Pressure ulcer prevention & management: Evaluation of a home-based education program for caregivers of elderly: A pilot study

Transcription

1 HA convention 2017 Presentation F8.1 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

2 Background Prevalence Healthcare cost Pressure ulcer (PU) is a great concern Adverse impact on patients with PU & caregivers

3 Most PUs are preventable Accurate prediction Appropriate preventive measures Provision of structural education on PUs

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

5 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

6 Study design: Methodology 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

7 Data collection 1 st contact (Home visit) 24 recruited 2 pre-tests were carried out to caregivers: Outcome 1 + Outcome 2 Post-test on outcome 1 24 completed Education program 2 nd contact (Home visit/ Phone FU) 2-4 weeks after intervention Post-test on Outcome 2 18 completed Remarks: Outcome 1: The brief pressure ulcer knowledge test Outcome 2: The checklist of compliance with pressure ulcer prevention & management measure

8 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

9 Results 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%

10 Results Outcome 1 Before program After program Average score of brief pressure ulcer knowledge test 0.4/10 6.7/10 Result of individual questions of brief pressure ulcer knowledge test before & immediate after education

11 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

12 Data analysis Normality test Wilcoxon Signed Rank Test 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)

13 Discussion 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

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

15 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

16 Acknowledgement Academic supervisor, Dr. Jenny Lee Ex-colleagues of Occupational therapy department of AHNH

17 The end Thank you!

18 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

19 A sample question of outcome 1: Q2. Is the statement correct? English The use of donut-shaped cushion can prevent pressure ulcers effectively. Chinese Bahasa Indonesia 使用水泡型坐墊可效地預防壓瘡 Penggunaan bantal berbentuk donat bisa mencegah luka tekan secara efektif. No Yes /No /Not sure 是 / 否 / 不知道 Ya / Tidak / Tidak yakin

20 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

21 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

22 Education materials: 1) A PU pamphlet PU common locations Proper positioning in sitting

23 Education materials: 2) Instruction of PU preventive measures Skin care Mechanical loading & support surface Proper positioning in sitting Nutrition

24 A sample of preventive measure: 10. English Chinese Bahasa Indonesia Use the 30 lateral inclined position. Avoid positioning directly on the trochanter when using the side-lying position 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 Atur 10. Use pada the posisi 30 lateral kemiringan inclined 30. position. Hindari Avoid memposisikan persis di positioning daerah tulang directly pinggul on the saat trochanter posisi berbaring ke samping when using the side-lying position Greater trochanter 30 degrees Sacrum

25 31 2 Back to Data collection