EUROPEAN PRESSURE ULCER ADVISORY PANEL

5. Procedure and data collection
Each participating country needs to identify a national co-ordinator who would be responsible for the training of the local co-ordinators. The national co-ordinator would have to offer a minimum level of commitment to the project. For 2001 this was defined as being 'A minimum of 750 patients to be recruited from at least one university and at least one general hospital.'
The tasks of the national co-ordinator are:

• Recruitment of acute care hospitals for participating in the survey
• To be a contact person between the local co-ordinator and the EPUAP working group To train the local co-ordinators
• To take care of the translation of the documents in the appropriate language
• To provide the local co-ordinators with sufficient data collection forms
• To see to the transfer of the data to the EPUAP working group

Each institute participating in the European data collection of pressure ulcers is expected to appoint their own local co-ordinator. The local co-ordinator will be responsible for the internal co-ordination during the data collection period and will function as the contact person for the national co-ordinator. The tasks of a co-ordinator are:

• To ask permission of the relevant internal bodies such as the Institutional Review Board (if present);
• To form a team of specialist nurses. Every member of the team will carry out measurements in one or more wards together with a nurse of that particular ward. So, the size of the team depends on the number of wards participating in the data collection;
• To draw up a time schedule for data collection within the institute;
• To draw up a roster for the team of nurses who are to carry out the measurements;
• To collect all the forms per ward and to check the data
• To copy all the forms
• To see to the transfer of the data (original forms) to the national co-ordinator or the EPUAP working group;
• To fill in and return an evaluation form about the survey.

The institute co-ordinator receives training by the national co-ordinator, together with the co-ordinators of the other institutions participating in the data collection. In addition, each institution co-ordinator is provided with materials for the instruction of the nurses, a protocol (including a sample request to the Institutional Review Board), patient information forms, consent forms, and sufficient data collection forms. Ward data and patient data are recorded by the nurses. Each participating patient is coded, still allowing the wards to check whether each patient who wanted to participate has been registered. The patients remain anonymous to the research group. The co-ordinator divides the team of nurses over the wards, taking into account that, if possible, the 'non-ward' nurses, performing tasks that are not related to one particular ward, should not carry out measurements in their own ward. These nurses are assisted during the measurement by a staff nurse who knows the ward well and can provide relevant background information about the individual patients as well as the ward. The 'non-ward' nurse and the staff nurse should agree on the grade to be filled in on the data collection form. If they do not agree, the 'non-ward' nurse decides which grade of pressure ulcer should be recorded.

To ensure reliability the local co-ordinator will randomly select one ward from each site and in addition to the team of two nurses who would be completing the data, will perform a second set of forms based on their individual observation of the patients. Furthermore, throughout the data collection time span the local co-ordinator should visit all wards involved and observe that they are following the procedure for data collection correctly, i.e., they are examining the patients and not taking information from patient notes. The local co-ordinator needs to inform the EPUAP working group which ward has had a dual measurement otherwise some patients could be registered twice. The EPUAP working group will analyse the dual measurements to establish the reliability of the performed data collections.

6. Data Processing
The EPUAP working group will use SPSS to process the data. The data will be described on a national level indicating the institution category and ward category. Depending on the measurement scale of the variables, either mean values or frequencies will be established, allowing each institution to compare their own results to the mean national results.

7. Data Protection
The EPUAP will ensure anonymity of all patients participating in the study. Specific data protection regulations of any of the participating countries will be adhered to as appropriate.

8. Informed Consent
All participating patients and/or contact persons will receive written information in advance about the aim and method of the national data collection (Appendix 3). This will be done during the visiting hours a day before the measurement. The patients will be asked for oral permission to participate, but they are not registered during that visit. This procedure deviates from the usual procedure, but because of the size of the study population (all patients in the institutions or receiving home care) that have to be examined for pressure ulcers on one and the same day, a written procedure to obtain informed consent can cause delay that may obstruct the survey. Also in some countries, the patients' anonymity may be at stake if they are to sign consent forms. In addition, it is a basic part of the care provided by nurses to examine and palpate for the presence of pressure ulcers in patients who are at risk of developing pressure ulcers. If any patient is not able to understand the information and to give informed consent, a relative or contact person should be informed and asked for permission. This procedure was approved by the Medical Ethical Approving Committee of the University Hospital Maastricht, in Maastricht.

Literature
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