Identifying patterns in implementation of hospital pressure ulcer prevention programs a multisite qualitative study

Purpose: To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. DESIGN: Multisite comparative case study. SUBJECTS AND SETTING: Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). METHODS: Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). RESULTS: All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffi ng levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffi ng, data monitoring, and staff education. CONCLUSION: We found hospital-level variations in PU prevention programs. Wound care specialist staffi ng may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.