Original research| Volume 100, ISSUE 2, P327-335, February 2019

Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network

Published:November 09, 2018DOI:



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


      Quality improvement.


      Six Canadian SCI rehabilitation centers.


      Inpatients (N=2371) admitted from 2011 to 2015.


      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).


      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.


      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.


      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)
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