title: Implementing a pressure ulcer prevention bundle in an adult intensive care.
abstract: BACKGROUND
  The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change.
  
  
  OBJECTIVE
  The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance.
  
  
  METHODS
  An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist.
  
  
  RESULTS
  Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants.
  
  
  CONCLUSIONS
  The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements.
authors: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia; School of Nursing, Umm Al-Qura University, Saudi Arabia. Electronic address: nahla.tayyib@connect.qut.edu.au.
authors: Nahla
authors: N
authors: Tayyib
authors: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia.
authors: Fiona
authors: F
authors: Coyer
authors: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia.
authors: Peter A
authors: PA
authors: Lewis
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D009726:Nurses / Q000592:standards / Q000706:statistics & numerical data; D064872:Patient Care Bundles / Q000295:instrumentation / Q000592:standards* / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000517:prevention & control*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Care bundle; Compliance; Implementation strategies; Pressure ulcer prevention bundle