title: Pressure ulcers: implementation of evidence-based nursing practice.
abstract: OBJECTIVE
  A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper.
  
  
  BACKGROUND
  The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies.
  
  
  METHODS
  The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data.
  
  
  RESULTS
  Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers.
  
  
  CONCLUSIONS
  There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers.
authors.affiliation: Health & Nursing Policy, Research & Evaluation Consulting, 1575 Trafalgar Street, Vancouver, BC, Canada V6K 3R4. heather.clarke@shaw.ca
authors.forename: Heather F
authors.initials: HF
authors.lastname: Clarke
authors.forename: Chris
authors.initials: C
authors.lastname: Bradley
authors.forename: Sandra
authors.initials: S
authors.lastname: Whytock
authors.forename: Shannon
authors.initials: S
authors.lastname: Handfield
authors.forename: Rena
authors.initials: R
authors.lastname: van der Wal
authors.forename: Sharon
authors.initials: S
authors.lastname: Gundry
mesh_terms: D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D033181:Information Dissemination; D009743:Nursing, Practical; D009936:Organizational Innovation; D003668:Pressure Ulcer / Q000451:nursing* / Q000517:prevention & control