public Health and Caring Sciences, Uppsala University, Sweden.