EUROPEAN PRESSURE ULCER ADVISORY PANEL

PROGRESS ACROSS EUROPE

Jeen RE Haalboom
Department of Internal Medicine,
University Hospital,
Utrecht, The Netherlands

During the second EPUAP conference in Oxford 1998 the results of a questionnaire among the representatives of the participating countries were presented. Using a management schedule questions were arranged around items such as registration, prevalence and incidence, the use and validation of risk assessment tools, standards for prevention and treatment, normations for anti-pressure ulcer devices and contacts with politicians at local, national or European levels. It was evident that in most countries attempts were made in all those respects, but that there were also large differences. In some countries all aspects were dealt with, in some others only some knowledge seemed to grow.

This year a second questionnaire was send also to new participating countries (Greece, Scotland, Portugal) and in the results they are listed also. The results of 1999 indicate that in most countries there is improvement in the awareness of politicians, in actual contacts with them and even in the interest of the minister of health, furthermore the introduction of normation is of growing importance. On the field of risk assessment tools only in Sweden there are validation attempts, in all other countries this seems to be a minor item. In 1999 almost all European countries are represented in EPUAP. During this year also Germany joined the group. For the year 2000 the questionnaire will be repeated.

UPDATE ON THE INDIVIDUAL EUROPEAN COUNTRY PRESSURE ULCER PROGRAMMES

Mrs Helvi Hietanen
Helsinki University Central Hospital,
Department of Plastic Surgery,
Chairperson of Finnish Wound Care Society,
Finland

National
National statistics concerning the number of bed days, gender and age of the patients including the length of their hospitalisation. (STAKES, National Research and Development Center for Welfare and Health).

• figures drawn from all areas of hospital-care through Finland
• these statistics show only patients who, according to their first diagnosis, suffer from pressure ulcers.
• annually approximately 19,000 bed days

Continuing follow-up concerning the prevalence of pressure ulcers in recently handicapped tetraplegic and paraplegic patients during the rehabilitation phase (Association of the disabled in Finland/Käpylä Rehabilitation Centre).

Local
Several hospitals have started to concentrate their attention to prevalence of pressure ulcers and purchase of aides due to the fact that it has been shown by prevalence studies that high prevalence of pressure ulcers is a human problem which requires both personnel and economic resources.

Studies
Some scientific studies have done on the prevalence of pressure ulcers, their properties and costs including applicability of using risk classifications. The sample of pressure ulcer patients was the patient population of one day of eleven hospitals and five out-patient clinics in the southern part of Finland (total population 500,000). There were 186 pressure ulcer patients and totally they had 300 pressure ulcers.

Publications
A text book concerning wound treatment (will be completed in the year 2000). Articles about pressure ulcers are published in professional journals.

• Finnish Wound Care Society
• Haava (Journal of wound since Dec 1998)
• Pressure ulcer theme issue Dec 4/99
• EPUAP prevention and treatment guidelines will be published after translation.

EPUAP leaflets have a nationwide distribution. Wound conferences are organised annually. An expert panel will be organised during winter 1999–2000. Its topic is how to take the EPUAP prevention and treatment guidelines into use. Organisation of a wound treatment education event for educated nursing personnel in co-operation with School of Social Work and Health Care (City of Mikkeli).

SECOND NATIONAL PRESSURE ULCER PREVALENCE SURVEY IN THE NETHERLANDS

Gerrie J.J.W. Bours, RN MSN, Researcher, University Maastricht, Department of Nursing Science, Ruud JG Halfens, PhD, Associate Professor, University Maastricht, Department of Nursing Science, Kris Joosten, Research Assistant, University Maastricht, Department of Nursing Science and Maarten Lubbers, MD, Surgeon at the Academic Medical Centre of the University of Amsterdam, The Netherlands.

Last year, on the 26 May 1998, the first national pressure ulcer prevalence survey was carried out across 89 health care providers covering various settings ranging from residential homes to University Teaching Hospitals on a voluntary basis. This project, initiated by the Dutch National Steering Group on Pressure Ulcers, surveyed 16,344 patients with the purpose to gain insight into the prevalence, which may stimulate the health care settings to enhance their policy focusing on the prevention of pressure ulcers. The overall prevalence on this first survey was 23.2% with a range from 13.2% in University Teaching Hospital to 34.8% in a institution for the physical handicapped.

