Improving pressure ulcer management in Australian nursing homes: results of the PRIME trail organisational study

Pressure ulcer prevalence is frequently cited as a factor used to determine the quality of nursing care and is used as a proxy measure fornursing home quality. This paper reports the results of the organisational study conducted as a subcomponent of the PRIME trial. ThePRIME trial was a multi-dimensional clinical trial designed to investigate the effectiveness of an integrated pressure ulcer managementsystem in reducing the pressure ulcer prevalence and incidence in a cohort of Australian nursing homes. A stratified random sample ofstaff were interviewed from 17 consenting nursing homes (n=120). The interviews used a 10 question, semi-structured questionnairecovering four organisational quality factors and six PRIME trial implementation factors. Responses to questions were ranked on a scaleof 1-5, 1 representing no evidence and 5 representing embedded practice. Data were aggregated by nursing home and the mean scoreswere calculated. Data were correlated with baseline pressure ulcer prevalence and the post PRIME pressure ulcer prevalence.The results of this study show that there was no relationship between baseline pressure ulcer prevalence and the context of careas measured by a range of organisational factors, including staff development planning, equipment and resource management,communication management and effectiveness of staff and resident feedback. The PRIME trial was able to significantly reduceprevalence of pressure ulcers regardless of the context of care. Paired sample t-tests showed a significant difference between the meanbaseline prevalence (25.8%) and the mean post PRIME pressure ulcer prevalence (16.6%) (p=0.008) in nursing homes participating inthe organisational component of the PRIME trial.