7. LPZ Adam Gordon“We are able for the first time to benchmark the prevalence of care problems and how care homes respond at a local and regional level, and compare these to similar measurements from other countries, building understanding of good practice and working to make things better for residents.”

Dr Adam Gordon, Clinical Associate Professor in Medicine of Older People, University of Nottingham


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).

We have been working with East Midlands care homes to test out if this system, proven abroad, could be implemented in the UK to improve the care and safety of care home residents. LPZ supports learning and allows local, national and international benchmarks against common problems in care


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.

We have worked with care homes to upload the data of hundreds of residents (focusing on the main problem areas of pressure ulcers and continence). Working with The University of Nottingham, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham CityCare Partnership and Derbyshire and Nottingham Clinical Commissioning Groups, we helped with training for care home staff and have supported the audit from start to completion. Care home staff also received training to recognise pressure ulcers using the ‘React to Red’ training package

What’s the impact?

  • The pilot demonstrated that the LPZ tool can be used in the UK to improve care, providing validated and consistent measure of common problems
  • Staff taking part have been engaged and reported by positively on  the process. In total 30 care homes took part and data from 511 residents was uploaded in year 2 compared to 26 homes and 489 residents in year 1
  • One care home in Lincolnshire has taken on board the LPZ findings and has implemented changes and improvements relating to nutrition using Wessex AHSN’s toolkit and resources.
  • Care homes have actively engaged in quality improvement capability events in order to support the development of improvementapproaches. Over 180 care home staff have attended the events across the East Midlands.
The latest findings flagged/found up using LPZ:

  • A pressure ulcer prevalence of 7%, 70% of which were acquired in the care home
  • 78% of residents were incontinent of urine
  • 39% of residents had fallen in the last 12 months
  • 42% of residents were found to be at risk of malnutrition
  • Average number of residents in acute pain on a daily basis
  • How restraint policies were being applied
  • Demographics of the care home population

What’s next?

With the partners we are developing plans for the wider adoption and spread of LPZ, we are aiming to scale it across the East Midlands, whilst also working with NHS Improvement to explore the potential for wider roll out.

View a summary of the LPZ project in 30 seconds here:

You can visit our PSC pages for more information.