On 20 April 1999 the second survey was conducted. In general the same institutions participated in this second national prevalence survey. During the presentation the results of this second survey will be presented. Attention will be given to the prevalence rates, policy’s on prevention of pressure ulcers, the application of preventative methods, and the treatment of pressure ulcers. Furthermore, the results of the first and the second survey will be compared. Special attention will be given to the reliability and validity of the results.

UPDATE IN PRESSURE ULCERS PROGRAMS IN FRANCE

Brigitte Barrois
P.E.R.S.E Association,
Service de M.P.R,
CH de Gonesse,
Gonesse, Cedex, France

Pressure ulcers are still a problem in France as in every occi-dental country. Prevalence has been evaluated by PERSE surveys. In hospitalized patients it is 8.6% from 46000. In intensive care wards it is 22% on 750 patients. At home we are just about to know from a 10000 patients survey.

So programmes must be conducted in every ward, in all the hospitals to standardize care strategies, A local group in Gonesse hospital has been working for ten years (10th birthday in 1999) to organize protocols. And we found a reduction of pressure ulcers severity after four years of protocols: 30% of stages 3 and 4* against 70% before. Then a reduction of prevalence after eight years of protocol 8% against 9%.

PERSE Association wants to improve knowledge about pressure ulcer. We organize protocols for preventive and curative cares. We assess actual and new materials and technologies. We promote research. We organize leading methods and create educational tools. We centralize bibliographic data.

PERSE tries to organize national specific groups in each hospital as specific groups for nosocomial infection: pressure ulcer is a ‘nosocomial pathology’. This is the only way to reduce their number.

* international classification

EPUAP GUIDELINES: IMPLEMENTATION STRATEGY

Jacqui Fletcher
University of Hertfordshire,
Hatfield, Herts, England

‘There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the new order of things.’

Machiavelli, 16th Century

The prevention and management of pressure ulcers remains a problem across the globe. Building on the work of the American Pressure Ulcer Panel the European Pressure Ulcer Panel has developed guidelines to address both of these areas and now it seems likely that this initiative will be taken forward in to Asia (EPUAP, 1999). However guidelines on their own are meaningless, they have value only when the words affect clinical practices, implementation therefore involves translating guidelines into actions (Field & Lohr 1992).

Grimshaw, Eccles and Russell (1995) state that the introduction of guidelines can change clinical practices and positively affect the patient’s outcome but the Department of Health (1994) caution that they are more likely to be effective if they take in to account local circumstances. This presents a considerable challenge for an organisation such as the EPUAP which draws its representation from many different countries whose healthcare systems vary considerably, both in their level of sophistication and mechanisms of funding.

The initial ‘wave’ of the implementation strategy has been to ensure dissemination of the published guidelines as widely as possible across the member countries. This initiative has been co-ordinated by the representatives from each country who have undertaken not only the translation of the guidelines into different languages but also distribution via their nation wound care organisations. Further work has seen the publication of either the guidelines in full or information about the guidelines in a number of national and international journals and also on a number of web based resources including that of EPUAP itself. Supporting the widely accepted view that implementation strategies are more effective the guidelines have also been presented and discussed at a range of international forums.

This presentation will highlight some of the strategies it is suggested may support the process of translating the guidelines in to practice in such a diversity of settings, identifying areas of potential conflict and ways of introducing collaborative working practices.

• Department of Health (1994) Implementing Clinical Practice Guidelines. Effective Health Care Bulletin 8
• European Pressure Ulcer Advisory Panel (1999) EPUAP Review 1 (2), 26
• Field, M. and Lohr, K. (1992) Guidelines/or clinical practice: from development to use National Academy of Sciences, National Academy Press, Washington DC.
• Grimshaw, J., Eccles, M. and Russell, I. (1995) Developing clinically valid practice guidelines. Journal of Evaluation in Clinical Practice 1 (1), 37–48