My career objective is to contribute to the development of improved evidence based approaches in geriatric medicine. In particular, I am interested in understanding and improving the translation of basic science knowledge into national guidelines for geriatric care and then into clinical practice. In support of this goal, the proposed research will examine the appropriateness and implementation of guidelines for the prevention of pressure ulcers, a common complication of hospitalization among the elderly that result in costs of more than $2 billion. National guidelines for prevention of pressure ulcers recommend that at-risk patients use pressure-redistributing support surfaces and that bedbound patients receive both manual repositioning and pressure-redistributing support surfaces. Our prior analyses have shown that pressure-redistributing devices are commonly used by elderly hospital patients, but that the incidence of pressure ulcers in these patients remains high. It is critical to determine if the use of these two recommended prevention methods are effective at reducing the incidence of pressure ulcers;only one prior study has included both of these methods in an evaluation of effectiveness. Furthermore, it is critical to determine whether these guidelines are being properly implemented. It is a common but unproven perception among hospital staff that the use of pressure-reducing devices decreases the need for manual repositioning. No study has examined whether bedbound patients using pressure-redistributing devices are repositioned less frequently than those not using such a device;if found to be the case, this would represent an improper application of guidelines. To investigate the appropriateness and implementation of guidelines for the prevention of pressure ulcers, this research proposes to: 1) determine if the use of pressure-redistributing support surfaces is associated with reduced incidence of pressure ulcers;2) determine whether the incidence of pressure ulcers is reduced for bedbound patients repositioned according to guidelines, compared to bedbound patients who did not receive this intervention;and 3) determine whether repositioning is as common in bedbound patients using pressure-redistributing support surfaces as in those not using these devices, as is recommended by guidelines. A study of pressure ulcer prevention guidelines is particularly timely as recent policy changes have classified the development of pressure ulcers as an indicator of quality of care.
Pressure ulcers are a common problem for elderly persons in health care settings. Determining whether or not current guidelines for the prevention of pressure ulcers are appropriate will help to ensure that programs to prevent pressure ulcers are as effective as possible
