Prevention of pressure ulcers in patients with hip fractures Definition, measurement and improvement of the quality of care

Abstract: The aims of the present thesis were to survey the prevalence and incidence ofpressure ulcers in patients with hip fracture and to investigate nursing staffknowledge and documentation regarding pressure ulcer prevention for the samepatient group. Another aim was to test the effect of three preventive interventions:risk assessment and pressure ulcer grading, a pressure-reducing mattress and aneducational programme. Experimental, comparative and descriptive designs wereused and quality improvement philosophy guided the research. In 1997 and 1999, atotal of 124 and 101 patients > 65 years with hip fractures were included andfollowed with risk assessment and skin observation. Audit of patient records, aquestionnaire to nursing staff and a focus group interview were also employed.The findings from the first studies showed that 20% of the patients hadpressure ulcers on arrival to the hospital. During the hospital stay, 55% developednew pressure ulcers. Nursing staff knowledge and documentation regardingpressure ulcer prevention was unsatisfactory. An extensive educational programmewas developed and conducted in 1998. Twenty-five registered nurses participatedfrom the hospital and the community setting.There were no significant differences in the prevalence/incidence ofpressure ulcers between the experimental and control groups in the twoexperimental studies. However, there was a significant reduction of the incidence ofpressure ulcers between 1997 and 1999 (from 55% to 29%). The focus group indicatedthat there had been changes since 1997 in nursing and treatment routines in theAccident and Emergency Department and in the orthopaedic wards.