Pressure ulcers: implementation of evidence-based nursing practice.

Area of Science:

• Healthcare Management
• Clinical Informatics
• Nursing Practice

Background:

• Pressure ulcers represent a significant financial and time burden on healthcare systems.
• Treatment costs per pressure ulcer range from $10,000 to $86,000.
• Limited empirical evidence exists on the effectiveness of implementing clinical practice guidelines for pressure ulcers.

Purpose of the Study:

• To evaluate multi-component, computer-assisted strategies for implementing clinical practice guidelines over two years.
• To describe the implementation process and identify lessons learned.
• To assess the impact on pressure ulcer prevention and treatment strategies.

Main Methods:

• A 2-year project implemented computer-assisted strategies across primary, secondary, and tertiary care settings in a Canadian urban Health Region.
• Seven healthcare organizations (acute, home, extended care) participated.
• Registered Nurses surveyed patients to determine pressure ulcer prevalence and incidence.
• A computerized decision-support system aided staff in selecting evidence-based care, recording data, and analyzing outcomes.

Main Results:

• Increased staff knowledge regarding pressure ulcer prevention, treatment, resource needs, and interdisciplinary team roles.
• Identified barriers included lack of senior nurse leadership, time for computer skill acquisition and guideline implementation, and computer system difficulties.

Conclusions:

• A comprehensive, supported, and sustained approach is crucial for implementing evidence-based practice in pressure ulcer care.
• Understanding and addressing organization-specific barriers is essential for successful guideline implementation.
• Mechanisms are needed to overcome identified implementation challenges.