Pressure Ulcer Prevention: How Do Perceptions On Prevention And Current Initiatives Relate To Actual Pressure Ulcer Prevalence?
Alison L. Wong, MD, MSE1,2, Gurjot S. Walia, BS2, Ricardo J. Bello, MD, MPH2, Carla S. Aquino, MSN2, Justin M. Sacks, MD, MBA2.
1Dalhousie University, Halifax, NS, Canada, 2Johns Hopkins University, Baltimore, MD, USA.
PURPOSE: Hospital acquired pressure ulcers (HAPUs) remain a significant problem, despite implementation of numerous prevention initiatives. We aimed to assess the relationship between healthcare professionals’ (nurses, residents, and attending physicians) perceptions of the importance of HAPU prevention and actual HAPU prevalence. Additionally, we were interested in their perception of the effectiveness of existing prevention initiatives and devices, as well as their satisfaction with the same. We hypothesized that perceptions of the importance of pressure ulcer prevention would not be correlated with pressure ulcer prevalence. We also hypothesized that there would be low perceived effectiveness for, and satisfaction with, existing initiatives.
METHODS: An online survey was developed using the 11 questions from the AHRQ’s Views on Pressure Ulcer Prevention validated survey. Additionally, participants were asked to rate their perceived effectiveness and satisfaction on: education, visual tools, skin care, repositioning, pressure-offloading bandages, pressure-offloading mattress pads, air mattresses, and documentation of patient movement. All questions used a 5 point Likert scale. The survey was distributed to nurses, residents and attending physicians across all inpatient and perioperative departments through a human resources mailing list, with approval by our Institutional Review Board. The results of the survey were then compared to quarterly pressure ulcer prevalence data by inpatient unit (medical, surgical, oncology, ICU) to assess for any significant correlation. Statistical analysis using ANOVAs and linear regression was done using Stata.
RESULTS: In total 839 healthcare professionals completed the survey (579 nurses, 131 residents, 119 attending physicians), representing all inpatient units as well as perioperative and emergency departments. The mean score for the AHRQ survey was 42.5 out of 55, above the cut-off score of 40 denoting positive perceptions on the importance of prevention. There was a statistically significant difference between professions (P < 0.01; nurses = 43.3, nurse practitioners = 44.6, residents = 40.3, attending physicians = 41.3) and no interaction between profession and department or unit (P = 0.462). Repositioning was felt to be the most effective intervention (4.54±0.64), followed by skin care (4.21±0.75) and pressure-offloading mattress pads (4.20±0.73). Posters were felt to be the least effective (3.31±0.99). Respondents generally rated satisfaction much lower, with no single initiative significantly better than the others (range 3.21-3.79). Perceived effectiveness and satisfaction were all positively correlated. HAPU prevalence ranged from 1-29% (medical = 3, surgical = 1, oncology = 1, ICU = 29). There was not a significant correlation between AHRQ scores and prevalence of HAPUs by unit (r = -0.60, P = 0.402).
CONCLUSION: Despite an overall positive perception of the importance of pressure ulcer prevention, HAPUs continue to be a major problem. Contrary to our hypothesis, many current initiatives are felt to be effective. There was no correlation between perceptions on the importance of prevention and HAPU prevalence, suggesting that prevention methods are not as effective as thought or they are not being used as widely as they should. Further research should take advantage of these positive attitudes by prospectively investigating novel interventions, especially in the ICU setting.
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