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Keywords:

  • continence;
  • falls;
  • malnutrition;
  • nursing;
  • pressure ulcers;
  • prevalence;
  • restraint

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

Aim

This report describes the results from the last international prevalence measurement of care problems in the Netherlands, Austria and Switzerland, including the course of the prevalence rates during the past 4 years.

Background

Basic care problems such as pressure ulcers, malnutrition and falls occur frequently in healthcare organizations. Measuring these care problems provides insight into their occurrence, and, while a measurement is included of the prevention, treatment and structural quality indicators, this gives institutions the possibility of improving their care regarding these care problems.

Design

An annual cross-sectional multicentre study.

Method

The prevalence measurement of care problems is conducted annually on one specific day in different healthcare settings, among which are hospitals and care homes. Data are collected by means of a comprehensive, standardized questionnaire that comprises three levels: institutional, ward/department and patient level.

Results

Besides general characteristics of patients, results are presented for prevalence rates, prevention, treatment and quality indicators regarding each care problem for each country.

What is already know about this topic

  • Although several international studies are available about one or more specific care problems, it is difficult to compare these because of the different methodologies and instruments they used. Therefore, no overview is available of the quality of care of basic care problems internationally.
  • Quality of basic care problems must be described in outcome, process and structure indicators.
  • Measuring the outcome (prevalence), process (prevention and treatment) and structure (structural quality indicators) of basic care problems in healthcare organizations is the first step in improving the quality of care.

What this paper adds

  • With this study, a beginning has been made to build a European database of basic care problems.
  • An overview is given of the prevalence, prevention, treatment and structural quality indicators of several basic care problems.
  • This study shows that some prevalence figures are comparable among the studied countries, although the prevention of these care problems differs among the countries.

Implications for practice and/or policy

  • Measuring the prevalence, prevention, treatment and quality indicators is not only important to gain insight into differences in the quality of care among countries, but offers the participating institutions also the opportunity to improve their quality regarding the measured care problems.
  • Increasingly, European and International guidelines are developed. The results so far show that prevention and treatment vary among the countries, indicating that these international guidelines are not fully adopted in the studied countries. More attention to the implementation of international guidelines is, therefore, recommended.
  • Measuring the prevalence, prevention, treatment and quality indicators means that not only can a European database of care problems be built, but it also provides the opportunity to monitor the effect of implementing international guidelines.

Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

Extensive information is available about the prevalence and incidence of medical diagnoses and treatments at international and European levels. However, until now, no information has been available about the prevalence and incidence of nursing diagnosis or care problems at these levels. Since 1998, the occurrence of six basic care problems in healthcare institutions have been surveyed in the Netherlands on one specific day each year in April by means of the National Prevalence Measurement of Care Problems (In Dutch: Landelijke Prevalentiemeting Zorgproblemen (LPZ)). Since 2009, the LPZ has also been carried out in Austria and since 2011, in Switzerland. It is also carried out on a smaller scale in New Zealand.

The LPZ is a cross-sectional descriptive study that investigates the prevalence, prevention, treatment and quality indicators of six basic care problems: pressure ulcers, intertrigo, incontinence, malnutrition, falls and restraints.

This report is the first to describe data concerning basic care problems in three different European countries. Prevalence data are provided from 2009 until the last measurement, which was taken in Switzerland in November 2011 and in the Netherlands and Austria in April 2012. The prevention, treatment and quality indicators are described for the last measurement. For practical reasons, the measurements in Switzerland and New Zealand take place in November instead of April. Data from New Zealand are not included due to the small number of participating institutions.

