Presentation on theme: "Succesful implementation of a multi- modal pressure ulcer prevention program in nursing homes Eva, Nuria, Luk, Theo, Cecile, Niina, Vivi, Antoinette."— Presentation transcript:
Succesful implementation of a multi- modal pressure ulcer prevention program in nursing homes Eva, Nuria, Luk, Theo, Cecile, Niina, Vivi, Antoinette
Rationale Pressure ulcers Pressure ulcer prevalence in nursing homes (8.8%- 29.2%) in Europe (Demarre et al. 2011) Treatment costs ($10000-$86000 (median: $27000) per pressure ulcer (Clarke et al. 2005); 1.4 billion – 2.1 billion pounds in UK (Bennet et al. 2004) Increases nursing time by 50% (Clarke et al. 2005) Pressure ulcer reduce quality of life in patients: pain, depression, anxiety, immobilization, reduced social participation (Goreckie et al. 2009) Compliance with evidence-based guidelines is low (e.g. 41% in Saliba et al )
Rationale Nursing homes Vulnerability in residents is high, resulting from reduced activity or mobility limitations, increased age. Nursing homes have a higher proportion of lower level educated care providers (Demarre et al. 2011). Nursing homes lack pressure ulcer prevention strategies more often compared to hospitals (Kwong et al. 2011).
Objectives Design and facilitate implementation of practice- based evidence changes associated with decreases in pressure ulcer development and impact on staff competencies and skills in nursing homes Evaluation of the effectiveness of the implementation strategy.
Study design Pragmatic cluster randomised-controlled trial (Zwarenstein et al., 2009) Convenience sample of 3 nursing homes 4 wards per nursing home of which 2 wards randomised to control and 2 to intervention Preceded by pilot-study
Improvement strategy multi-modal implementation strategy 1 day focused training courses for nurses Feedback to the wards through ward manager, and the discussion of action plan with nursing team (active participation element) baseline and 1 month, supporting the leadership in the change process (external facilitator available) 2-3 role models ”champion” per ward (selected with specific criterias, volontary) as social influencing factor
Measurements Pressure ulcer prevalence surveys (Van derwee et al. 2007) Observation of pressure ulcer prevalence Observation of materials in residents rooms Check patient documentation for risk assessment Check patient documentation for prevention interventions Nurses openness to redesign (survey). Knowledge and skills before and after the training (Beeckman et al. 2011).
Evaluation Effect evaluation: Pressure ulcer prevalence, proportion of risk assessement and interventions (baseline, 1 month, 3 month), teamwork, knowledge and skills increase, milestones achieved (level) Process evaluation: how many nurses attended the training? Did problems arise? Did barriers by the PARIHS Framework (Rycroft-Malone 2004) occur, interview the providers (ward manager, nurses, patients) about evidence, context, facilitation? Assess team's openness to redesign Economic evaluation (cost-benefit): work time of nurses attending and educators versus total estimated cost of pressure ulcers (based on difference in prevalence)
Total Staff (full-time PhD student) Staff (40% post-doc) Personal computer Research stays and participation at conferences Software license General costs (photocopies, scientific literature, office equipment) Open acces publishing Budget
Thank you! The European Academy of Nursing Science 10