Process evaluation of a cluster-randomised trial testing a pressure ulcer prevention care bundle: a mixed-methods...

Area of Science:

• Healthcare Implementation Science
• Clinical Nursing Research
• Patient Safety Studies

Background:

• Pressure ulcers pose a significant burden on patients and healthcare systems, making prevention a critical clinical priority.
• A complex intervention, a pressure ulcer prevention care bundle promoting patient participation, was developed and tested in a cluster-randomised trial.
• Process evaluation is recommended for complex interventions to understand implementation successes and failures.

Purpose of the Study:

• To evaluate the implementation processes of a pressure ulcer prevention care bundle.
• To explore end-users' perceptions of the care bundle to understand its effects.
• To provide insights into the effectiveness of the intervention in a real-world clinical setting.

Main Methods:

• A mixed-methods process evaluation was conducted alongside a cluster-randomised trial.
• Data collection focused on recruitment, reach, intervention delivery, and response across eight Australian hospitals.
• Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data underwent thematic analysis.

Main Results:

• Recruitment and reach for the pressure ulcer prevention care bundle were high among clusters and individuals.
• The intervention was delivered to 96.7% of 799 patients, with delivery time under 10 minutes.
• Patients and nurses accepted the care bundle, recognizing its benefits and role in enabling patient participation in prevention care.

Conclusions:

• No major implementation failures were identified for the pressure ulcer prevention care bundle.
• The care bundle was easy to understand, deliver, and acceptable to patients and nurses.
• The intervention shows potential as an effective method for patient engagement in pressure ulcer prevention and promoting evidence-based practice.