Nursing home quality and pressure ulcer prevention and management practices.
OBJECTIVE
To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs).


METHODS
Retrospective analysis of a large data set and comparative survey.


METHODS
LTCFs in Missouri.


METHODS
Three hundred sixty-two LTCFs participated in the survey. Three hundred twenty-one facilities had pressure ulcer QI scores between April 1 and September 30, 1999.


METHODS
Pressure ulcer QI scores, Pressure Ulcer Prevention & Treatment Practices Survey.


RESULTS
The mean+/-standard deviation pressure ulcer QI score was 10.9+/-6.2%, with a risk-adjusted score of 15.7+/-8.9% for high-risk residents and 3.1+/-3.6% for low-risk residents. Minimizing head-of-bed elevation to less than 30 degrees was used by fewer than 20% of facilities. More than 40% of facilities used a risk assessment tool that was not evidence based. Fewer than 13% of facilities used the Agency for Health Care Policy and Research pressure ulcer prevention and treatment guidelines. No relationship was found between the number of prevention strategies (P=.892) or the number of treatment strategies (P=.921) and the pressure ulcer QI scores.


CONCLUSIONS
Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment guidelines appear to be rarely implemented. This study provides a basis for developing educational and quality improvement programs and future research related to pressure ulcer prevention and treatment in LTCFs.
Wipke-Tevis
Deidre D
DD
MU Sinclair School of Nursing, University of Missouri-Columbia, 65211, USA. wipke-tevisd@missouri.edu
Williams
Donna A
DA
Rantz
Marilyn J
MJ
Popejoy
Lori L
LL
Madsen
Richard W
RW
Petroski
Gregory F
GF
Vogelsmeier
Amy A
AA
D000368:Aged; D019985:Benchmarking; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research; D006801:Humans; D008923:Missouri / Q000453:epidemiology; D020380:Needs Assessment; D009720:Nurse Clinicians / Q000592:standards; D009730:Nursing Assessment / Q000592:standards; D015403:Nursing Evaluation Research; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards; D012307:Risk Factors; D012308:Risk Management / Q000592:standards*; D017749:Total Quality Management / Q000592:standards