Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network

Carol Y Scovil; Jude J Delparte; Saagar Walia; Heather M Flett; Stacey D Guy; Michelle Wallace; Anthony S Burns; Dalton L Wolfe; SCI KMN Group

doi:10.1016/j.apmr.2018.07.444

Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network

Arch Phys Med Rehabil. 2019 Feb;100(2):327-335. doi: 10.1016/j.apmr.2018.07.444. Epub 2018 Nov 9.

Authors

Carol Y Scovil¹, Jude J Delparte², Saagar Walia³, Heather M Flett⁴, Stacey D Guy³, Michelle Wallace⁵, Anthony S Burns⁶, Dalton L Wolfe³; SCI KMN Group

Collaborators

SCI KMN Group:
D L Wolfe, A Kras-Dupuis, S Walia, S D Guy, H Askes, A Casalino, C Fraser, M Paiva, S Miles, J Gagliardi, S Orenczuk, J Sommerdyk, M Genereaux, D Jarvis, J Wesenger, L Bloetjes, H M Flett, A S Burns, C Y Scovil, J J Delparte, D J Leber, L T McMillan, T M Domingo, M Wallace, B Stoesz, G Aguillon, C Koning, L Mumme, M Cwiklewich, K Bayless, L Crouse, J Crocker, G Erickson, M Mark, R Charbonneau, A Lloyd, C Van Doesburg, J Knox, P Wright, M Mouneimne, R Parmar, T Isaacs, J Reader, C Oga, N Birchall, N McKenzie, S Nicol, C Joly, M T Laramée, I Robidoux, M Casimir, S Côté, C Lubin, J F Lemay, J Beaulieu, C Truchon, L Noreau, V Lemay, J Vachon, D Bélanger, F Proteau, C O'Connell, J Savoie, S McCullum, J Brown, M A Duda, K Bassett-Spiers, R J Riopelle, J T Hsieh, W Reinhart-McMillan, P Joshi, V K Noonan, S Humphreys, L Hamilton, G MacIsaac

Affiliations

¹ Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada. Electronic address: carol.scovil@uhn.ca.
² Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
³ Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada.
⁴ Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
⁵ Adult Brain Injury, Spinal Cord Injury and General Neurology Programs, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.
⁶ Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 30419231
DOI: 10.1016/j.apmr.2018.07.444

Abstract

Objective: To use the theoretical frameworks of implementation science to implement pressure injury (PI) prevention best practices in spinal cord injury (SCI) rehabilitation.

Design: Quality improvement.

Setting: Six Canadian SCI rehabilitation centers.

Participants: Inpatients (N=2371) admitted from 2011 to 2015.

Interventions: The SCI Knowledge Mobilization Network (SCI KMN) selected and implemented 2 PI prevention best practices at 6 Canadian SCI rehabilitation centers: (1) completing a comprehensive PI risk assessment comprised of a structured risk assessment instrument followed by an individualized, interprofessional risk factor determination and prevention plan; and (2) providing structured and individualized PI prevention patient education. Active Implementation Frameworks provided a systematic approach to best practice implementation.

Main outcome measures: Implementation indicators (completion rates) and patient outcomes (PI incidence, patient education survey).

Results: After implementation, risk assessment completion rates improved from 46% to 94% (P<.05). Between initial (2012-2013) and full (2014-2015) implementation stages, completion rates improved for both interprofessional risk factor determination (67% to 96%) and prevention plans (67% to 94%). Documentation of patient education also increased to 86% (vs. 71% preimplementation). At rehabilitation admission 22% of patients had PIs, with 14% of individuals developing new PIs during rehabilitation. The overall PI prevalence was 30%. Considering only PIs of stage 2 or greater, prevalence was 21% and incidence 7%. There were no statistically significant differences in PI incidence between pre- and postimplementation. Patient education surveys indicated that PI education improved patients' knowledge of prevention strategies.

Conclusions: Active Implementation Frameworks supported successful implementation of PI prevention best practices across the 6 participating SCI KMN sites. Achieving a reduction in PI incidence will require additional measures, and there is an ongoing need to strengthen the evidence base underpinning PI prevention guidelines.

Keywords: Evidence-based practice; Pressure ulcer; Rehabilitation; Spinal cord injury; Translational research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Canada
Clinical Competence
Female
Humans
Incidence
Inservice Training
Male
Middle Aged
Patient Education as Topic / organization & administration*
Practice Guidelines as Topic
Pressure Ulcer / prevention & control*
Rehabilitation Centers / organization & administration*
Rehabilitation Centers / standards
Risk Assessment
Risk Factors
Spinal Cord Injuries / rehabilitation*