Variation in pressure ulcer prevalence and prevention in nursing homes: A multicenter study

Aim: To estimate the prevalence of pressure ulcers in nursing homes and its variability, the frequency of use of preventive measures and treatment. Background: Pressure ulcer is a frequent pathology across healthcare settings. Most pressure ulcers are preventable and are considered an important quality of care indicator. Methods: Assessments were done on a single day of November 2015 in nursing homes in Geneva, Switzerland. Of the 51 institutions (3824 patients) eligible, 33 homes agreed to participate, representing 2671 patients (69.8%). One referent nurse per nursing home received training on pressure ulcer detection. To estimate the residual variability in prevalence and in number of prevention measures, adjusted multilevel logistic regressions were used. Results: Patients were on average 85.6 years old, with a median length of stay of 2.1 years. The overall prevalence was 5.7% but varied considerably, from 0% to 19.6%. The variability across nursing homes decreased slightly when taking into account patient-level and institution-level characteristics. In the adjusted models, pressure ulcers prevalence was significantly associated with Braden risk; number of preventive measures was significantly associated with nursing home size, and Braden risk, and marginally associated with length of stay. Conclusions: Overall prevalence of pressure ulcers was relatively low. While several prevention measures for patients at risk were taken, the correct use of all of them was rare. The variability in prevalence and in number of preventive measures across nursing homes was very high. Programmes focusing on the correct use of all recommended prevention measures could help reducing pressure ulcers prevalence.