Abstract
Silver Chain is the largest aged and community care provider in Western Australia and assists the frail aged and disabled to remain in their own homes. Many of these individuals have compromised mobility and health status and without appropriate prevention are at significant risk of developing pressure ulcers.
Like many other community organisations, Silver Chain did not have any standardised work processes for predicting the risk and reporting of pressure ulcers. As part of its commitment to providing high quality care, Silver Chain is currently undertaking a project to introduce the Australian Wound Management Association’s (AWMA) Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers. This will be achieved by incorporating the guidelines into everyday work processes and accompanying the introduction of the new processes by a comprehensive staff education and training programme.
The methodology and the tools developed by Prentice for the introduction and evaluation of the AWMA guidelines in Australian tertiary hospitals were adapted for use within a community setting. Baseline measurements of clinical and non-clinical staff knowledge and pressure ulcer prevalence were collected in December 2002. The results of the baseline study clearly demonstrated a need to improve staff knowledge of pressure ulcer prevention and the need to implement standardised quality processes to prevent pressure ulcers.

Abstract
The objective was to determine whether there was a change over time in referral patterns, as well as clinical and demographic features, of patients attending a hospital based outpatient leg ulcer clinic based at a tertiary referral hospital servicing a total population of 473,500. This prospective clinical audit involved the collection of comprehensive clinical data of all patients referred to the ulcer clinic over an 8 year study period. The referral source, patients’ demographic and clinical features, as well as the type of management instituted were recorded. Six hundred and twenty seven patients attended the clinic. The mean age of patients at admission was 72.3 years. General practitioners (GPs) referred approximately 80% of these patients and there was no significant change in patients’ demographic features. Over time, there was a statistically significant increase in the number of patients who presented with an ulcer which had been present for less than 3 months and there was a significant decrease in the proportion of subjects who presented with multiple ulcers. The proportion of venous ulcers treated at the clinic decreased from 53.7% during the first two year period to 35.9% in the final two year period, whilst there was a 6% increase in the proportion of ulcers caused by combined arteriovenous insufficiency over this time. In conclusion, although there was only minimal change in patients’ demographic features or referral source, there was a significant change in the clinical features of patients over time.

Abstract
Pressure ulcers are recognised internationally as iatrogenic injuries of the skin and underlying tissues and, in most cases, are seen as avoidable adverse events. They are also seen as clinical indicators of the standard of care provided. Numerous researchers have examined pressure ulcer prevalence within a variety of clinical settings. Meaningful comparison of data is impaired by reoccurring anomalies relating to different methodological approaches used to collect and analyse data. Therefore the conclusions that can be drawn regarding pressure ulcer prevalence and the impact of pressure ulcers on both patients and health care systems are lessened.
This paper describes a subsection of the methodology used in a national multi-centre study which evaluated the efficacy of Australian guidelines for pressure ulcers in improving doctors’ and nurses’ knowledge of pressure ulcers, and in reducing pressure ulcer prevalence when implemented in conjunction with an education programme. The subsection presented here proposes a standardised model for surveillance of pressure ulcer point prevalence. It addresses discrepancies with data collection methods used in previous Australian studies assessing pressure ulcer prevalence and meets international standards for conducting multi-centre prevalence studies. Using a standardised approach, as this model proposes, ensures a common understanding of pressure ulcer terminology, improved inter-rater reliability (IRR) in classifying pressure ulcers, and less variance in the quality of data collected.
Only a brief summary of the prevalence found in this study will be discussed here. Detailed results of the study will be presented in a forthcoming article. This study, however, has found Australian guidelines for pressure ulcers to be effective in reducing pressure ulcer prevalence from 26.5% to 22% (p<0.002) when implemented in conjunction with an education programme.