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2015 HSR&D/QUERI National Conference Abstract

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3085 — Implementing the Spinal Cord Injury Pressure Ulcer Monitoring Tool

Guihan M, CINCCH, SCI QUERI; Bates-Jensen BM, UCLA School of Medicine; Hill JN, SCI QUERI; Khan H, SCI QUERI; Thomason SS, HSR&D Center of Innovation on Disability and Rehabilitation Research, Tampa; Powell-Cope G, HSR&D Center of Innovation on Disability and Rehabilitation Research, Tampa;

Objectives:
Pressure ulcers (PrUs) are a significant source of morbidity, mortality, and diminished quality of life of Veterans with spinal cord injury (SCI) and treatment is expensive ( > $100,000 annually). The SCI Pressure Ulcer Monitoring Tool (SCI-PUMT) is a reliable tool for evaluating PrUs in Veterans with SCI. A multi-faceted strategy (national train-the-trainer conference, toolkit and 12 monthly facilitation calls) was used to implement the SCI-PUMT in VA. One year later, a survey indicated that only about half of 24 VA SCI centers were consistently using the SCI-PUMT. This study evaluated the SCI-PUMT implementation to identify barriers/ facilitators and best practices for a future study to promote its full implementation at all VA SCI Centers.

Methods:
Mixed methods were used to evaluate SCI-PUMT implementation at high (n = 3), moderate (n = 2), and low (n = 2) adopting SCI centers (n = 7 total). Semi-structured interviews with VA wound care clinicians (n = 49) obtained information on the wound care process and barriers/facilitators to SCI-PUMT use. Interviews were transcribed and coded using the Consolidated Framework for Implementation Research (CFIR). Completion of SCI-PUMTs used medical record reviews for a random sample (n = 137) of Veterans admitted to the 7 SCI centers for PrUs between January-September, 2013.

Results:
Inner setting characteristics were cited as barriers (e.g., time/staffing constraints, training, leadership) as well as facilitators (e.g., presence of an experienced/dedicated interdisciplinary wound care team, strong staff/leadership support). Documentation (inner setting) was reported as a facilitator because it provided a common language and as a barrier because some facilities were documenting PrUs in up to three different places. Chart reviews identified 72 unique Veterans with 206 PrUs (mean = 2.9 ulcers/Veteran); only a quarter had a weekly SCI-PUMT score documented. More severe PrUs (stage III-IV) were twice as likely to be documented than less severe PrUs (Stage II) (mean = 40% vs. 19%, range 15%-66%).

Implications:
Findings show that intervention and inner setting characteristics (reflecting organizational and unit-level factors) influenced implementation.

Impacts:
Our evaluation identified high and moderate adopting centers as potential targets for increased implementation and improved sustainability. Findings contributed to a growing literature on CFIR domains and constructs.