Successful implementation of clinical practice guidelines for pressure risk management in a home nursing setting.
BACKGROUND
This paper reports an initiative which promoted evidence-based practice in pressure risk assessment and management among home nursing clients in Melbourne, Australia.


OBJECTIVE
The aim of this study was to evaluate the introduction and uptake of the Australian Wound Management Association Guidelines for the Prediction and Prevention of Pressure Ulcers.


METHODS
In 2007 a pilot study was conducted. Nurse perspectives (n=21) were obtained via survey and a client profile (n=218) was generated. Audit of the uptake and continued use of the pressure risk screening tool, during the pilot study and later once implemented as standard practice organizational wide, was conducted.


RESULTS
Nurses at the pilot site successfully implemented the practice guidelines, pressure risk screening was adopted and supporting resources were well received. Most clients were at low risk of pressure ulcer development. The pilot site maintained and extended their pilot study success, ensuring more than 90% of clients were screened for pressure risk over the 18 months which followed. All other sites performed less well initially, however subsequently improved, meeting the pilot sites success after 18 months. Two years later, the organization continues to screen more than 90% of all clients for pressure risk.


CONCLUSIONS
Implementation of clinical practice guidelines was successful in the pilot project and pressure risk screening became a well-adopted practice. Success continued following organizational wide implementation. Pilot study findings suggest it may be prudent to monitor the pressure ulcer risk status of low risk clients so as to prevent increasing risk and pressure ulcer development among this group.
Research Fellow, Registered Nurse, Royal District Nursing Service Helen Macpherson Smith Institute of Community Health, St Kilda, Victoria, Australia.
Suzanne
S
Kapp
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D019317:Evidence-Based Medicine; D005260:Female; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000592:standards*; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000175:diagnosis / Q000451:nursing / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods* / Q000458:organization & administration