[Decubitus lesions in patients referred to acute and post-acute home nursing care for the elderly in Genova]. / Le lesioni da decubito nella popolazione afferente al nucleo operativo assistenza anziani e RSA post-acuti della USL 3 "Genovese".

The Elderly Services of USL 3 "Genovese" together with the team for Continuing Education designed and implemented a survey on the elderly clients referred to the home care and nursing home services. The aim of the study was to describe the frequency, distribution and severity of pressure ulcers. The data were collected during a period of seven months: from 1st November 1997 to 31st May 1998. One thousand seven hundred and twenty nine clients were observed; 705 (41%) had single or multiple pressure ulcers. Patients with multiple pressure ulcers accounted for 42% of the total. The sacrum was the most affected site (43% of the patients with a single ulcer and 33% with multiple ulcers). Patients with severe pressure ulcers (stages 3 degrees and 4 degrees NPUAP classification) accounted for 42% of the total. Pressure sores were observed in 15% of "at no risk" patients and in 40% of those at low risk (Norton Scale score). The study highlighted a lack of documentation (90% patients) on treatments performed in the hospital and prescribed at discharge for the pressure sores. These findings reflects possibly the fact that this aspect of care is unduly disregarded by nursing personnel, and that a goal-oriented retraining, underlining also the need of appropriate documentation, is warranted.

[A multicenter study on the quality of use of long-term medication card]. / Estudio multicéntrico de la calidad en la utilización de la tarjeta de medicación crónica.

OBJECTIVE: To evaluate and improve the use of Long-term Medication Cards (LMC) at three Primary Care Centres and to obtain information about the impact of ongoing education on quality guarantee methodology. DESIGN: A before and after study. SETTING: The Caldes de Montbui, Rubi-1 and Concordia (Sabadell) Primary Care Centres. PARTICIPANTS: LMC samples from these three centres: 462 and 333 LMC for the first and second evaluations, respectively. INTERVENTIONS: The professionals involved were fed back the results of the evaluations carried out. Modifications in the system of control and organisation of the LMC were introduced. These included keeping the information contained on the LMC in the centres and changes in their cancellation and renewal norms. MEASUREMENTS AND MAIN RESULTS: The results showed intracenter increases on all except one of fifteen measurements, presenting the following extreme values in the two evaluations performed at the three centres: record on the LMC of the length of treatment (from 63 to 98%); non-inclusion of treatments with authorization of less than three months (58 to 100%); non-inclusion of authorization above a year (83 to 100%); recording of the guidelines (61 to 87%); non-inclusion of antibiotic treatments on the LMC (94 to 100%). CONCLUSIONS: As for training, experience showed that its is feasible and profitable to follow up ongoing training, both to evaluate the impact of this training and to use the application of the quality guarantee cycle in the introduction and setting-up of internal QEI activities.