Can meaningful quality benchmarks be derived from pressure ulcer prevalence data?

The burdensome process of collecting, analysing and reporting pressure ulcer outcome data has changed very little since its introduction some years ago; simply growing in complexity and frequency. Typically, prevalence audit has focused on the scale of negative outcomes i.e. number, severity, size, location and origin of the wound, while missing the opportunity to measure other critical metrics such as concordance with key measures within preventative care protocols. As a result, pressure ulcer assessment remains largely disconnected from patient safety or quality improvement programmes and thus may have little impact on overall outcomes. The data itself is also problematic, with healthcare providers increasingly expected to publish performance against healthcare targets. It is necessary to consider the ramifications of reporting outcome data which has not been normalised against important variations in risk exposure, particularly when more than half of all wounds may be occurring during an episode of supervised care. It is recommended that outcome measures are mathematically adjusted in order to account for population differences over time and between facilities; this will enable accurate trend analysis, 'hot spot' identification and reliable comparison. If pressure ulcer data collection is to have a place in contemporary healthcare systems it must meet the robust standards required for clinical benchmarking. There will be a need to refocus the assessment process to reflect upon the quality of the preventative care delivered in order to improve patient safety.