Sving Eva, Fredriksson Lennart, Mamhidir Anna-Greta, Högman Marieann, Gunningberg Lena
Department of Patient Safety, Region Gävleborg, Gävle, Sweden.
Department of Public Care and Caring Sciences Uppsala University, Uppsala, Sweden.
JBI Evid Implement. 2020 Dec;18(4):391-400. doi: 10.1097/XEB.0000000000000239.
To assess sustainability of an intervention used to implement pressure ulcer prevention.
The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing.
The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed.
The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses.
Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.
评估用于实施压疮预防的一项干预措施的可持续性。
采用卫生服务研究实施促进框架来制定一项干预措施，旨在医院环境中实施基于证据的压疮预防。短期随访显示，接受压疮预防的患者显著增多。定性过程评估表明，该干预措施及实施过程改变了对压疮预防工作的理解和方法，从治疗转变为预防。
本研究采用序贯混合方法，结合定量和定性数据。对于定量数据，将初始研究中报告的基线和短期随访（6 - 8个月）数据与长期随访（36 - 42个月）数据（n = 259例患者）进行比较。对于定性数据，对注册护士（n = 20）、助理护士（n = 7）和一线管理人员（n = 5）进行访谈。
压疮预防措施自实施起3年内效果持续。压疮患者数量减少（P = 0.021）。质量测量的系统工作、一线管理人员的支持、内部促进、协作以及压疮预防技能可以解释这种可持续性。实现高质量压疮预防的障碍包括沟通不足､工作量大以及新护士和替代护士比例高。
描述了微观层面可持续性的三个不同组成部分；对患者的益处、随着时间推移进行常规化和发展的必要性。将可持续性的威胁描述为宏观层面的因素。医疗保健组织需要从微观到宏观层面进行协作，并且需要有经验的敬业护士来实现高质量的可持续压疮预防。
