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Purpose: Clinical practice guidelines have identified a number of best practices that are effective in reducing the occurrence of pressure ulcers. Yet rates of pressure ulcer development remain high at many hospitals, in large part due to difficulties in systematically implementing these best practices. Increasingly, the Agency for Healthcare Research and Quality (AHRQ) and Department of Veterans Affairs (VA) have promoted the use of toolkits as a way to assist hospitals in implementing effective pressure ulcer prevention practices. We describe results from the initial evaluation of the draft AHRQ/VA toolkit Preventing Pressure Ulcers in Hospitals.
Methods: The toolkit, developed by study investigators in conjunction with an advisory expert panel is organized around six questions:
• Are we ready for this change?
• How will we manage change?
• What are the best practices in pressure ulcer prevention that we want to use?
• How should those practices be organized in our hospital?
• How do we measure our pressure ulcer rates and practices?
• How do we sustain the redesigned prevention practices?
It contains program guidance and checklists and tools for assessing, planning, implementing and evaluating practices. Interdisciplinary teams at 6 hospitals across the US used the toolkit in a quality improvement project and shared their experiences with the tools. Site visits were conducted to examine clinical and management participation.
Results: Each site selected and used different tools from the toolkit that were best suited for their institution including knowledge and attitude surveys, performance mapping, and incidence/prevalence calculation. Responses to the toolkit were positive and modifications were made based on comments. Several sites reported improved pressure ulcer rates and toolkit satisfaction
Conclusion: The AHRQ/VA toolkit may be useful in quality improvement initiatives to help prevent hospital-acquired pressure ulcers.