RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Nursing Best Practice GuidelineImplementation StrategiesThere are several key strategies organizations can utilize to implement the Assessment and Management ofStage I to IV Pressure Ulcers guideline. These strategies are comprised of the following:■■■■■■■Identification of an individual to lead the project that will dedicate time to implementation of theAssessment and Management of Stage I to IV Pressure Ulcers guideline. This nurse will provide support,clinical expertise and leadership to all nurses involved in implementation.Utilization of a systematic approach to planning, implementation and evaluation of the guidelineinitiative. A work plan is helpful to keep track of activities and timelines.Provide opportunities for staff to attend interactive, adult-learning programs which incorporate thekey recommendation from the guideline.Teamwork and collaboration through an interdisciplinary approach is essential.Consider establishing an implementation team that includes not only the organization implementingthe guideline, but others such as community partners (referral sources) and support groups.Leadership and commitment from nurse managers is vital to successful implementation(Clarke et al., 2005).“Best Practice” is quickly forgotten unless it becomes part of day-to-day care. This lapse in practicecan happen regardless of the organization commitment to change. One way of improving ongoingapplication of a guideline is to insert information into the bedside documentation. This could includeupdates to flowsheets, care plans and/or admission/discharge summaries to reflect best practice in theday-to-day events seen in client care. For example, though many organizations use the Braden Scalefor Predicting Pressure Sore Risk (Bergstrom, Braden, Laguzza, & Homan, 1987), often the client’s condition isscored and the nurse moves on to other work without reflecting on the results. Documentationdesigned to compel a choice and which provides cues to action at the point of assessment, may bemore useful (Bauer, Bushey, & Amaro, 2002). Certainly, the advent of electronic documentation has proveduseful in this regard. As the nurse enters information electronically, certain fields will not permit theuser to go on until such assessment, decisions or actions are documented. Appendix R provides anexample of documentation tool to prompt decision making.In addition to the tips mentioned above, RNAO has published implementation resources that are availableon the website. A Toolkit for implementing guidelines can be helpful, if used appropriately. It is availablefor free download at www.rnao.org/bestpractices.55