title: Pressure ulcer prevention in homecare: do Dutch homecare agencies have an evidence-based pressure ulcer protocol?
abstract: OBJECTIVE
  The purpose of this study was to gain insight into the availability and quality of protocols for pressure ulcer prevention in homecare agencies in the Netherlands.
  
  
  METHODS
  A descriptive study was completed.
  
  
  METHODS
  Forty-one homecare agencies in the Netherlands that provide nursing care were queried.
  
  
  METHODS
  Three instruments were used to collect data: (1) a structured questionnaire containing 46 closed and open-ended questions, (2) a checklist used by experts to analyze the protocols for conformity to guidelines, and (3) a tool used to generate a numerical score for each protocol based on the experts' reviews.
  
  
  METHODS
  A questionnaire was mailed to all homecare agencies in the Netherlands that provided nursing care. The quality of each protocol was judged and scored by 3 pressure ulcer prevention experts. The scores were analyzed using descriptive statistics.
  
  
  RESULTS
  A pressure ulcer protocol was available in 78% of the agencies. Seventy-five percent had at least 1 wound care nurse who spent an average of 10 hours per week on pressure ulcer prevention. In 20% of the agencies, no introduction or instruction was given to the nurses when the protocol was implemented. In 25% of the agencies, nurses did not participate in the revision of the protocol. At the end of 2003, only 13% of the agencies had executed 1 or more revisions of their protocol since 2002, when the last Dutch pressure ulcer guideline was introduced. The 26 pressure ulcer prevention protocols had a mean score of 47 points out of a maximum of 100 points (range 9 to 82; SD, 18).
  
  
  CONCLUSIONS
  Although the use of protocols is considered an important adjunct in the prevention of pressure ulcers, 22% of the participating agencies did not have a pressure ulcer prevention protocol and 25% did not have wound care nurses, indicating a need for further promotion of standardized pressure ulcer prevention strategies. In addition, the available protocols were frequently of low quality or outdated, reflecting a need for increased attention to current and accurate tools to guide nursing practice.
authors.affiliation: University of Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands. pdmc@wxs.nl
authors.forename: Lidice M
authors.initials: LM
authors.lastname: Chaves
authors.forename: Mieke H F
authors.initials: MH
authors.lastname: Grypdonck
authors.forename: Tom
authors.initials: T
authors.lastname: Defloor
mesh_terms: D015984:Causality; D002985:Clinical Protocols / Q000592:standards; D003152:Community Health Nursing / Q000458:organization & administration; D003659:Decision Making, Organizational; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D018574:Home Care Agencies / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D009720:Nurse Clinicians / Q000458:organization & administration; D024802:Nurse's Role; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D018570:Risk Assessment; D017592:Skin Care / Q000451:nursing / Q000592:standards; D011795:Surveys and Questionnaires