Reduced incidence of pressure ulcers in patients with hip fractures: a 2-year follow-up of quality indicators

OBJECTIVE: The aims of the present study were to (i) investigate the incidence of pressure ulcers in 1997 and 1999 among patients with hip fracture, (ii) study changes of nursing and treatment routines during the same period and (iii) to identify predictors of pressure ulcer development. DESIGN: The present comparative study was based partly on data collected in two prospective, randomized, controlled studies conducted in 1997 and 1999. SETTING: The study was carried out in the Accident & Emergency (A&E) Department and the Department of Orthopaedics at the University Hospital in Uppsala, Sweden. INCLUSION CRITERIA: patient with hip fracture, > or = 65 years, admitted without pressure ulcers. Forty-five patents were included in 1997 and 101 in 1999. INTERVENTIONS: Risk assessment, pressure ulcer grading, pressure-reducing mattress and educational programme. MAIN OUTCOME MEASURES: Incidence of pressure ulcers. RESULTS: There was a significant reduction of the overall incidence of pressure ulcers from 55% in 1997 to 29% in 1999. The nursing notes had become significantly more informative. Nursing and treatment routines for patients with hip fractures had changed both in the A&E Department and the orthopaedic ward through initiatives developed and implemented by pressure ulcer nurses. CONCLUSION: In the framework of a quality improvement project, where research activities were integrated with practice-based developmental work, the incidence of pressure ulcers was reduced significantly in patients with hip fractures. The best predictor of pressure ulcer development was increased age.