Method

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

The LPZ International follows a cross-sectional design and is conducted on one specific day each year in different healthcare settings (hospitals, care homes and home-care organizations) in the Netherlands, Austria, Switzerland and New Zealand. Maastricht University is responsible for the central coordination of the study, and a national coordinator in each participating country organizes the measurement in their own country. Data are collected by means of standardized, comprehensive questionnaires, which are developed and regularly updated by consulting experts and based on existing psychometrically tested instruments, guidelines and literature reviews (Bours et al. 1999, 2000, Dijkstra et al. 1999, Hannestad et al. 2000, Lohrmann et al. 2003, Rohr et al. 2005, Neyens et al. 2006, Meijers et al. 2010, Thüroff et al. 2010). The questionnaire comprises three measurement levels: institutional, ward/department and patient level. The questions at institutional and ward level relate to the type of institution/ward and structure indicators such as the existence of clinical guidelines. The patient questionnaire includes a general part containing questions about patient characteristics and the assessment of each separate care problem. In addition to this general part, specific modules have been developed for each care problem to measure the more in-depth characteristics of the care problem, process indicators (preventive and treatment measures), and structural quality indicators such as the presence of a pressure ulcer committee or a screening policy for malnutrition. In addition to the obligatory general form in the Netherlands, each institution can decide whether to measure all modules or only a selection. Austrian institutions are obliged to measure all modules to build a national database about the care problems addressed in this study. In Switzerland, the National Association for Quality Development in Hospitals and Clinics (ANQ) has developed a set of national quality indicators for acute care settings within the framework of a national quality contract. All acute care hospitals that adhere to this contract are obliged to participate in the annual LPZ measurement and to measure the care problems ‘pressure ulcers’, ‘falls’ and ‘restraints’. In the future, other institutions (for example, long-term care institutions) will be able to participate on a voluntary basis.

Data at institutional level are collected by an institutional coordinator appointed in each participating institution. Data at ward/department level are collected by the head of the ward/department. Data at patient level are obtained both by means of observation and inspection of the patients and from the patient files. To enhance reliability, each patient is assessed by two healthcare professionals (nurses, dieticians or doctors). Of these two, one works on the patient's ward/department and one is an independent professional from another ward/department. The interrater reliability of certain parts of the instrument has been tested and found to be good for hospitals, nursing homes and home care (Cohen's k of 0·87) (Kottner et al. 2009, Meijers et al. 2009a,b).

In each participating healthcare organization, one institutional coordinator is responsible for organizing the measurement in that organization. All institutional coordinators are trained collectively by their national coordinator on how to manage the measurement and how to use the printed standardized questionnaire and the specially designed web-based data-entry program. The institutional coordinators train the healthcare professionals who perform the measurements at the institutions in how to collect data at patient level. The institutional coordinators receive a protocol and training package with questionnaires, instruction manuals, guidelines and the study protocol.

Data can be entered either immediately with a laptop or tablet when using the specially designed web-based data-entry program or afterwards when using a paper and pencil questionnaire. Within a few days after entering the data, the institutions receive a fully automated report about their results. After 8 weeks, when all institutions have entered their data, the institutions also receive the national results for benchmarking.

A more in-depth description of the LPZ instruments and methodology can be found in Van Nie et al. (2013). The data analyses for this report included data from patients older than 18 years.

Full Research Ethics Committee approval was granted for this study by the medical ethics committees of the Maastricht University Medical Centre (MUMC+) in the Netherlands and the Medical University of Graz in Austria. In Switzerland, the cantonal ethics committees each granted Research Ethics Committee approval separately, in accordance with the Swiss procedure for multicentre studies.

Findings

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

This section describes the prevalence data collected from 2009 to the last measurement, which was made in November 2011 for Switzerland and in April 2012 for the Netherlands and Austria. The prevention, treatment and quality indicators from the last measurement are also described.

General characteristics

The number of institutions, wards and patients that participated in the 2011/2012 measurement can be found in Table 1. This table shows that the response rate in the Netherlands is much higher than in the two other countries. In Austria and Switzerland, more patients refused to participate. This might be explained by the fact that no written consent is needed nowadays from patients in the Netherlands, because the measurement is considered part of the regular care. Table 1 also describes several general patient characteristics. Besides some small differences in gender and age among the countries, the patients in the Austrian nursing homes are more care dependent (CDS: high score means less care dependent) compared with the patients in the Dutch nursing homes.

