Implementation of pressure injury prevention best practices across six Canadian rehabilitation sites: results from the Spinal Cord Injury Knowledge Mobilization Network

Publication date: Available online 9 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Carol Y. Scovil, Jude J. Delparte, Saagar Walia, Heather M. Flett, Stacey D. Guy, Michelle Wallace, Anthony S. Burns, Dalton L. Wolfe, SCI KMN Group

Abstract

Objective

To utilize the theoretical frameworks of implementation science to implement pressure injury (PI) prevention best practices in spinal cord injury (SCI) rehabilitation.

Design

Quality Improvement

Setting

Six Canadian SCI rehabilitation centers

Participants

Inpatients admitted 2011-2015

Interventions

The SCI Knowledge Mobilization Network (SCI KMN) selected and implemented two PI prevention best practices at six Canadian SCI rehabilitation centers: (1) completing a comprehensive PI risk assessment comprised of a structured risk assessment instrument followed by an individualized, interprofessional risk factor determination and prevention plan; and (2) providing structured and individualized PI prevention patient education. Active Implementation Frameworks provided a systematic approach to best practice implementation.

Outcome Measures

Implementation indicators (completion rates) and patient outcomes (PI incidence; patient education survey).

Results

Following implementation, risk assessment completion rates improved from 46% to 82% (p<0.05). Between initial (2012-13) and full (2014-15) implementation stages, completion rates improved for both interprofessional risk factor determination (67% to 96%) and prevention plans (67% to 94%). Documentation of patient education also increased to 86% (71% pre-implementation). The incidence of PIs at rehabilitation admission was 22%, with 14% of individuals developing new PIs during rehabilitation. The overall PI prevalence was 30%. Considering only PIs of stage 2 or greater, prevalence was 21% and incidence 7%. There were no statistically significant differences in PI incidence between pre- and post-implementation. Patient education surveys indicated that PI education improved patients' knowledge of prevention strategies.

Conclusions

Active Implementation Frameworks supported successful implementation of PI prevention best practices across the six participating SCI KMN sites. Achieving a reduction in PI incidence will require additional measures, and there is an ongoing need to strengthen the evidence base underpinning PI prevention guidelines.

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