|Type of Patient Safety Practice|
|Clinical Practice (CP)||
Related practices from PaSQ database
|“Best fit” category of the reported practice|
|Patient safety theme the SCP/clinical risk management practice is aimed at|
|Reduction in the incidence of health care acquired pressure ulcers|
|Objective of the CRM practice|
|Pressure Ulcers can be avoided with the right knowledge and use of appropriate prevention measures by health care staff . Pressure ulcers endure a cost to the health care systems across Europe, as high as 25 billion € a year which equates to almost one sixth’ [17 %] of the total EU budget . It is now more important than ever to adopt interventions that are not only effective in delivering high quality of care, but are also cost-effective. The EU can play a significant role in sharing best practices for pressure ulcer prevention and treatment in health care settings particularly through the Joint Action on Patient Safety and Quality of Care. Different wounds require different treatment and although evidence-based guidelines for healthcare professionals are available for treatment, they are often not implemented in many healthcare settings [1, 20, 21]. None the less, the incidence of wounds can be considerably reduced in every Member States by following basic clinical guidelines .|
|Short description of the CRM practice, including any references for further information|
|Risk assessment is the first step in planning pressure ulcer prevention strategies . The purpose of risk assessment is to identify those at risk of pressure ulcer development, by identifying key factors considered important . Following this assessment, effective prevention interventions may be planned and implemented . Pressure ulcer prevention involves a range of interventions, such as nutritional care , skin care , use of pressure redistribution surfaces , and repositioning |
|Innovator of the SCP, country of origin|
|United States of America, Ireland, the Netherlands, Wales and England.|
|Involved health care staff|
|Pressure ulcers are not related to a specific health care group. However, care givers, such as nurses, are relevant involved professionals.|
|Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references|
|The “skin bundle” has been/are currently tested in Wales and England as well as Denmark. Please find information above.|
|Summary of evidence for effectiveness, including references|
|Pressure ulcers are largely a preventable problem, yet despite the advances in technology, preventative aids and increased financial expenditure, they remain a common and debilitating concern . The presence of a pressure ulcer is considered to be an indicator of quality of care  and incidence figures reduce society’s confidence in the health service’s ability to deliver care that is timely, appropriate and effective . Pressure ulcers impose a significant financial burden on health care systems, with current estimates suggesting that approximately 4% of health care budgets is spent on pressure ulcer management . The literature clearly articulates the impact of pressure ulcers on the individual’s quality of life, noting that the emotional, physical, mental and social domains of life are all profoundly affected . It is of concern that pressure ulcers are also associated with increased mortality. Indeed, evidence suggests a higher incidence of death among those with pressure ulcers when compared to their matched counterparts without pressure ulcers .
Indeed, studies have shown that with effective preventative strategies, a reduction of up to 73 % of the pressure ulcer incidence is possible. Indeed, a recent study  demonstrated that use of an alternate method of repositioning reduced the incidence of pressure ulceration by 8 per 100 patients [11%-3%]. The study reiterated that repositioning individuals at risk of pressure ulcer development [one component of pressure ulcer prevention strategies] makes both economic and clinical sense, thereby supporting the EPUAP/NPUAP 2009 guidelines . In addition, the Institute of Health Improvement in the USA ahs transferred its patient safety ‘Skin Bundles’ to Europe, with Wales and parts of England adopting this. Early results demonstrate hundreds of ‘pressure ulcer free’ days (National Leadership and Innovation for Health, 2009).
Despite evidence demonstrating the efficacy of pressure ulcer prevention strategies in reducing pressure ulcer incidence figures, there is a corresponding evidence base suggesting a lack of integration of best practice within clinical practice. For example, from a European perspective the mean use of pressure redistribution devices is varies from 28%  to 97.3% . Whereas, the mean use of repositioning for pressure ulcer prevention varies from 0%  to 37% .
|Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references|
|In 2009 the European Pressure Ulcer Advisory Panel and the National Pressure Ulcer Advisory Panel, USA, developed international guidelines for the prevention and management of pressure ulcers . These guidelines reflect the diversity of clinical settings where pressure ulcers occur, for example, primary and secondary care, older person services and acute medical specialities. Furthermore, the guidelines are based on best evidence which has been systematically searched, retrieved, appraised and outlined within the document. In addition, the work has been subject to peer review to ensure that the contents provide appropriate guidance for practice. Dissemination does not necessarily imply implementation . For example, despite the presence of guidelines in the Netherlands since 1991, knowledge about pressure ulcer prevention had improved little over the subsequent 12 years . Conversely, other clinical settings have shown significantly improved outcomes with systematic implementation and evaluation of guidelines .|
|Summary of available information on feasibility, including references|
limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices [22, 23].Methods for overcoming barriers:
Use of a multifaceted dissemination and implementation strategy increases the likelihood of uptake in practice Diffusion of innovation theory 
Transtheoretical model of behaviour change 
Health education theory 
Social influence theory 
Social ecology 
|Existing implementation tools, including references|
Selected risk assessment tools: Braden and Norton
|Potential for/description of patient involvement in the CRM practice, including references|
|Patients should be afforded more say in decisions about their care and treatment, more opportunity to make choices with information and support as a means of securing better care and better outcomes |
|Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))|
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 Posnett J, Gottrup F, Lundgren H, Saal G. The resource impact of wounds on health-care providers in Europe. Journal of Wound Care. 2009;18:154-61.
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