Carol Y Scovil1, Jude J Delparte2, Saagar Walia3, Heather M Flett4, Stacey D Guy3, Michelle Wallace5, Anthony S Burns6, Dalton L Wolfe3. 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.
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.
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.
Authors: B Catharine Craven; S Mohammad Alavinia; Matheus J Wiest; Farnoosh Farahani; Sander L Hitzig; Heather Flett; Gaya Jeyathevan; Maryam Omidvar; Mark T Bayley Journal: J Spinal Cord Med Date: 2019-10 Impact factor: 1.985
Authors: Emma A Bateman; Vidya A Sreenivasan; Farnoosh Farahani; Sheila Casemore; Andrea D Chase; Jennifer Duley; Ivie K Evbuomwan; Heather M Flett; Anellina Ventre; B Catharine Craven; Dalton L Wolfe Journal: J Spinal Cord Med Date: 2021 Impact factor: 1.985
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859