<b>EVALUATION OF PRESSURE ULCERS PREVENTION PRACTICES AND ASSOCIATED OUTCOMES IN MEDICAL AND SURGICAL DEPARTMENTS OF MEDICARE HOSPITAL MULTAN</b>

Background: Pressure ulcers (PUs) represent a significant patient safety concern and quality indicator in hospital settings worldwide. In Pakistan, limited research exists on pressure ulcer prevention practices and their relationship to patient outcomes, particularly in private sector hospitals. Medicare Hospital, Multan, serves as an important healthcare provider in Southern Punjab, yet the effectiveness of its pressure ulcer prevention protocols remains unevaluated. Objective: This study aimed to evaluate the pressure ulcer prevention practices among nurses working in medical and surgical departments of Medicare Hospital, Multan, assess the incidence and severity of hospital-acquired pressure ulcers, and examine the relationship between prevention practices and patient outcomes. Methods: A mixed-methods sequential explanatory design was employed. Phase I involved a cross-sectional survey of 108 registered nurses in medical and surgical departments using validated tools: the Pressure Ulcer Knowledge Assessment Tool (PUKAT) and the Attitudes towards Pressure Ulcer Prevention (APuP) instrument. Phase II comprised a prospective observational cohort study of 280 adult patients admitted to these departments, followed for two weeks or until discharge, to document pressure ulcer development using the National Pressure Ulcer Advisory Panel staging system. Phase III included semi-structured interviews with 15 nurses to explore barriers and facilitators to prevention practices. Quantitative data were analyzed using SPSS version 26 with descriptive and inferential statistics. Qualitative data were analyzed using thematic analysis. Results: The mean knowledge score among nurses was 55.2% (SD=12.8), with only 28.7% achieving a passing score of ≥70%. Knowledge deficits were most pronounced in risk assessment tools (47.3% correct) and nutrition (41.7% correct). Attitudes were moderately positive (mean score 72.4%, SD=9.6), with 58.3% demonstrating positive attitudes. Observed prevention practices revealed significant gaps, particularly in documentation of risk assessment (38.9% compliance) and repositioning every two hours (41.7% compliance). The incidence of hospital-acquired pressure ulcers was 19.6% (55/280 patients), with most being Stage I (47.3%) or Stage II (40.0%). Sacrum (43.6%) and heels (23.6%) were the most common sites. Significant associations were found between pressure ulcer development and nurses' knowledge scores (p=0.003), attitude scores (p=0.012), and practice scores (p<0.001). Logistic regression identified Braden score ≤16 (OR=4.82, 95% CI: 2.41-9.63), immobility (OR=3.76, 95% CI: 1.92-7.35), and nurse practice score <70% (OR=2.94, 95% CI: 1.48-5.84) as independent predictors. Qualitative findings revealed five themes: knowledge as a double-edged sword, the workload challenge, resource constraints, organizational culture and support, and teamwork and communication. Conclusion: This study identified significant gaps in nurses' knowledge, attitudes, and practices regarding pressure ulcer prevention at Medicare Hospital, Multan, with a correspondingly high incidence of hospital-acquired pressure ulcers. The findings underscore the urgent need for comprehensive educational interventions, enhanced organizational support, and systematic implementation of evidence-based guidelines to improve patient outcomes.