Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland.
Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland.
PLoS One. 2020 May 29;15(5):e0233471. doi: 10.1371/journal.pone.0233471. eCollection 2020.
Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes.
Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses.
A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers.
Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
压疮是住院养老院患者常见的并发症，对生活质量和整体健康有严重影响。此外，溃疡治疗费用高昂。多项研究表明，压疮预防具有成本效益。审核和反馈方案有助于改善压疮预防的专业实践，从而减少其发生。本研究旨在通过前瞻性纵向研究，分析在 1 年和 2 年随访时，审核和反馈方案对降低养老院压疮发生率和增强预防措施依从性的有效性。
2015 年、2016 年和 2017 年在日内瓦州（瑞士）的养老院中测量压疮的现患率和预防措施。每次调查后 2 个月向养老院参考护士提供口头和书面反馈。
2015 年和 2016 年共有 27 家养老院参加了该方案（4607 名患者），2017 年有 15 家继续参加（1357 名患者）。患者主要为女性，平均年龄>86 岁，中位住院时间约 2 年。该方案显著改善了两项预防措施：患者翻身和防压疮床或床垫。它还降低了参加所有 3 年的养老院中获得性压疮的发生率（从 2015 年的 4.5%降至 2017 年的 2.9%，p<0.035），特别是在那些有更多压疮患者的养老院中。
审核和反馈在养老院的区域层面相对容易实施，可以增强预防措施的依从性，降低养老院的压疮发生率。
