title: The effect of a simple 3-step pressure relieving strategy for preventing pressure ulcers: an explorative longitudinal study from 2002-2011.
abstract: OBJECTIVE
  Pressure ulcers (PUs) still form an important and distressing problem in Dutch nursing homes. Pressure ulcer prevention protocols are generally based on current guidelines. The authors developed an alternative 3-step protocol to help prevent pressure ulcers. The effects of this new 3-step protocol on the prevalence of pressure ulcers in patients at risk of developing PUs in the Avoord nursing homes in Etten-Leur/Zundert (Netherlands) were calculated. In addition, the protocol's general cost effects were explored.
  
  
  METHODS
  Data on the prevalence of PUs and the use of preventive measures were derived from the annual independent International Prevalence Measurement of Care Problems of Maastricht University (Landelijke prevalentiemeting Zorgproblemen [LPZ]). This annual measurement was implemented in 1998 and measures care problems such as the prevalence of PUs and related preventive measures. Data on patients at risk of developing PUs at the Avoord nursing homes in Etten- Leur/Zundert (Netherlands) were analyzed and compared with national data between 2002 and 2011.
  
  
  RESULTS
  The introduction of the 3-step protocol resulted in a significant reduction of the nosocomial prevalence of category 2-4 PUs. The prevalence was reduced from 8.7% to 0.5% during the first year and remained stable at about 2% throughout the rest of the study period. The prevalence at the national level also decreased during this period, but not as much, and was still significantly higher in 2011. The use of alternated systems decreased to almost 1%. Use of static air mattresses showed an almost linear rise in the Avoord nursing homes from the start of the implementation of the protocol, while the trend for both types of mattresses remained stable on a national level. Introducing the static air mattress instead of the more expensive alternating mattresses helped to reduce the mean daily costs of mattresses at the Avoord nursing homes by more than 70% compared to national figures. The workload of the nursing staff decreased as well due to the reduction of repositioning.
  
  
  CONCLUSIONS
  The introduction of the 3-step protocol showed to be effective. The prevalence of PUs and the mean daily costs were reduced to, and have been sustained at, a significantly lower level. ﻿﻿﻿.
authors: Avoord Zorg en Wonen, Etten-Leur, the Netherlands; Faculty of Health, Medicine and Life Sciences, Caphri/Department of Family Medicine, Maastricht University, Maastricht,the Netherlands; email: martin_van_leen@zonnet.nl.
authors: Martin W F
authors: MW
authors: van Leen
authors: Faculty of Health, Medicine and Life Sciences, Caphri/Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
authors: Jos M G A
authors: JM
authors: Schols
authors: Department of Plastic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
authors: Steven E R
authors: SE
authors: Hovius
authors: Faculty of Health, Medicine and Life Sciences, Caphri/Department of Health Services Research, Maastricht University, Maastricht, Netherlands.
authors: Ruud J G
authors: RJ
authors: Halfens