Factors in facilitating an organisational culture to prevent pressure ulcers among older adults in health-care facilities.

Abstract

Despite the availability of high-quality clinical practice guidelines, pressure ulcers (PU) continue to develop among older adults in acute and long-term health-care facilities. Except during acute medical crisis or near end-of-life, most PUs are preventable and their development is a health-care quality indicator. The aim of this study was to understand which factors facilitate pressure ulcer prevention among adults over 65 years-of-age receiving care in health-care facilities. A critical literature review from three scholarly databases examined components of organisational culture associated with PU prevention. Research papers involving adults >65 years-of-age who were admitted to acute and long-term health-care facilities with PU prevention programmes between 2010 and 2017 were included. A secondary manual search included literature discussing health-care organisational culture, with a total of 41 articles reviewed. Based on a synthesis of this literature, the Factors Facilitating Pressure Ulcer Prevention Model was developed to depict five multilevel factors for PU prevention among older adults in health-care facilities. These five factors are: senior leadership, education, ongoing quality improvement, clinical practice, and unit level champions. Ongoing prioritisation of these factors sustains PU prevention and assists health-care facilities to redefine their culture, expand education programmes, and promote accountability to improve health outcomes of older adults receiving care.