550 / Prevention of decubitus ulcers for inpatients

SPAIN
Classification of the PSP
Type of Patient Safety Practice Potentially Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Decubitus ulcers
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Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
General aims:
1. Prevent decubitus ulcers in long-term inpatients
2. Improve health status of patients with decubitus ulcers in the hospital

Specific aims:
1. Assess the ulcers prevalence, according to their classification and location, in patients hospitalized at the University Clinic of Navarra
2. Define the patient´s profile who develops ulcers in our context
3. Analyze the risk assessment at the patient admission and if this has been reassessed
4. Evaluate the Information on pressure ulcers that is recorded
Description of the Patient Safety Practice
 
We carried out a prevalence study of pressure ulcers in our hospital in order to have an in-depth knowlegde of the situation. (june 2011)
A cross-sectional study was conducted using a convenience sample. The collection of data was carried out using a questionnaire developed and piloted. The data analysis was descriptive and inferential statistics. This study has allowed us to know the current situation about which we assume and implement improvement actions as the dissemination of the obtained data, training professionals, unification of the scale of the risk assessment and improvement of records and re-evaluation of pressure sores.
PRESSURE ULCER PREVALENCE STUDY (UPP)
The study was conducted in June 2011 (from 7 to 9) at the University Clinic of Navarra. It is a University Hospital of tertiary level, characterized by its high medical specialization. The average length of stay in the hospital is 5.6 days.
All the patients hospitalized for longer than 24 hours were included in the study, except those from Psychiatry Unit, Women´s & Newborn Unit (Maternity) or those who were medically unstable or at the end of life.
Data was collected by eight nurses that were previously trained for UPP assessing and registration. This was considered important for reducing variability.
A questionnaire was the tool used for data collection. It was proposed by researchers and previously piloted with a reduced group of patients.
This questionnaire included the following variables:
•    Age and sex
•    Inpatient unit
•    Level of UPP risk (using the Norton risk scale in inpatients units and the Waterlow risk scale in the intensive care unit)
•    Presence of UPP: number, stage (European Pressure Ulcer Advisory Panel classification system) and location of UPP
•    Risk assessment at the patient admission and if this has been reassessed
•    Information on pressure ulcers recorded in the patient record
Firstly, every UPP was assessed and classified according to the the risk scale. Then a risk assessment of the patient was carried out. After that, the UPP was reevaluated by other nurse. If there was no agreement between them, a third evaluation was developed.
Results:
•    138 patients (87,3%) of inpatients were assessed. 12 from 138 developed UPP (8,8%)
•    The pressure ulcers were mostly stage I (58,33%) and were located in the sacral area (33,3%).
•    Patients who developed UPP in our context are around 65, the majority were male (73,68%).
•    The degree of completion of risk assessment of UPP is 84%. However, it is necessary to improve the record of the UPP in the medical history of the patient in our hospital.
IMPROVEMENT ACTIONS
The improvements developed, after the study, were:
1. Training on UPP prevention and treatment was oriented to all professionals related to that topic (nurses, auxiliary nurses and health workers). This training was face-to-face and also online.
2. Update the Pressure Ulcer Prevention and Treatment Guide of the hospital
3. Standardize the use of the Braden scale to assess the UPP risk
4. Distribute posters for inpatients units with useful information obtained from the guide (ulcer pressure treatment and available products in our hospital)
5. Develop a pressure ulcer prevalence study in other areas, such as surgical area
COST
The cost of the pressure ulcer prevalence study is not detailed because it is considered a part of the Quality Department activity. There is not information of the economic impact of the improvement actions because they were included in the Continuous Training Area activity.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
No
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Scientific staff / researchers
Administrative support (secretary, clerk, receptionist etc.)
Quality manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Not known or not relevant
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Not relevant
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Juana Labiano
Country: SPAIN
Organisation: Clínica Universidad de Navarra, Navarre
E-mail: jlabiano@unav.es
Phone: There is no specified text here
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