Table 1. General characteristics of the participating institutions, wards and patients in 2011/2012
Characteristics of participantsThe NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Participating institutions38158337140
Participating wards43447622633884
Response rate (%)94·696·775·084·368·4
Non-response (%)
Refused37·448·651·756·958·1
Not available32·616·516·26·216·9
Other30·034·932·136·925·0
Number of participating patients662212,653364869610,098
Female (%)49·873·253·380·951·3
Age (mean)65·983·463·882·865·3
CDS score (mean)65·650·268·238·264·7

Pressure ulcers

Table 2 gives an overview of the number of institutions, wards and patients that participated in the pressure ulcer module in 2011/2012. Pressure ulcers are defined according to the definition of the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel (NPUAP/EPUAP) (2009).

Table 2. Number of participating institutions, wards and patients for the pressure ulcer module in 2011/2012
 The NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Participating institutions3683337140
Participating wards42422322633884
Participating patients64866273364869610,098

Figure 1 shows the prevalence rates of pressure ulcers (excluding category 1) developed after admission to the institution (hospital-acquired pressure ulcer) from 2009–2012. Compared with Austrian and Swiss hospitals, the prevalence is highest in Dutch hospitals. An explanation for these differences could be that the risk levels for pressure ulcers differ for populations among the countries. However, comparing only the rates of the at-risk patients (Braden score less than 21) gives almost the same picture (Figure 2).

image

Figure 1. Hospital-acquired pressure ulcer prevalence rates (excluding category 1) from 2009–2012 (%).

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image

Figure 2. Hospital-acquired pressure ulcer prevalence rates (excluding category 1) of at-risk patients from 2009–2012 (%).

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Another explanation for the differences among the countries could be the use of different preventive measures for pressure ulcers. Table 3 shows a great variation among the countries regarding preventive measures for patients at high risk of developing a pressure ulcer. The most frequently applied preventive measure is the use of a pressure-relieving mattress, although its use differs among the countries. Almost all patients in Dutch hospitals have a pressure-relieving mattress, while in Switzerland, only half of the patients have one. Repositioning is only applied in one-fourth of the patients, but in Austrian nursing homes it is applied more often. Furthermore, it is remarkable that in Austria a moisturizer is used to protect patients' skin more often. In general, the Austrian nursing homes use the highest number of preventive measures.

Table 3. Pressure ulcer preventive measures for patients at risk for pressure ulcer development in 2011/2012 (%)
Preventive measuresThe NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Pressure-relieving mattress94·568·353·481·851·7
Repositioning27·912·227·441·226·9
Prevention of dehydration and/or malnutrition47·936·619·853·520·2
Providing client with information and instruction30·316·712·250·123·6
Floating heels29·619·933·549·730·1
Heel protectors5·15·85·013·94·0
Moisturizer/barrier cream to protect the skin18·540·663·195·446·7
Sheepskin0·10·40·21·70·9
Average number of preventive measures3·53·03·35·22·8

Table 4 gives an overview of the average number of pressure ulcer-related structural quality indicators at institutional level and ward level in 2011/2012. For the individual indicators, we refer to the article by Van Nie et al. (2013). Dutch nursing homes and hospitals meet the largest number of structure indicators, both at institutional and ward level.

Table 4. Average number of pressure ulcer quality indicators in 2011/2012
LevelThe NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Institutional level (7 quality indicators)6·76·03·05·65·5
Ward level (8 quality indicators)6·47·25·36·75·9

Incontinence

Table 5 gives an overview of the number of institutions, wards and patients that completed the incontinence module in 2012. Incontinence was not measured in Switzerland. Urinary incontinence is defined as the complaint of any involuntary leakage of urine, according to the ICS (Thüroff et al. 13). However, patients with a catheter are not perceived as incontinent for the analyses here. Faecal incontinence is defined as being incontinent of faeces at least three to four times a month.

