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Landelijke Prevalentiemeting Zorgkwaliteit (LPZ) - Care Homes Harms Prevalence Audit Tool measures the occurrence of common care issues such as pressure ulcers, continence, nutrition, falls, restraint and pain. Routinely reviewing LPZ data, allows care homes to make improvements to the care they deliver resulting in reduced falls, reduced pressure ulcers and improved continence and pain management.
The East Midlands Patient Safety Collaborative (EM PSC) initially started delivering the LPZ programme, which was developed by Maastricht University in the Netherlands, in 2016. After establishing that improving safety in care homes was a priority area, the East Midlands’ team searched for best-practice examples of care home safety initiatives to address common care issues. LPZ was selected as an exemplar for improving patient care and safety in this area.
Here Irma Project Lead for LPZ in the Netherlands speaks about the history of LPZ, the landscape of care homes in the Netherlands and offers a comparison of this programme and system in the UK. Her insights highlight the benefits of working internationally to deliver the most appropriate and best possible patient safety initiatives.
LPZ has been active for 21 years. It first started in 1998 as the ‘National Prevalence Research for Pressure Ulcers’. Throughout the years, the tool was adapted, including additional care indicators of malnutrition and incontinence in 2004 and falls and restraints in 2007. In 2009, the LPZ was disseminated to Austria and Switzerland and this was the start of the international research group. The UK and Turkey followed in 2016.
The main reason for initiating the audit was the fact that members of the Dutch Pressure Ulcer Association (Decubitus Nederland) felt that pressure ulcers were becoming a growing problem in Dutch health and care and up until 1998 there was no prevalence measurement of pressure ulcers. The LPZ team decided to organize a pressure ulcer prevalence measurement. This was extremely well received by participating institutions and agreed that it was important to do the measurement once per year from then on.
Based on my experience, the size of the care homes in the UK compared to the Netherlands is the biggest difference. In the Netherlands, care homes have 400 residents on average and have multiple locations.
There are also multidisciplinary teams employed directly by care homes. These teams include a care home physician, nurses, activities therapists, psychologists, physiotherapists, occupational therapists, speech therapists and dieticians. In addition to the multidisciplinary team, the care home employs managers, policy advisors and quality advisors. Almost all care homes in the Netherlands are public and funded by a state-controlled mandatory insurance, meaning that everyone living or working in the country contributes.
The care homes I visited on my trip to the UK were a lot smaller and did not have the large multidisciplinary teams. Due to this smaller scale I did sense a very personal and intimate atmosphere when visiting – residents and staff really knew each other.
It was great to learn more about how EM PSC deliver the LPZ programme in the UK by visiting and attending the annual LPZ audit results and awards event, which provides training to participating care homes. The thing I really liked, and which I believe is very important, is that the event was visited by care workers. At LPZ events in the Netherlands attendees are mainly the coordinators, quality advisors or managers.
The LPZ audit event in the UK was really focused on the people providing the care to the residents. These are the people who can actually improve the care quality and it’s so important for them to be involved in these events.
The event agenda was extremely high quality with the opportunity for delegates to hear about how to use the LPZ dashboard and to ask experts about the different care problems. I particularly liked that participants took the floor to share what they did to improve their care quality. At our next event in the Netherlands we will definitely deliver some similar sessions and content based on what we saw in the UK – getting a different take and perspective on this based on the way LPZ training is delivered in the UK is an example of how our collaboration is working effectively.
Some key differences to the way LPZ is delivered in the Netherlands to the UK is scale, in the Netherlands participants can choose which modules they want to take while in the UK all organizations do all modules and lastly in the Netherlands we use electronic health record. In the Netherlands almost all care homes use an electronic health record and they upload large parts of this data into to LPZ audit tool while this is not the case in the UK. This is just one example of how the programme needs to be adapted to meet the structure and abilities of the system it is placed in – this highlights how even though internationally we have different care systems, we can still learn from and adapt proven initiatives.
The similarities, however, are the dedication of the care homes participating in the LPZ. As participation is voluntary, care homes only participate if they are intrinsically motivated to critically reflect on their care quality and want to improve it.
As the approaches by the different countries participating in LPZ are very different, it’s important to use this opportunity to undertake comparative research, using the data collected we can then continue with more in-depth studies to explore the differences in more detail. This highlights a strength of participating in an international patient safety initiative, as data for common care issues can be compared and contrasted to establish if there are any structural or societal factors that may be an underlying cause of care issues and enable us to recognise and therefore act on these more effectively.
We look forward to continuing to work with and share learnings with the East Midlands PSC and hope the LPZ programme is used as an example of best practice for patient safety in care homes – with the potential for other UK organisations spreading initiative.
Irma Everink, LPZ Project Lead, Maastricht University