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J Clin Nurs. 2010 Jul;19(13-14):1803-11. doi: 10.1111/j.1365-2702.2009.03170.x.

Implementation of a guideline for pressure ulcer prevention in home care: pretest-post-test study.

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Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.



To investigate the effect of the implementation of a patient and family education programme for pressure ulcer prevention in an organisation for home care nursing on guideline adherence and on prevalence and severity of pressure ulcers and to examine the determining factors for the application of measures for pressure ulcer prevention.


Quality improvement programmes in pressure ulcer prevention are not always successful.


Implementation study using a pretest-post-test design. Data were collected in three probability samples. The first post-test data collection was held after six months, the second after 18 months.


Statistical analysis was used, comparing the pretest sample and the second post-test sample.


After 18 months, the proportion of subjects with adherent measures had increased from 10·4-13·9%, the proportion of subjects with non-adherent measures decreased from 45·7-36·0%, the proportion of subjects without pressure ulcer prevention increased from 43·9-50·1% (p<0·0001, Chi-square test). Sub-analysis revealed that a positive change in guideline adherence was observed principally in the group at risk. Better process-of-care indicators were associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses' judgement of a patient risk status was the most important factor for applying preventive measures. Furthermore, application of pressure ulcer prevention was determined by higher age (from the age category of 70-79 years), higher dependency for the activities of daily living, higher than baseline mobility score and the presence of a pressure ulcer.


Guideline adherence in pressure ulcer prevention changed significantly after implementation of the education programme. There might have been inconsistencies in the nurses' risk judgement.


Quality of pressure ulcer prevention improved, but several items for improvement remain. Adaptation of risk assessment procedures is needed.

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