Journal of Clinical Nursing vol:19 issue:13-14 pages:1803-1811
Aims and objectives
To investigate the effect of the implementation of a patient and family education programme
for pressure ulcer prevention in an organisation for home care nursing on guideline adherence
and on prevalence and severity of pressure ulcers and to examine the determining factors for
the application of measures for pressure ulcer prevention.
Quality improvement programs in pressure ulcer prevention are not always successful.
Implementation study using a pretest-posttest design. Data were collected in three probability
samples. The first posttest data collection was held after six months, the second after 18
Statistical analysis was used, comparing the pretest sample and the second posttest sample.
After 18 months, the proportion of subjects with adherent measures had increased from 10.4-
13.9%, the proportion of subjects with non-adherent measures decreased from 45.7-36.0%,
the proportion of subjects without pressure ulcer prevention increased from 43.9-50.1% (p <
0.0001, Chi-square test). Subanalysis revealed that a positive change in guideline adherence
was observed principally in the group at risk. Better process-of-care indicators were
associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses’
judgement of a patient risk status was the most important factor for applying preventive
measures. Furthermore, application of pressure ulcer prevention was determined by higher
age (from the age category of 70-79 years), higher ADL dependency, higher than baseline
mobility score and the presence of a pressure ulcer.
Guideline adherence in pressure ulcer prevention changed significantly after implementation
of the education programme. There might have been inconsistencies in the nurses’ risk
Relevance to clinical practice
Quality of pressure ulcer prevention improved, but several items for improvement remain.
Adaptation of risk assessment procedures is needed.