Exploratory Study of Nursing Home Factors Associated with Successful Implementation of Clinical Decision Support Tools for Pressure Ulcer Prevention

Sharkey, Siobhan S.; Hudak, Sandra; Horn, Susan D.; Barrett, Ryan; Spector, William D.; Limcangco, Rhona

doi:10.1097/01.asw.0000426718.59326.bb

Cited by 46 publications

(74 citation statements)

References 9 publications

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“…For DSCUs with this orientation, the attitude of the key persons in implementing the care program is crucial. Earlier research on implementation of a multifaceted intervention in nursing homes also showed that having a team champion (for example, someone who is passionate about the use of the care program) has a substantial impact on the effectiveness of a team to adapt to innovation [9]. Implementation indeed seemed to be facilitated when an enthusiastic key person was willing to commit to the care program and that absence or departure of such a team champion seriously impacted the implementation process.…”

Section: Discussionmentioning

confidence: 99%

“…Next to the Grip on Challenging behavior project, projects to improve care for residents with depression, to improve medication administration, to prevent pressure ulcers and to better detect and treat pain are just a few other examples of recent attempts to establish evidence-based care of high quality [6–9]. Implementing such new interventions in nursing homes is difficult, for the structure and culture of the nursing home setting is complex and heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

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Grip on challenging behavior: process evaluation of the implementation of a care program

Zwijsen

Smalbrugge

Eefsting³

et al. 2014

Trials

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BackgroundThe Grip on Challenging Behavior care program for managing challenging behavior was implemented in the dementia special care units of 17 Dutch nursing homes. A process evaluation of the implementation of the care program was performed to determine the quality of the implementation and the lessons to be learned for future implementation.MethodsThe care program was implemented according to a stepped wedge design. First-order data (data on recruitment, reach, relevance and feasibility) were used to determine the validity of the study, and second-order data (intervention quality and the barriers and facilitators for implementing the care program) were used to describe the implementation process. Two structured questionnaires were administered to care staff and key stakeholders and semi-structured interviews were held in the units.ResultsUniversity affiliated and non-affiliated nursing homes from different parts of the Netherlands participated. The resident participation rate was over 95% and the participation rate for the training sessions was 82%. Respondents considered the care program relevant and feasible. The degree of implementation was not optimal. The barriers and facilitators in implementing the care program could be divided into three categories: organizational aspects, culture on the unit and aspects of the care program itself.ConclusionsThe recruitment, reach, relevance and feasibility are sufficient to allow for analysis and generalization of the effects of the care program, but the degree of implementation should be taken into account in further analysis. Future projects that involve implementation should consider the specific features of the organization and the cultural orientation of the unit to better adapt to specific needs.Trial registrationThe Netherlands National Trial register under number NTR2141 registered on 11 December 2009. Randomization took place in November 2010, and the first intervention group started using the intervention in February 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-302) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Grip on challenging behavior: process evaluation of the implementation of a care program

Zwijsen

Smalbrugge

Eefsting³

et al. 2014

Trials

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“…12 These factors align with factors important to other types of improvement initiatives implemented in nursing homes. The training of supervisors and administrators in addition to direct care staff was critical in a successful mouth care program, 13 for example, and management support and integration of learning into job descriptions were key factors in a mental health learning initiative.…”

Section: Introductionmentioning

confidence: 84%

“…These job categories were chosen because of their relevance to PrU prevention efforts. 6,12 Multiple job categories were selected to aid in data triangulation. A telephone interview was scheduled with those who responded.…”

Section: Design and Methodsmentioning

confidence: 99%

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Contextual Facilitators of and Barriers to Nursing Home Pressure Ulcer Prevention

Hartmann

Solomon

Palmer

et al. 2016

Advances in Skin &Amp; Wound Care

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OBJECTIVE Important gaps exist in the knowledge of how to achieve successful, sustained prevention of pressure ulcers (PrUs) in nursing homes. This study aimed to address those gaps by comparing nursing leadership and indirect care staff members’ impressions about the context of PrU prevention in facilities with improving and declining PrU rates. SETTING The study was conducted in a sample of 6 Veterans Health Administration nursing homes (known as community living centers) purposively selected to represent a range of PrU care performance. DESIGN AND PARTICIPANTS One-time 30-minute semistructured interviews with 23 community living center staff were conducted. Qualitative interview data were analyzed using an analytic framework containing (a) a priori analytic constructs based on the study’s conceptual framework and (b) sections for emerging constructs. MAIN RESULTS Analysis revealed 6 key concepts differentiating sites with improving and declining PrU care performance. These concepts were (1) structures through which the change effort is initiated; (2) organizational prioritization, alignment, and support; (3) improvement culture; (4) clarity of roles and responsibilities; (5) communication strategies; and (6) staffing and clinical practices. Results also pointed to potential contextual facilitators of and barriers to successful PrU prevention. CONCLUSIONS Leadership’s visible prioritization of and support for PrU prevention and the initiation of PrU prevention activities through formal structures were the most striking components represented at sites with improving performance, but not at ones where performance declined. Sites with improving performance were more likely to align frontline staff and leadership goals for PrU prevention.

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Quality of Care

Bates‐Jensen

Cheng

2013

Pressure Ulcers in the Aging Population

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Exploratory Study of Nursing Home Factors Associated with Successful Implementation of Clinical Decision Support Tools for Pressure Ulcer Prevention

Abstract: The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.

Cited by 46 publications

References 9 publications

Grip on challenging behavior: process evaluation of the implementation of a care program

Grip on challenging behavior: process evaluation of the implementation of a care program

Contextual Facilitators of and Barriers to Nursing Home Pressure Ulcer Prevention

Quality of Care

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