Table 5. Number of participating institutions, wards and patients for the incontinence module in 2012
 The NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Participating institutions855337
Participating wards8313422633
Number of participating patients112538793648696

Figure 3 gives an overview of the prevalence of urinary incontinence over the years. It shows a stable incontinence prevalence rate over the past years, with the highest rates in nursing homes and the lowest in hospitals. The rates in Austria are somewhat higher than in the Netherlands.

image

Figure 3. Urinary incontinence prevalence from 2009–2012 without catheters (%).

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Figure 4 gives an overview of the prevalence of faecal incontinence. It gives a comparable picture to Figure 3, although the faecal incontinence in the Austrian nursing homes is twice as high as in the Dutch nursing homes.

image

Figure 4. Faecal incontinence prevalence from 2009–2012 (%).

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As described in the general characteristics of the samples, the patients in the Austrian nursing homes are more care dependent than the ones in the Dutch nursing homes, which could explain why more patients are incontinent in Austria.

Several treatment measures taken for patients with urinary incontinence are described in Table 6. The most frequently used measures for urinary incontinence are disposable materials. These are used in Austria even more than in the Netherlands. Adjustments to the environment and clothing also occur more frequently in Austrian nursing homes, possibly because they have more experience with incontinence due to the higher prevalence rate.

Table 6. Urinary incontinence treatment measures in 2012 (%)
MeasuresThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Environmental adjustments1·91·917·354·3
Clothing adjustments11·99·020·068·9
Bladder training/pelvic floor muscle training0·00·58·15·7
Fixed-time bathroom visits per client6·735·48·257·0
Fixed-time bathroom visits per ward0·09·55·55·4
Disposable materials44·485·960·694·0
No measures45·77·330·92·4

Table 7 gives an overview of the average number of incontinence-related structural quality indicators at institutional and ward level. In both countries, nursing homes meet more quality indicators, both at institutional and ward level.

Table 7. Average number of incontinence quality indicators in 2012
LevelThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Institutional level (7 quality indicators)4·45·43·65·4
Ward level (7 quality indicators)3·95·94·05·7

Intertrigo

Table 8 gives an overview of the number of institutions and wards and patients that completed the intertrigo module in 2012. Intertrigo was not measured in Switzerland.

Table 8. Number of participating institutions, wards and patients for the intertrigo module in 2012
 The NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Participating institutions1045337
Participating wards11311022633
Number of participating patients180030603648696

Intertrigo is a superficial skin disorder at the bigger folds of the skin, and is characterized by skin reddening (erythema) on both sides of the fold. Possible symptoms are maceration, erosions, fissures (cracks) and wet skin.

Figure 5 gives an overview of the prevalence of intertrigo. Although the prevalence of intertrigo in the Dutch nursing homes has reduced since 2009, the Austrian hospitals and nursing homes still have the lowest prevalence of intertrigo.

image

Figure 5. Prevalence of intertrigo from 2009–2011/2012 (%).

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Tables 9 and 10 give an overview of the measures taken to prevent and treat intertrigo. These show that nursing homes pay more attention to the prevention of intertrigo than hospitals, especially in Austria, although they have fewer patients with intertrigo. The treatment of intertrigo is given most attention in Austrian nursing homes. Furthermore, it appears that zinc oil is used more often in the Netherlands and a barrier spray or cream more often in Austria.

Table 9. Intertrigo preventive measures in 2012 (%)
MeasuresThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Washing and patting skin folds daily46·059·325·692·0
Wash the skin without soap or with a pH-neutral soap10·619·010·156·4
Zinc oil, barrier spray or cream9·521·77·037·3
Daily inspection of skin and skin folds46·161·529·692·0
No measures47·729·965·42·9
Table 10. Intertrigo treatment in 2012 (%)
MeasuresThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
1 or more preventive measures (at least 2 times a day)41·446·659·084·2
1 or more preventive measures (at least 3 times a day)2·91·333·310·5
Zinc oil52·954·317·931·6
Barrier spray or cream12·914·365·452·6
Antimycotic agent4·312·620·552·6
Consultation expert7·117·97·726·3
Other kind of treatment5·710·317·910·5
No treatment12·94·500

Table 11 gives an overview of the average number of intertrigo-related quality indicators at institutional and ward level. At institutional level, it shows that the Dutch institutions meet the largest number of structure indicators.

