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Quality improvement, research, and evidence-based practice: 5 years experience with pressure ulcers

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“The first requirement of a hospital is that it should do the sick no harm.” Florence Nightingale (1863)

Skincare, a fundamental component of basic patient care, reflects on the overall quality of care that a patient receives in hospital. Quality care aimed at preventing and minimising skin breakdown and pressure ulcers has been identified as a nursing research priority.1 During the past 5 years, we have undertaken a large research utilisation effort focused on skincare and pressure ulcers involving more than 20 nursing units at a Canadian university affiliated teaching institution. Diverse activities were undertaken to address the barriers to evidence-based practice with efforts occurring across the setting and at many levels of the organisation.

Starting with a clinical problem

The initiative began in 1993 when an increase in the incidence of pressure ulcers was perceived in our setting. There had been more referrals to the enterostomal therapist and to plastic surgery, and sporadic reporting by clinical staff of their suspicions that skin breakdown was increasing in their areas. At that time no unit based mechanism for capturing reliable data on pressure ulcers was in place nor was it possible to retrieve data from the hospital information system.

Even though it is a quality issue, the pressure ulcer initiative was set in a larger context of professional practice by linking it to the existing nursing quality improvement, research, and education infrastructures. The nurse specialists for quality improvement and research and evaluation took the lead on the project with support from several clinical nurse educators and managers. Critical to the success of the project was the support of the chief nursing officer who was vice president of patient services.

A multidisciplinary task force developed and implemented a skincare programme. Two key initiatives ran concurrently: design and implementation of skincare programmes on the clinical units and …

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