Abstract
Objective
To use 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 (N=2371) admitted from 2011 to 2015.
Interventions
The SCI Knowledge Mobilization Network (SCI KMN) selected and implemented 2 PI prevention
best practices at 6 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.
Main Outcome Measures
Implementation indicators (completion rates) and patient outcomes (PI incidence, patient
education survey).
Results
After implementation, risk assessment completion rates improved from 46% to 94% (P<.05). Between initial (2012-2013) and full (2014-2015) 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% (vs. 71% preimplementation). At rehabilitation admission 22% of patients had PIs,
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 postimplementation. 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 6 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.
Keywords
List of abbreviations:
FMC (Foothills Medical Centre), GRH (Glenrose Rehabilitation Hospital), IRDLM (Institut de Réadaptation Gingras-Lindsay-de-Montréal), IRDPQ (Institut de Réadaptation en Déficience de Physique de Québec), IRGLM (Institut de Réadaptation Gingras Lindsay-de-Montréal), NIRN (National Implementation Research Network), PI (pressure injury), PI-SJHC (Parkwood Institute—St. Joseph’s Health Centre), SCI (spinal cord-injury), SCI KMN (Spinal Cord Injury Knowledge Mobilization Network), SCIPUS (Spinal Cord Injury Pressure Ulcer Scale), TRI-UHN (Toronto Rehabilitation Institute—University Health Network)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 09, 2018
Footnotes
The SCI KMN Group was funded through a partnership of the Rick Hansen Institute, Ontario Neurotrauma Foundation, and Alberta Paraplegic Foundation.
Disclosures: none.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
