Jo Ann Otts, DNP, RN, NEA-BC, CENP, College of Nursing, University of South Alabama, Mobile.
Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile.
J Wound Ostomy Continence Nurs. 2023;50(6):463-473. doi: 10.1097/WON.0000000000001019. Epub 2023 Sep 12.
This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management.
A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project.
The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center. Both institutions are located in the Southeastern United States (Mobile, Alabama).
The A-P council used a participatory action research approach and developed a practice-informed active learning program incorporating Melnyk's evidence-based practice (EBP) steps, the Donabedian Model and the Patient-Centered Outcomes Research Institute (PCORI) Stakeholder Engagement in Question Development and Prioritization (SEED).
Hospital-acquired pressure injuries were selected as the quality outcome to address. To identify HAPI prevention/management evidenced-based practices, the A-P council conducted an integrative literature review and developed a concept map and the Pressure Injury Prevention Gap Analysis Instrument. The gap analysis identified significant gaps between EBP and current pressure injury prevention practices, with priority ranking of gaps for action by key stakeholders.
Following the practice-informed active learning program objectives, the A-P council identified 79 HAPI best EBPs organized by Donabedian domains of structure, process, and outcome and prioritized 3 gaps for action. Actions to address the HAPI gaps included: restructuring the hospital HAPI program, incorporating appropriate leadership to guide the HAPI program, modifying the HAPI reporting process, hiring specialized experts (WOC nurses) with emphasis on pressure injury prevention, establishing a standardized HAPI prevalence survey, improving electronic documentation, increasing transparency of HAPI reporting, improving HAPI accountability at the unit level, and exploring technology to enhance skin assessment. While HAPIs increased by 6.3% from 2019 (n = 104) to 2021 (n = 111), HAPI severity (Stages 3 and 4) decreased by 9.9% from 2019 (n = 14, or 13.46%) to 2021 (n = 4, or 3.6%).
Our experience with this quality improvement initiative indicates that an A-P partnership can provide a model to address complex clinical problems, quality indicators, and quality improvement while advancing a culture of inquiry and scholarship and building nursing capacity.
本循证质量改进 (EBQI) 计划研究了学术实践 (A-P) 伙伴关系对改善急性护理环境中质量措施的影响，特别是医院获得性压力性损伤 (HAPI) 的预防和管理。
使用实践导向主动学习计划进行了预/后描述性设计，以指导项目。
EBQI 计划在南墨西哥湾海岸大学护理学院和其附属的 406 张床位学术健康中心/一级创伤中心、地区烧伤中心和综合卒中中心的临床护理实践领导者中进行。这两个机构都位于美国东南部（阿拉巴马州莫比尔）。
A-P 委员会采用参与式行动研究方法，并制定了一项实践导向的主动学习计划，纳入了 Melnyk 的循证实践 (EBP) 步骤、Donabedian 模型和患者为中心的成果研究所（PCORI）利益相关者参与问题开发和优先级排序（SEED）。
选择医院获得性压力性损伤作为要解决的质量结果。为了确定 HAPI 预防/管理的循证实践，A-P 委员会进行了综合文献回顾，并制定了概念图和压力性损伤预防差距分析工具。差距分析确定了 EBP 与当前压力性损伤预防实践之间存在显著差距，并对关键利益相关者的行动确定了差距的优先排序。
在实践导向主动学习计划目标之后，A-P 委员会确定了 79 项 HAPI 最佳 EBP，按 Donabedian 结构、过程和结果领域进行组织，并对 3 项行动差距进行了优先排序。解决 HAPI 差距的措施包括：重组医院 HAPI 计划，纳入适当的领导来指导 HAPI 计划，修改 HAPI 报告流程，聘请专门的专家（WOC 护士），重点是压力性损伤预防，建立标准化的 HAPI 患病率调查，改善电子文件记录，提高 HAPI 报告的透明度，提高单位级别的 HAPI 问责制，探索增强皮肤评估的技术。尽管 2019 年（n = 104）至 2021 年（n = 111）期间 HAPI 增加了 6.3%，但 2019 年（n = 14，或 13.46%）至 2021 年（n = 4，或 3.6%）HAPI 严重程度（第 3 级和第 4 级）下降了 9.9%。
我们在这项质量改进计划中的经验表明，A-P 伙伴关系可以提供一种模式来解决复杂的临床问题、质量指标和质量改进问题，同时推进探究和学术的文化，并建立护理能力。
