The Effectiveness of Clinical Practice Guideline for Prevention of Pressure Ulcer in Private Hospital, Bangkok Thailand

Purpose:
To study effectiveness of clinical practice guidelines (CPG) for pressure ulcer prevention and compare the result of hospital acquired pressure ulcer before and after the implementation of clinical practice guideline for prevention of pressure ulcer.

Background/Significance:
Pressure ulcers are a complex clinical problem with a multi factorial etiology.Prevention of pressure ulcers is a fundamental aspect of nursing care and methods towards quality improvement are arguably the most cost-effective and intuitive approach to addressing this potentially serious problem. We sought to increase nursing awareness and enhance the quality of nursing care and patients' outcomes by reducing the prevalence rate of pressure ulcers.Thus, we researched in this topic.

Methods:
This research aimed to study the effectiveness of clinical practice guidelines (CPG) for pressure ulcer prevention in private hospital. The process for implementation of the CPG utilized the framework from The National Health and Medical Research Council of Australia [NHMRC, 1999]) was applied.The sample consisted of all inpatients who were admitted in 2010 and 2011.The tool in this study was the CPG for prevention of pressure ulcer with consisted of 6 sections. The CPG was assesses for content validity by 3 experts. Data were collecting using: Braden Risk Assessment Scale (Braden & Bregstrom, 1992) and Pressure ulcer incident report form.Data were analyzed with descriptive statistics.

Results:
We found that before the implementation of clinical practice guideline for pressure ulcer prevention, hospital acquired pressure ulcers (HAPU) rate in 2010 was 0.78 per 1000 patient days, amount 102 cases.HAPU were divided into stage 1 for 37.3%, stage 2 for 61.8%, stage 3 for 0.9%, and no cases of stage 4 were found. After the implementation of clinical practice guideline for pressure ulcer prevention in 2011, pressure ulcer rate was decreased to 0.52 per 1000 patient days, total 67 cases. HAPU were divided into stage 1 for 58.2%, stage 2 for 41.8%, and no cases after stage 3 and 4 were found after being admitted in the hospital.

Conclusions and Implications for Practice:
The finding of this study that implementation of clinical practice guideline for prevention of pressure ulcer is effective in reducing hospital acquired pressure ulcer rate, lets nurses know how to assess patient, prevent risk of pressure ulcer from developing from stage 1 to stage 2.