Assessing the adequacy of pressure ulcer prevention in Belgian geriatric hospital wards

Introduction: Pressure ulcers are a serious complication of hospitalisation in terms of increased morbidity, mortality and health care expenditure as well as patient suffering. Multipathology and ageing make older patients vulnerable to pressure ulcers. The main aim of this study was to obtain insight into the adequacy of preventive measures for pressure ulcers in Belgian geriatric hospital wards. Methods and Materials: The setting for this cross-sectional multicentre prevalence study consisted of the Belgian geriatric hospital wards. All hospitals were invited to participate in this study. The methodology to measure pressure ulcer prevalence developed by the EPUAP was used. Results: The total sample consisted of 3222 geriatric patients (70 hospitals). The prevalence of pressure ulcers category 1–4 was 18Æ9% and of category 2–4 12Æ3%. Sacrum (45Æ4%) and heels (43Æ2%) were the most frequently affected locations. Only 12% of the at risk geriatric patients received fully effective prevention. The majority of the at risk patients (73%) received partly adequate prevention. Generally, a higher percentage at risk patients received effective prevention in an armchair (36Æ5%) than in bed (28Æ3%). Conclusion: The pressure ulcer prevalence in Belgian geriatric hospital wards was high according to international standards. Regretfully, the adequacy of pressure ulcer prevention in geriatric hospitals was suboptimal. Only one out of 10 patients at risk for pressure ulcers received fully adequate prevention. Conversely, many patients not at risk received some kind of preventive measures which was an unnecessary and expensive strategy. Barriers for adequate preventive pressure ulcer care such as knowledge, motivation, attitude, priority, and availability of equipment may partly explain these low figures. A challenge for the hospitals is to disseminate and implement pressure ulcer guidelines to individual wards and to address barriers