Table 11. Average number of intertrigo quality indicators in 2012
LevelThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Institutional level (5 quality indicators)2·73·21·32·9
Ward level (7 quality indicators)4·35·13·95·5

Malnutrition

Table 12 gives an overview of the number of institutions, wards and patients that participated in the malnutrition module in 2012. Malnutrition was not measured in Switzerland. Malnutrition and the risk of malnutrition are defined according to the definitions of Meijers et al. (2009a).

Table 12. Number of participating institutions, wards and patients for the malnutrition module in 2012
 The NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Participating institutions1456337
Participating wards15015822633
Number of participating patients216342493648696

Figure 6 shows the prevalence of patients at risk of malnutrition over the past years. Besides the prevalence rate of the Austrian nursing homes, the prevalence rates are relatively stable and comparable among the two countries. In nursing homes, more patients have a risk of malnutrition.

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Figure 6. Prevalence of risk for malnutrition from 2009–2012 (%).

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Figure 7 gives an overview of the prevalence of malnutrition. It shows a substantial decrease during the past 4 years in the two sectors and two countries.

image

Figure 7. Malnutrition prevalence from 2009–2012 (%).

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Table 13 provides an overview of the measures taken to prevent malnutrition in patients who are at risk of malnutrition. It shows that the Austrian nursing homes pay more attention to preventive measures. Referral to a dietician is the most frequently reported measure in the two settings and countries.

Table 13. Preventive measures for patients with a risk for malnutrition in 2012 (%)
MeasuresThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Dietician referral30·023·27·461·7
Energy (protein)-enriched diet14·94·14·133·7
Energy-enriched snacks provided between meals10·26·33·435·4
Supplementary oral nutrition (liquid nutrition and supplements)13·211·12·420·0
Enteral tube feeding9·70·32·63·4
Intravenous feeding3·706·01·1

The treatment of malnourished patients is shown in Table 14, which gives a comparable picture to Table 13, although the treatments are used more often. It is remarkable that a dietician is consulted less often in Austrian hospitals, especially when compared with the nursing homes. In the Netherlands, this finding is reversed. In fact, Dutch nursing homes take more measures overall for patients with (a risk of) malnutrition than in Austrian nursing homes.

Table 14. Treatment of malnourished patients in 2012 (%)
MeasuresThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Dietician referral62·746·025·071·2
Energy (protein)-enriched diet41·514·215·451·9
Energy-enriched snacks provided between meals33·620·711·061·9
Supplementary oral nutrition (liquid nutrition and supplements)27·729·39·241·9
Enteral tube feeding12·91·52·96·9
Intravenous feeding5·608·75·0

Table 15 gives an overview of the average number of malnutrition-related structural quality indicators at institutional and ward level. In general, nursing homes meet more structural criteria than hospitals.

Table 15. Average number of malnutrition quality indicators in 2012
LevelThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Institutional level (7 quality indicators)5·94·93·66·0
Ward level (11 quality indicators)8·49·16·49·7

Falls

Table 16 gives an overview of the number of institutions, wards and patients that participated in the fall module in 2011/2012. A fall is defined as an event that causes the patient to unintentionally fall to the ground or some lower level, regardless of the cause (Kellogg 1987). We measured the incidence of falls after admission to the institution (hospital-acquired falls) over the 30 days prior to the measurement.

Table 16. Number of participating institutions, wards and patients for the fall module in 2011/2012
 The NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Participating institutions666337140
Participating wards6217622633884
Number of participating patients8275395364869610,098

Figure 8 gives an overview of the incidence of falls, which shows that the rates have been relatively stable over the years, but that falls are much more common in nursing homes. In nursing homes, the incidence lies around 8·5% and in hospitals around 2·5%. The prevalence in Swiss hospitals is somewhat higher. When interpreting these results, it must be taken into account that most patients stay in a hospital for only a few days, which results in a lower incidence compared with the nursing homes, because the chance to fall is higher during 30 days than during a few days.

image

Figure 8. Hospital-acquired fall incidence (during the 30 days before the measurement) from 2009–2011/2012 (%).

