pressure ulcer prevention and management: evaluation …€¢ a quasi-experimental pre-test &...

Pressure ulcer prevention & management: Evaluation of a home-based education

program for caregivers of elderly: A pilot study

Chong Ka Wing, Cynthia Occupational Therapist

Shatin Hospital

HA convention 2017 Presentation F8.1

Background

Pressure ulcer (PU)

is a great concern

Prevalence

Adverse impact on patients

with PU & caregivers

Healthcare cost

Pressure ulcer prevention & management program for family caregivers

• Most PUs are preventable

• Accurate prediction • Appropriate preventive measures

• Provision of structural education on PUs


• However, in literature, structural education programs on PU with proven effectiveness for informal caregivers are rare


Objectives

To fill this service gap, this study is to 1. Develop a new home-based education program

2. Evaluate its effectiveness in term of a) Their knowledge b) Their compliance


Methodology Study design: • A quasi-experimental pre-test & post-test design

Subject population: • Convenient sampling • Were referred to Community Outreach Service Team Occupational

therapy (COST-OT)

The inclusion criteria: • The major family caregiver • Taking care of elderly with Norton ulcer score < 14

The exclusion criteria: • Caregivers could not comprehend Cantonese, Putonghua or English Pressure ulcer prevention & management program for family caregivers

24 recruited

1st contact

(Home visit)

Remarks: Outcome 1: The brief pressure ulcer knowledge test Outcome 2: The checklist of compliance with pressure ulcer prevention & management measure

24 completed

Post-test on outcome 1

2nd contact

(Home visit/

Phone FU)

2- 4 weeks after intervention

18 completed

Post-test on Outcome 2

Education program

2 pre-tests were carried out to caregivers:

Outcome 1 + Outcome 2

Data collection


Results Demographic characteristics of cases Mean age • 82, range 65 to 95

Sex • 58 % female

Cognitive function • ~90% were impaired (Abbreviated Mental Test < 6 marks )

Activity of daily living (ADL)

• >80% required max assistance to dependent

Nutrition • >60% were in malnutrition (Mid calf circumference below cut-off)

Existence of PU • >70% • Mainly grade II to III • At sacrum/ foot/ hip


Demographic characteristics of caregivers Mean age • 44

Sex • 90 % Female

Relationship with case • Mainly maid/ spouse/ child

Mother languages • Cantonese/ Bahasa Indonesia/ Filipino

Education • >80% up to secondary level

No PU education program before

• >90%

Results


Outcome 1

Before program After program

Average score of brief pressure ulcer knowledge test

0.4/10 6.7/10

Results

Result of individual questions of brief pressure ulcer knowledge test before & immediate after education


Results Outcome 2

Before program After program

Average compliance rate of preventive measures

46% 78%

Result of compliance of pressure ulcer prevention & management measures before & after education


Normality test

Wilcoxon Signed Rank Test

Data analysis

Results After program, there was significant improvement of caregivers’

PU knowledge (Z= 4.294, p <0.000)

compliance with the measures (Z= 3.726, p <0.000)


1. Significant improvement in the test results after program • Caregivers were ready to learn, apply the skills & follow the

preventive measures

• The program was essential for better PU prevention

Discussion


2. Limitation • Convenient sampling • No direct measure on PU outcome


Conclusion

• The home-based PU program was effective

• Further study on whether the program can contribute to the healing of PU & decrease its incidence is recommended


Acknowledgement

• Academic supervisor, Dr. Jenny Lee

• Ex-colleagues of Occupational therapy department of AHNH


The end Thank you!


• Study outcome: • Outcome 1: “The brief pressure ulcer knowledge test” • Was simplified from a

validated instrument called The Pressure Ulcer Knowledge Test [Pieper & Mott, 1994]

• 10 Yes/ No questions • Evaluate on PU knowledge


Q2. Is the statement correct? English The use of donut-shaped cushion can

prevent pressure ulcers effectively.

Chinese 使用水泡型坐墊可效地預防壓瘡。

Bahasa Indonesia

Penggunaan bantal berbentuk donat bisa mencegah luka tekan secara efektif.

Yes /No /Not sure 是 /否 / 不知道

Ya / Tidak / Tidak yakin

• A sample question of outcome 1:

No


• Outcome 2: “The checklist of the compliance with pressure ulcer prevention & management measures” • Based on the international

guidelines: 1) National Pressure Ulcer Advisory Panel (NPUAP) [2015] 2) The Institute for Clinical Systems Improvement (ICSI) [2014] • Evaluate on the application of the

12 preventive measures Back to Data collection


• Study intervention:

A) Conventional practice B) This study

Content • No standardized program among hospitals

• Structural and program –based • Followed the international guidelines: 1) NPUAP [2015] 2) ICSI [2014]

• Included: - PU knowledge - Skin care - Use of support surfaces - Demonstration of preventive measures

Language of education materials

• Chinese/ English • Chinese/ English/ Bahasa Indonesia


1) A PU pamphlet

• Education materials:

Proper positioning in sitting

PU common locations


Proper positioning in sitting

• Education materials: 2) Instruction of PU preventive measures

Skin care

Mechanical loading & support surface Nutrition

10. Use the 30° lateral inclined position. Avoid positioning directly on the trochanter when using the side-lying position

10. English Use the 30° lateral inclined position. Avoid positioning

directly on the trochanter when using the side-lying position

Chinese 側臥時, 使用30°側睡法, 以避免患者身體重量直接施於股骨

轉子。

Bahasa Indonesia

Atur pada posisi kemiringan 30°. Hindari memposisikan persis di daerah tulang pinggul saat posisi berbaring ke samping

• A sample of preventive measure:

Sacrum

Greater trochanter

30 degrees


1 2 3

Back to Data collection


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