Recording and utilising patient-based data in clinical settings: The pressure ulcer case.
Pressure ulcers (PUs) are a very common health problem. Nurses in clinical practice collect large volumes of PU data every day, which must be recorded and used appropriately. With this in mind, this research explored how PU data is recorded and used in clinical settings. In addition, the magnitude of PU problem in Jordan was assessed. A mixed methods approach was utilised to address the research objectives. As a first stage, Tissue Viability Nurses (TVNs) in the UK from the Tissue Viability Society (TVS) and the National Health Service (NHS) were asked to complete an online questionnaire. Subsequently, a number of them (n=16) participated in semi-structured interviews in order to complement and explain the questionnaire responses. In Jordan, a cross sectional point prevalence survey employing the European Pressure Ulcer Advisory Panel (EPUAP) methodology was conducted to measure the prevalence rate of pressure ulcers. Integration between the questionnaire and interview results occurred on a number of different occasions. The questionnaire findings (n=167) showed there to be a difference in the prevalence rate between the primary and secondary settings (X2=20.59, df=3, p<0.001), with an overall mean of 7%, and a range of 0.5-25%. It was also found that the prevalence survey and clinical audits (71.8%, n=120), conducted annually (40.9%, n=67) or monthly (22.6%, n=37) by TVNs (63.6%, n=105), were the most common methods of calculating the reported prevalence rate. The field notes taken during the interviews, which were analysed thematically using the template analysis approach, highlighted that PU audits can be conducted via additional methods to those reported in the questionnaires. These include: actual audits where patients are inspected by TVNs or link nurses; relying on the nurses to complete audit forms; and, finally, reviewing the recording systems to generate reports. Moreover, the questionnaire findings showed that PU data is mainly recorded on a combination system (48.2%, n=79), or in some cases recorded on a computerised system (9.8%, n=16). The interviews again complement these findings by expanding that PU data can be recorded, reported and referred using paper, electronic or combination records. The advantages and disadvantages of each recording system were explored and defined into separate themes. Additionally, conducting a PU audit requires certain tools. It was clear from the questionnaire that the Waterlow risk assessment scale (RAS) (88.8%, n=142), and the EPUAP classification tool (83%, n=132) were the most commonly used in the UK. Regarding the uses of PU data, the interview findings showed that there are several. For example, it can be used to generate reports about PU in a given organisation, and these reports can be used to provide feedback to the nurses, TVNs, and management, and could also prompt decisions about purchasing equipment, employing nurses or offering training in areas where there are high levels of PU cases. Prevalence and incidence data, in particular, can be used to evaluate intervention, to monitor quality, to ensure best practice is provided, as educational tools for conducting audits, and for initiating safeguarding and investigating procedures. Despite all these potential uses, however, some interviewees think that some PU data, especially the prevalence data, is useless and difficult to capture, and that incidence data is more reliable and powerful. In Jordan, the researcher examined the skin of all inpatients aged eighteen or above, except patients in the emergency, day care and maternity wards, in both university and general hospitals. This yielded a sample of 302 patients. Any PU identified was graded according to the EPUAP grading scale (GS). The risk of PU development was assessed using the Braden scale. Data was also collected on preventive measures used in the clinical setting. Of the patients examined, 11.9% (n=36) had PU grade 1-4 (excluding grade 1: 6.6%, n=20). Interestingly, this PU prevalence rate is lower than that published in most studies which have employed the same methodology but it is thought that the differences in age and frailty in the Jordanian sample, compared with most others, could explain the low prevalence. The sacrum and heel were the most commonly affected sites (55.6%, n=20). Grade one was the most common grade (44.4%, n=16) and 85 (28.1%) patients were considered at risk of developing pressure damages. Despite the relatively low prevalence, very few patients at risk received adequate prevention measures (16.5%, n=14), and there is therefore a need to raise awareness of the need for PU prevention in Jordan.
- PhD