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Table 17 lists the percentage of fall injuries and severe injuries (among which a hip fracture) of those who suffered from a fall incident in the institutions in 2011/2012. The table shows that, in general, the percentages of injuries are comparable among the countries. Only in Dutch hospitals, the percentage is somewhat lower. Although the prevalence rates of the injuries are comparable, the falls in the Austrian nursing homes appear to more often result in a severe injury.

Table 17. Fall injuries in 2011/2012 (%)
PrevalenceThe NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Fall injuries20·034·138·535·134·7
Severe injuries (among which, hip fracture)6·32·54·412·34·9

Table 18 gives an overview of the measures taken to prevent falls. It shows that preventive measures are taken more often in nursing homes, especially in the Austrian nursing homes. Dutch hospitals were reported most often to have no preventive measures. In Austria, more attention is paid to adapting the environment, while in the Netherlands, alarm systems are used more frequently.

Table 18. Fall preventive measures for all patients in 2011/2012 (%)
Fall preventive measures The NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Evaluate/adapt medication2·88·63·939·78·0
Adaption environment6·67·422·366·317·1
Practice therapy19·913·510·318·723·7
Alarm (alarm mat/sensor)11·351·31·125·82·8
No fall prevention61·723·548·44·648·8

Table 19 gives an overview of the average number of fall-related quality indicators at institutional and ward level. The Austrian nursing homes and hospitals meet the largest number of quality indicators, both at institutional and ward level. Between 2011–2012, the quality indicators were revised and updated. Therefore, the quality indicators measured in November 2011 in Switzerland cannot be compared with the 2011 quality indicators and, for this reason, they are not listed in the table.

Table 19. Average number of fall quality indicators in 2012
LevelThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Institutional level (8 quality indicators)4·06·55·66·7
Ward level (9 quality indicators)5·67·26·37·8

Restraints

Table 20 gives an overview of the number of institutions, wards and patients that participated in the restraint module in 2011/2012. Restraints are interventions often used to protect the patient, to prevent dangerous or risky situations or to make medical treatment possible. Examples of restraints are bedrails, the Swedish belt and also medication.

Table 20. Number of participating institutions, wards and patients for the restraint module in 2011/2012
 The NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Participating institutions665337140
Participating wards5720922633884
Number of participating patients8125224364869610,098

Figure 9 gives an overview of the prevalence of restraint use. The prevalence of restraint use is highest for the nursing homes and lowest for the hospitals. Almost no difference exists among the countries.

image

Figure 9. Prevalence of physical restraints use from 2009–2011/2012 (%).

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An overview of the application of different restraint measures can be found in Table 21. The most frequently reported restraint in all sectors and countries is the use of bed rails. The Swedish belt or special blankets or both are used in around 5% of Dutch and Swiss hospitals.

Table 21. Restraint measures (2011/2012)
 The NetherlandsAustriaSwitzerland
HospitalsNursing homesHospitalsNursing homesHospitals
Bed rails95·958·388·877·978·4
Special blankets/sheets4·11·0005·9
Swedish belt5·50·11·304·9
Medication17·816·213·90·614·3

Table 22 gives an overview of the average number of quality indicators at institutional and ward level related to the use of restraints. Nursing homes meet more quality indicators than hospitals, at both institutional and ward level. For the same reason as for falls, no comparable data are available for Switzerland.

