Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

Area of Science:

• Healthcare management
• Nursing research
• Patient safety

Background:

• Hospital-acquired pressure ulcers (PUs) remain a significant patient safety concern.
• Effective prevention programs are crucial for reducing PU incidence and improving patient outcomes.
• Understanding the operationalization of PU prevention programs is essential for quality improvement.

Purpose of the Study:

• To describe the presence and implementation of key components in hospital pressure ulcer (PU) prevention programs.
• To compare PU prevention program components across six acute care hospitals.
• To identify variations in program operationalization based on hospital characteristics.

Main Methods:

• A multisite comparative case study design was employed.
• Six Veterans Health Administration hospitals were selected based on PU rates and size.
• Semi-structured interviews (n=48) with key personnel explored practice environments, prevention practices, and barriers.

Main Results:

• All participating hospitals had implemented all core PU prevention program components.
• Significant variation existed in the operationalization of these components across hospitals.
• Wound care specialists were central to program implementation, though their staffing and roles varied widely.

Conclusions:

• Hospital-level variations in pressure ulcer prevention programs were identified.
• Wound care specialist staffing emerged as a key factor influencing program effectiveness.
• Targeting wound care specialist resources may enhance performance monitoring and staff education for PU prevention.