GRP-025 Application of a Pressure Ulcer Prevention and Treatment Protocol in the Fatebenefratelli and Ophthalmic Hospital in Milan
Background Pressure ulcers are very common in hospitalised patients and if not prevented or properly treated may increase the length of hospitalisation, infections due to complications, and patient suffering. Prevention is thus relevant for high quality care. To improve the quality of care and to monitor the incidence of pressure ulcers, a multidisciplinary team was created in our hospital in 2009, and a diagnostic and therapeutic pressure ulcers protocol was defined (‘Percorso Diagnostico Terapeutico Assistenziale Lesioni da Pressione’).
Purpose To describe the verification, performed by the multidisciplinary team, of the correct use of the protocol, using the indicators specified in the protocol itself.
Materials and Methods The protocol, created from the guidelines already in use in the hospital, was implemented with the definition of operational tools for the verification of its application. Adherence to the protocol is intended to prevent and provide the best treatment for pressure ulcers. Two analyses (one in 2010 and one in 2011) of the clinical charts were performed in order to cheque the adherence of the health care professionals to the use of the procedure: this was evaluated using a cheque list composed of nine criteria, each of which was assigned 1 point if ‘correct’ and 0 if ‘incorrect’.
Results In 2010 a total of 214 clinical charts were analysed: in general, data was collected correctly (57% of cases). Pressure ulcers were properly identified and prevented in 37% of cases: only some nurses follow the guidelines in the detection and treatment of injuries. Of patients with pressure ulcers, 36% were properly treated. The departments that mainly detected a risk of pressure skin damage and prevented it following the procedure for the treatment of lesions were Neurosurgery, Medicine, and Cardiology. A further analysis of 62 clinical charts in 2011 showed that in 52% of cases, pressure ulcers were correctly identified, but in only 5% of cases were they then properly treated. A third analysis is ongoing, with the aim of identifying and correcting errors in the treatment of the ulcers. A poster will also be distributed to departments, for quick reference to the treatment protocol.
Conclusions The protocol is a practical tool applicable in the various departments. Verification of its correct use showed a low adherence to the guidelines: it is fundamental continuing the training of the staff to achieve the required standard. Among the objectives for 2013, another audit with a modified cheque list will be performed, involving a greater number of health care professionals.
No conflict of interest.