A Secondary Analysis of Longitudinal Prevalence Data to Determine the Use of Pressure Ulcer Preventive Measures in Dutch Nursing Homes, 2005-2014

Pressure ulcers (PUs) are an important and distressing problem in Dutch nursing homes. A secondary analysis of longitudinal data from the Dutch National Prevalence Measurement of Care Problems (LPZ) - an annual, multicenter, point-prevalence survey - was conducted for the years 2005-2014 to determine the use of specific recommended PU preventive measures from the European Pressure Ulcer Advisory Panel 1998, the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel 2009, and the 2002 and 2011 Dutch PU guidelines. Preventive care was investigated among nursing home residents at risk for PUs and included skin care (moisturization); nutritional and hydration status assessment and optimization; and pressure redistribution involving mattresses, cushions, and heel pressure-relieving strategies and devices. Following abstraction from the study database, data for 3 at-risk groups were distinguished: 1) residents with a Braden score of 17, 18, or 19; 2) residents with a Braden score below 17; and 3) residents with a PU. Data were aggregated at the institutional level. Differences were tested with multiple regression analyses. The mean number of residents over the study period was 5435, the mean age was 82.8 years, and the mean Braden score was 15.3. None of the recommended preventive measures from the guidelines consulted was applied 100% of the time: preventive skin care measures were used in 25.1% to 63.8% of cases and dehydration and/or malnutrition were identified and managed in 27.8% to 65.6% of patients. Pressure redistribution with special types of mattresses was used in 85.2% of patients, cushions in (wheel) chairs were used in 64.8% of patients, and heels were offloaded in 57.8% of patients. The results regarding repositioning for the 3 groups, respectively, showed a maximum use of 9.7%, 30.3%, and 65.6%; the higher the PU risk, the more preventive measures were used. Although the results show a decrease in the percent of category 2 through category 4 PUs from 16.6% to 5.5% and a trend toward increased use of preventive measures (more skin care, attention for dehydration/malnutrition, use of floating heels/heel devices, and pressure-relieving systems when a PU was present), the reason why measurements were suboptimally used remains unclear. Further research to address the application of guidelines in daily practice is needed.