title: The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program.
abstract: OBJECTIVE
  To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks.
  
  
  METHODS
  Quality improvement.
  
  
  METHODS
  SCI Rehabilitation Center.
  
  
  METHODS
  Inpatients admitted January 2012 to July 2013.
  
  
  METHODS
  Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges.
  
  
  METHODS
  Implementation processes (e.g. staff training) and BPI outcomes (completion rates).
  
  
  RESULTS
  Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation).
  
  
  CONCLUSIONS
  Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Scovil
authors.forename: Heather M
authors.initials: HM
authors.lastname: Flett
authors.forename: Lan T
authors.initials: LT
authors.lastname: McMillan
authors.forename: Jude J
authors.initials: JJ
authors.lastname: Delparte
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Leber
authors.forename: Jacquie
authors.initials: J
authors.lastname: Brown
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Burns
mesh_terms: D015984:Causality; D015897:Comorbidity; D005260:Female; D006284:Health Plan Implementation / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012046:Rehabilitation / Q000592:standards*; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Best practice; Implementation; Pressure ulcer; Risk assessment; Spinal cord injuries