title: Evaluation of a pilot Pressure Ulcer Prevention Initiative (PUPI) for patients with traumatic spinal cord injury.
abstract: OBJECTIVE
  The purpose of this study was to determine whether implementation of a Pressure Ulcer Prevention Initiative (PUPI) changed the assessment and treatment of patients with a traumatic spinal cord injury (SCI) in an acute care setting, and improved patient outcomes.
  
  
  METHODS
  The success of implementation was evaluated by examining the percentage of patients with completed occupational therapist (OT) skin care assessments and prescriptions for therapeutic support surfaces (TSS; i.e., mattresses) before implementation (historical, cohort 1) and after implementation (experimental, cohort 2). Patient outcomes were evaluated by examining changes in PU incidence, severity, timing and recurrence, as well as PU prevalence and satisfaction with life in the community.
  
  
  RESULTS
  Final analysis included 70 patients in cohort 1 and 73 in cohort 2. OT skin care assessment documentation (31% to 60%; p<0.001) and TSS prescriptions (31% to 60%; p=0.02) significantly increased following the implementation. The PU incidence based on patient charts (both nursing and OT assessments) did not increase significantly (26% to 36%; p=0.2). However, documented PU incidence according to OT assessments showed a substantial increase (14% to 33%; p=0.002). No effect of the PUPI was seen on immediate or long-term patient outcomes during the study period.
  
  
  CONCLUSIONS
  PUPI was successful in changing clinical practice in PU prevention but no statistically significant improvements in PU-related patient outcomes were demonstrated. Results from this study identified facilitators and barriers to implementation and highlighted the complexity and difficulty of instituting effective preventative or therapeutic interventions for this population in an acute care setting. This information will assist with refinements of the PUPI and inform similar future initiatives.
authors.affiliation: BSc, OT, Vancouver General Hospital, Vancouver, Canada; Rick Hansen Institute, Vancouver, Canada.
authors.forename: J E
authors.initials: JE
authors.lastname: Cobb
authors.affiliation: RN MSN, Vancouver General Hospital, Vancouver, Canada; Department of Orthopedics, University of British Columbia, Vancouver, Canada; Rick Hansen Institute, Vancouver, Canada.
authors.forename: L M A
authors.initials: LM
authors.lastname: Bélanger
authors.affiliation: BMLSc, Rick Hansen Institute, Vancouver, Canada.
authors.forename: S E
authors.initials: SE
authors.lastname: Park
authors.affiliation: MSc, Rick Hansen Institute, Vancouver, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Shen
authors.affiliation: PhD, Department of Orthopedics, University of British Columbia, Vancouver, Canada; Rick Hansen Institute, Vancouver, Canada.
authors.forename: C S
authors.initials: CS
authors.lastname: Rivers
authors.affiliation: MD, Department of Orthopedics, University of British Columbia, Vancouver, Canada.
authors.forename: M F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: MD, Department of Orthopedics, University of British Columbia, Vancouver, Canada.
authors.forename: J T
authors.initials: JT
authors.lastname: Street
authors.affiliation: PhD PT, Rick Hansen Institute, Vancouver, Canada.
authors.forename: V K
authors.initials: VK
authors.lastname: Noonan
mesh_terms: D001512:Bedding and Linens; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D009788:Occupational Therapy; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D017592:Skin Care / Q000379:methods*; D013124:Spinal Injuries / Q000150:complications*; D016896:Treatment Outcome