title: Comprehensive programs for preventing pressure ulcers: a review of the literature.
abstract: OBJECTIVE
  The objective of this study was to examine the evidence supporting the combined use of interventions to prevent pressure ulcers (PrUs) in acute care and long-term-care facilities.
  
  
  METHODS
  A systematic review of the literature describing multifaceted PrU prevention programs was performed. Articles were included if they described an intervention implemented in acute care settings or long-term-care facilities, incorporated more than 1 intervention component, involved a multidisciplinary team, and included information about outcomes related to the intervention.
  
  
  RESULTS
  Twenty-four studies were identified. Recurring components used in the development and implementation of PrU prevention programs included preparations prior to the start of a program, PrU prevention best practices, staff education, clinical monitoring and feedback, skin care champions, and cues to action. Ten studies reported PrU prevalence rates; 9 of them reported decreased prevalence rates at the end of their programs. Of the 6 studies reporting PrU incidence rates, 5 reported a decrease in incidence rates. Four studies measured care processes: 1 study reported an overall improvement; 2 studies reported improvement on some, but not all, measures; and 1 study reported no change.
  
  
  CONCLUSIONS
  There is a growing literature describing multipronged, multidisciplinary interventions to prevent PrUs in acute care settings and long-term-care facilities. Outcomes reported in these studies suggest that such programs can be successful in reducing PrU prevalence or incidence rates. However, to strengthen the level of evidence, sites should be encouraged to rigorously evaluate their programs and to publish their results.
authors.affiliation: Boston University School of Public Health, Massachusetts, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Niederhauser
authors.forename: Carol
authors.initials: C
authors.lastname: VanDeusen Lukas
authors.forename: Victoria
authors.initials: V
authors.lastname: Parker
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Ayello
authors.forename: Karen
authors.initials: K
authors.lastname: Zulkowski
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
mesh_terms: D000369:Aged, 80 and over; D002985:Clinical Protocols; D055317:Evidence-Based Practice; D016330:Frail Elderly; D006801:Humans; D033183:Interdisciplinary Communication; D008134:Long-Term Care / Q000458:organization & administration*; D050316:Medical Order Entry Systems / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D017749:Total Quality Management / Q000458:organization & administration*