Table 22. Average number of restraint quality indicators in 2012
LevelThe NetherlandsAustria
HospitalsNursing homesHospitalsNursing homes
Institutional level (8 quality indicators)6·07·23·06·6
Ward level (7 quality indicators)4·86·04·06·0

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

This report describes the prevalence, prevention, treatment and number of structural quality indicators for 6 care problems in hospitals and nursing homes in the Netherlands, Austria and Switzerland. The prevalence rates of some of these care problems are comparable among the countries and per type of healthcare institution. Other prevalence rates differ somewhat among the countries. In the Netherlands, the prevalence of pressure ulcers is higher in the hospitals and lower in the nursing homes compared with the prevalence rates in Austria and Switzerland. The prevalence of incontinence is higher in the Austrian nursing homes and hospitals. Over the years, the prevalence rates of some care problems, such as intertrigo and malnutrition, declined, while others seem more stable.

Although most prevalence rates across the participating countries are comparable, differences do exist in the prevention and treatment of the various care problems, for instance, the use of pressure-relieving mattresses for preventing pressure ulcers, or the consultation of a dietician for malnutrition. These differences may partly be based on differences in the healthcare system, but they might also be partly based on differences in prevention and treatment policies regarding the care problems measured in this study. In current times, with more and more international guidelines being developed, it is surprising to see the variations found in this study.

To our best knowledge, this report is the first international comparison of basic care problems in Europe. Although several international studies are available about one or more specific care problems, it is difficult to compare these because of the different methodologies and instruments they used. Furthermore, these studies are mostly based on data from only one or a few institutions. This report is based on data from the Netherlands, Austria and Switzerland, and must be seen as a first step in collecting European data about basic care problems in health care. In the near future, we hope to add more data from Switzerland and other countries. Countries that would like to start measuring these care problems are welcome to join.

Measuring the prevalence, prevention, treatment and quality indicators of care problems in healthcare organizations is an important step in improving the quality of care, because it raises explicit attention for these care problems. Focusing on these problems has a positive effect, which is clearly demonstrated by the course of the prevalence of these care problems over the years. This report only presented data collected since 2009. However, based on the Dutch data, Meijers et al. (2009b) found that the prevalence rate of malnutrition has declined in the period 2004–2007, and, more importantly, that this decline was higher in institutions that participated more often. Comparable results are found for the prevalence of pressure ulcers. Therefore, it is recommended to measure the prevalence of relevant basic care problems at least once a year, firstly to gain insight into the problem and secondly to take a first step in improving care by measuring the prevention, treatment and structural quality indicators of these care problems.

Limitations

This report has made no correction with case-mix adjustment, because we decided to only present the actual frequencies here and to present more case-mix-adjusted figures in future publications about individual care problems. Therefore, findings need to be interpreted carefully, although comparisons of some patient characteristics among the countries did show that only the level of care dependency differed among the nursing homes in Austria and the Netherlands.

A further limitation of this study is the non-response rate of about 25% in Austria and Switzerland, mostly caused by refusal of the patient. We hope this will be improved in the following years, when assessing patient care problems will become a bigger part of regular care.

Conclusions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

With this study, a beginning has been made to building a European database of basic care problems, which is important to gain insight into differences in some aspects of care among countries. As this study already shows, some prevalence figures are comparable among the studied countries, but the prevention of care problems is very different. More in-depth analyses have to be made to gain insight into the effects of these differences. Measuring the prevalence, prevention, treatment and quality indicators of basic care problems in healthcare organizations is also important; it is the first step in improving the quality of care. It raises explicit attention to these care problems, which can result in lower prevalence rates. Increasingly, European and International guidelines have been developed. The results so far show that prevention and treatment vary among the countries, indicating that these international guidelines are not fully adopted in the studied countries. More attention to the implementation of international guidelines is, therefore, recommended.

Measuring the prevalence, prevention, treatment and quality indicators means that not only can a European database of care problems be built, but it also provides the opportunity to monitor the effect of implementing international guidelines. We invite all European countries to participate in this prevalence measurement of care problems.

Funding

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author contributions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References

All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE (http://www.icmje.org/ethical_1author.html)]:

  • substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;
  • drafting the article or revising it critically for important intellectual content.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Findings
  6. Discussion
  7. Conclusions
  8. Funding
  9. Conflict of interest
  10. Author contributions
  11. References
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