Pressure ulcer risk: audit findings.

This article describes the findings of a pilot audit project that assessed the effects on practice and patient care of guideline recommendations for reducing pressure ulcer development. A national audit project to enable the implementation strategy and audit tools to be evaluated across a range of healthcare settings and patient groups should now be undertaken.

Aortic valve allograft structural deterioration is associated with a subset of antibodies to human leukocyte antigens.

BACKGROUND AND AIM OF THE STUDY: The association between aortic valve allograft dysfunction in patients with long-term follow up and human leukocyte class 2 antigen donor/recipient mismatch suggests that elements of the anti-donor immune response penetrate and damage the aortic valve allograft. An aortic valve allograft recipient cohort was studied to determine whether presence of recipient antibodies to donor human leukocyte class 1 or 2 antigen was associated with shorter time to aortic valve allograft dysfunction. METHODS: Both donor and recipient human leukocyte antigen (HLA) type, HLA antibody information and echocardiography data were available for 148 recipients of cryopreserved aortic valve allografts between 1986 and 1998. Structural deterioration of the aortic valve allograft was defined as at least moderate aortic stenosis or regurgitation by echocardiography. Recipient sera were assayed for anti-HLA (class 1 and 2) antibodies using three assays: complement-dependent cytotoxicity (CDC) on T- and B-lymphocyte panels (CDC PRA); flow cytometry using HLA-coated beads (Flow PRA); and an ELISA using HLA-coated microwells. The donor specificity of anti-class 1 and 2 HLA antibodies was determined on T- and B-cell panels using CDC. Associations between the results of the three assays and donor-specific class 1 and 2 antibodies and time to structural deterioration were analyzed using Kaplan-Meier curves of freedom from structural deterioration. Cox proportional-hazards were used to determine independent predictors of time to structural deterioration. RESULTS: Patients highly positive for HLA class 2 antibodies using an ELISA had a significant association (p = 0.007) with shorter time to aortic valve allograft structural deterioration using both a log rank test and Cox proportional-hazards analysis. Patients (n = 15) with donor-specific antibodies to class 2 antigen (DR antigens) had significantly more structural deterioration (p = 0.035) than those without specific antibodies. CONCLUSION: The association between aortic valve allograft structural deterioration and high titer human leukocyte class 2 antigen antibodies, a subset detected by ELISA adds further information about the link between HLA class 2 mismatch and structural deterioration. Further studies are needed to confirm the importance of class 2 antibodies on outcome, and to determine by which method these antibodies should be detected. Potential recipients with pre-existing antibodies of these specific types might be expected to sustain accelerated allograft damage.

Risk assessment and prevention audit project.

This article describes the aims and objectives of a small pilot audit project to evaluate the impact of guideline recommendations to reduce pressure ulcer development on practice and patient care.

A national pilot to implement pressure ulcer guidelines: results of the baseline audit.

The Royal College of Nursing (RCN) national pilot audit project aims to facilitate the dissemination and implementation of the RCN clinical guideline on pressure ulcer risk assessment and prevention using an evidence-based, tailored strategy. Recent government White Papers reinforced the move towards evidence-based healthcare that includes performance measures, clinical effectiveness and ongoing professional development. Structured dissemination and implementation of the RCN guideline can aid this process by improving patient care, as well as in a culture where more patients are seeking recompense for "poor" care assist in reducing litigation and complaints. This article focuses on the findings of the baseline audit. Providing a summary of the project to date, looking at site recruitment, the provisional results and recommendations of the baseline audit and local initiatives for supporting the ongoing implementation and the implementation resources developed to assist the sites in the process. The project is due for completion at the end of 2002 following which the final results will be published.

Correspondence.

To the editor Further to the LPNS lecture given by Sarah Mullally, chief nursing officer for England (Nursing Management July 2001), I would like to inform readers of a pilot audit project that commenced also in July. The aim is to assess the impact of implementation of the RCN Clinical Guidelines on Pressure Ulcer Risk Assessment and Prevention, which are designed to promote continuous quality improvement by providing high quality treatment and care, to reduce pressure ulcer development and, therefore, potentially, length of stay and resource use.