Anita Astle“There was a positive vibe on the audit day and everyone seemed to ‘feel good’ as if something positive had been achieved. We have changed our practice as a result of the LPZ audit. We would now like to continue with to the initiative and undertakea full LPZ audit”.

Anita Astle MBE, Care Home Manager


EMAHSN’s Patient Safety Collaborative (PSC) piloted a tool to measure the prevalence of common care problems. Called the International Prevalence Measurement of Care Problems in Care Homes (Landielijke Pravelentiemeting Zorgproblemen, or LPZ for short, in Dutch), it is currently used in the Netherlands, Germany, Austria, Switzerland, New Zealand, Indonesia and Brazil. It has demonstrated quantifiable improvements in standards of care problems (which we refer to as safety).

The PSC worked with a care homes to trial LPZ to establish whether it could be implemented in the UK to improve the care and safety of care home residents. Support included training on pressure ulcer recognition and using the locally developed ‘React to Red’ training package.


Pressure ulcers are a common problem in older people with frailty – but they are preventable. They occur frequently in care homes and have been recognised by experts as one of the leading causes of safeguarding care home referrals.

To prevent them, carers need to identify those most at risk and put in place preventative measures. When they occur, carers need to recognise them as early and put in place appropriate responses.

What’s the impact?

The PSC recruited 26 care homes and uploaded data related to 489 residents, concentrating on pressure ulcers and continence. This showed:
  • 80% of pressure ulcers were acquired in the care home setting
  • 80% of residents were incontinent of urine, many of which came to the home already incontinent
  • 82% of residents were identified as being at high risk or pressure ulcers
Other impacts:
  • The pilot has demonstrated the tool can be used in the UK to improve care, providing a validated and consistent measurement of common care problems
  • Care home staff taking part reported positively on the process

What’s next?
  • With stakeholders we will seek to spread this work, and will work with NHS Improvement to investigate potential for wider roll out
  • We will continue to assist the spread and adoption of the ‘React to Red’ training materials for staff, patients and carers

You can visit our PSC pages for more information.