Prof. Jos Schols MD, PhD from the Dutch LPZ team in Maastricht gives his views and feedback on this annual measurement of the prevalence which first started in the Netherlands in 1998 and is now being trialled by the Eats Midlands Patient Safety Collaborative.
Residents of care homes are very frail and often disabled people with a profile of multi-morbidity, multiple handicaps and loss of autonomy. Offering them high quality of care will contribute to their quality of life.

Just like very ill hospital patients, residents of care homes often suffer from basic care problems like pressure ulcers, incontinence, malnutrition, falls etc. High quality of basic care to this target group requires therefore adequate preventive and therapeutic attention for these care problems.

An annual measurement of the prevalence of these care problems, including their related quality indicators, may provide care homes with information about the level of quality of care they are offering.

Such an annual measurement, called the LPZ, exists in The Netherlands since 1998 and is nowadays also conducted in some other European countries, like Austria and Switzerland. In November 2015 the LPZ measurement was also done in the UK, as a pilot on a small scale.

LPZ puts care problems on the agenda and actually benefits care organizations and professionals by providing feedback on their performance. In addition, LPZ provides opportunities and possibilities for care homes to benchmark with comparable care organizations in the country and learn from that. It offers cues for optimizing basic care and leads to concrete improvement activities.

By measuring in different countries in the same way, LPZ also offers opportunities to compare between countries and to learn across borders about how to improve quality of care.

Some examples to illustrate LPZ-benefits
When we started measuring the prevalence of malnutrition in Dutch care homes, prevalence figures showed that over 25% of residents suffered from malnutrition. Moreover, it appeared that, next to an insufficient mealtime ambiance, in general care home professionals had not enough awareness of the importance of this care problem. Many homes became eager to improve nutritional care performance and their willingness to do so was supported by a national care improvement program of the Ministry of Health, called Care for Better.

Involvement in these improvement activities led to significantly lower prevalence rates of malnutrition and better nutritional care performance in the participating care homes.  Moreover, it appeared that the more often care homes participated in the annual LPZ measurements, the better their nutritional care performance was and the lower their prevalence rate of malnutrition remained.

What we also learned is that LPZ figures must be used to sustain a continuous climate of internal quality improvement; a climate that is supported by everyone in the care home, from the work floor to the manager or director. Otherwise attention may decrease again quickly.

Another Dutch experience involved the aspect of quality of pressure ulcer care (PU care) in care homes. LPZ measurements showed that the prevalence of PUs in Dutch care homes was structurally higher than the PU prevalence in German care homes. Because of this, from Dutch point of view, negative finding, we conducted an additional study to assess whether there is a difference in pressure ulcer incidence rates between nursing homes in the Netherlands and Germany and whether possible differences in incidence rates were caused by patient-, care- and/or institutional related factors? Again, this study showed and confirmed clearly that German nursing homes had a better performing PU care; but the study also provided nursing homes in the Netherlands with recommendations to improve their PU care performance. We learned for instance that Dutch nursing homes should pay more attention to repositioning, the necessity and correct use of transfer aids and to the necessity of analgesics use. In addition the nursing homes should reconsider the tasks of their tissue viability nurses and try to intensify and improve their regular internal quality controls.

Finally, what has appeared also during the years is that measurements like LPZ are mostly done with much enthusiasm and from a positive point of view.

Measuring means knowing and this contributes to learning. Lifelong learning and improving care performance require continuous measuring, which fits in the title of this blog!

Best wishes from the Dutch LPZ team in Maastricht,
Prof. Jos Schols MD, PhD