De Laat, E.H., Schoonhoven, L., Pickkers, P., Verbeek, A.L. and van Achterberg, T.
Implementation of a new policy results in a decrease of pressure ulcer frequency
Journal of Advanced Nursing, 18, (2), . (doi:10.1093/intqhc/mzi088). (PMID:16282333).
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Objective. To determine the effects of a new policy on the efficiency of pressure ulcer care.
Design. Series of 1-day pressure ulcer surveys before and after the implementation.
Setting. A 900-bed University Medical Centre in The Netherlands.
Participants. On the days of the surveys, 657 patients were included before the implementation, 735 patients at 4 months after
the implementation, and 755 patients at 11 months after the implementation.
Intervention. Implementation of a hospital guideline for pressure ulcer care combined with the introduction of viscoelastic
foam mattresses on the efficiency of the prevention and treatment of pressure ulcers.
Main outcome measures. Comparisons before versus after the implementation were made regarding the care behaviour of
nurses and the frequency of patients with pressure ulcer.
Results. Inadequate prevention decreased from 19 to 4% after 4 months and to 6% after 11 months (P < 0.001), and inadequate
treatment decreased from 60 to 31% (P = 0.005). Excluding the use of mattresses as a positive indicator for care behaviour,
we found no significant increase in adequate care to prevent pressure ulcers. Also, in adequate treatment activities, we
found no significant difference. Overall, we found a significant decrease in hospital-acquired pressure ulcer frequency from 18
to 13% (P = 0.003) after 4 months and 11% (P < 0.001) after 11 months.
Conclusion. The number of pressure ulcer patients in hospital can successfully be reduced. General measures such as the introduction
of adequate mattresses and guidelines for prevention and treatment are promising tools in this respect.
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