title: Evaluation of the dissemination and implementation of pressure ulcer guidelines in Dutch nursing homes.
abstract: OBJECTIVE
  Annual national prevalence surveys have been conducted in the Netherlands over the past 10 years and have revealed high prevalence rates in Dutch nursing homes. Pressure ulcer guideline implementation is one of the factors that can influence prevalence rates. Previous research has shown that these guidelines are often only partly implemented in Dutch nursing homes. Reasons for this lack of pressure ulcer guideline implementation are not known. Therefore, the aim of this study is to investigate the current situation regarding pressure ulcer guideline dissemination and implementation in Dutch nursing homes.
  
  
  METHODS
  Semi-structured interviews were conducted in eight nursing homes in the Netherlands from January till December 2008. In each nursing home, interviews were held with eight persons.
  
  
  RESULTS
  The implementation of pressure ulcer guidelines was lacking in some of the nursing homes. Risk assessment scales were often not used in practice, repositioning schemes were not always available and, when they were, they were often not used in practice. Knowledge about guideline recommendations was also lacking and pressure ulcer education was inadequate. Barriers to applying guideline recommendations in practice were mostly related to personnel and communication.
  
  
  CONCLUSIONS
  The implementation of pressure ulcer guidelines does not seem to be successful in all nursing homes and needs more attention. Barriers mentioned by the interviewees in applying guideline recommendations need to be addressed. Providing adequate education for nursing home staff and increasing attention for pressure ulcer care can be the first steps in improving the implementation of pressure ulcer guidelines.
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. e.meesterberends@zw.unimaas.nl
authors.forename: Esther
authors.initials: E
authors.lastname: Meesterberends
authors.forename: Ruud J G
authors.initials: RJ
authors.lastname: Halfens
authors.forename: Christa
authors.initials: C
authors.lastname: Lohrmann
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.forename: Rianne
authors.initials: R
authors.lastname: de Wit
mesh_terms: D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education; D011050:Policy Making; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment