Implementation into Practice
Regardless of their sizes, missions, and health care programs, health care facilities have a professional mandate to provide timely, safe, and quality care. The standard obligation requires health care facilities to apply multi-dimensional interventions to address patient needs. Research translation into clinical practice promotes evidence-based care and is instrumental in reducing adverse health outcomes through creative problem-solving (Wensing & Grol, 2019). Its significance obliges health care practitioners and organizational leaders to implement programs that reduce gaps between research findings and clinical practice. Accordingly, health care facilities should be open to change and support evidence-based practice (EBP) adequately. The purpose of this paper is to discuss a topic where a gap exists between research findings and their implementation into practice.
Topic, Supporting Research, and Desired Outcomes
The Agency for Healthcare Research and Quality (AHRQ) explores many health topics relevant to current nursing practice. A topic related to the direct practice improvement (DPI) project is hospital readmissions, represented as a priority for payers, providers, and policymakers striving to improve health outcomes and reduce costs (AHRQ, n.d.). Hospital readmissions connect with the DPI project since their occurrence hampers care quality in the practicum site. Besides, pressure ulcers are a leading cause of hospital readmissions, hospitalizations, and high costs (Wassel et al., 2020). Accordingly, any significant rise in pressure ulcers leads to a proportional increment in hospital readmissions, reducing care quality.
Hospital readmissions adversely affect health outcomes and require evidence-based, sustainable, and relevant solutions. Recent health data shows that over $52.4 billion is spent annually on readmitted patients (Beauvais et al., 2022). Unless health care organizations implement lasting programs, the cost will increase as time advances. Upadhyay et al. (2019) noted that readmission penalties exceed over half a billion dollars annually. Such penalties are detrimental to the growth of organizations and their ability to sustain safe and quality care. Furthermore, crucial aspects of quality sustainability, like organizational reputation and partnerships, become dysfunctional when readmission rates are high in hospitals. Patient-provider relationships are also broken due to reduced patients’ trust in health care professionals.
Pressure ulcers increase the risk of readmissions, and their prevention should be a priority for all hospitals. Research translation into practice implies implementing interventions supported by scientific evidence. Veith et al. (2019) emphasized high attention to wound care, patient education, and modifying risk factors to prevent pressure ulcers. Wound care strategies include preventive dressing, patient repositioning, and wound cleaning for the admitted patients. These strategies are among the core components of a preventive pressure bundle that is highly effective in reducing the incidence of pressure ulcers in critical care settings (Darvall et al., 2018; Hahnel et al., 2020). Implementing such a bundle would be pivotal in reducing readmission rates in the current setting.
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Health care professionals implement research into clinical practice to improve health outcomes. The primary goal of implementing research on wound care is to reduce pressure ulcers which will lead to a proportional reduction in hospital readmissions. Reducing readmissions will reduce health care costs and improve the organization’s ability to invest in quality care programs. As Rasiah et al. (2020) mentioned, patients’ trust in health care professionals depends on the care quality and health care experiences. Consequently, implementing a care bundle and other wound care programs will improve patient-provider relationships and patients’ trust in health care professionals. High hospital readmissions hamper organizational reputation (Upadhyay et al., 2019). Implementing research will improve the organization’s reputation and accelerate its growth.
The Extent of Research Implementation
Organizations implement different wound care practices depending on the patients’ type and severity of health conditions. As an established health care institution, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in numerous programs to optimize patient outcomes. They include patient education, telehealth, follow-up care, and testing new treatments and care models (ProMedica, 2021). Despite these programs, the facility primarily relies on routine pressure ulcer prevention care. Overreliance on this care program depicts a huge gap between research findings and implementation into practice, and substantive improvement is essential. More evidence-based interventions should be implemented to reduce the incidence of pressure ulcers among high-risk groups such as the elderly and debilitated patients. Their implementation will reduce the incidence of pressure ulcers and associated adverse outcomes, including hospital readmissions, mortality, and hospitalization.
Possible Barriers to Implementation
Research translation faces multiple barriers depending on the intensity of work required, resources, and the project’s type. Potential barriers to implementing a preventive bundle to prevent pressure ulcers and hospital readmission in the facility include resource facilitation, availability of implementation team members, and patients’ reluctance to participate in the project. Resource inadequacy is a significant barrier since effective research implementation of a care bundle for pressure ulcers requires technologies like patient monitors and alert systems to optimize patient turns. Research also recommends silicone dressing as the most effective preventive dressing for wound care for pressure ulcers (Hahnel et al., 2020). Combining such resources makes the project expensive and inconvenient for timely implementation. The implementation requires teamwork, where the change leader works together with organizational leaders and support nursing staff. However, the intensity of nursing care in the facility would affect their availability and successful research implementation.
Possible Ways to Overcome the Barriers
Success in research translation depends on how change implementers overcome present and emerging barriers. A suitable strategy to overcome the identified barriers is stakeholder engagement. As Haynes et al. (2018) underlined, active stakeholder engagement is crucial to successful change since it influences them positively to support change. The engagement process involves providing stakeholders with adequate information about the research translation and its potential benefits while engaging them throughout the implementation. The other potential intervention is implementing the affordable components of a preventive bundle. For instance, patient repositioning and optimizing turns are affordable and would improve outcomes. Importantly, intensive patient education is crucial to improve health literacy, increase patients’ confidence in the project, and ensure participation and compliance.
Resources Available on the Site
As a modern facility and an affiliate of the extensive ProMedica Health System, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has multiple resources vital in informing the transition from research into practice. They include an equipped health workforce, modality-based equipment, comfortable surroundings, and essentials like the internet (ProMedica Health System, 2022). An equipped and educated health workforce is open to change and readily supports research translation into practice to achieve positive change. Modern equipment and comfortable surroundings are also vital in successful research translation to ensure that research subjects are protected from harm and are comfortable with the process.
Health care facilities should be committed to continuous quality improvement. Such a commitment necessitates continuous research translation into practice and progressive outcomes assessment. Although ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in massive programs to improve care quality, more interventions are needed to reduce hospital readmissions. Reducing pressure ulcers will be instrumental in achieving this goal hence implementing research on interventions for pressure ulcer prevention like wound care, patient education, and risk assessment.
AHRQ. (n.d.) Hospital readmissions. https://www.ahrq.gov/topics/hospital-readmissions.html
Beauvais, B., Whitaker, Z., Kim, F., & Anderson, B. (2022). Is the hospital value-based purchasing program associated with reduced hospital readmissions?. Journal of Multidisciplinary Healthcare, 15, 1089–1099. https://doi.org/10.2147/JMDH.S358733
Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784
Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621
Haynes, S. C., Rudov, L., Nauman, E., Hendryx, L., Angove, R. S., & Carton, T. (2018). Engaging stakeholders to develop a patient-centered research agenda: Lessons learned from the research action for health network (REACHnet). Medical Care, 56(10 Suppl 1), S27-S32. doi: 10.1097/MLR.0000000000000785
ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#
ProMedica Health System. (2022). ProMedica Skilled Nursing and Rehabilitation. https://www.promedicaskillednursing.org/locations/promedica-skilled-nursing-and-rehabilitation-wheaton/?contentIdString=14063
Rasiah, S., Jaafar, S., Yusof, S., Ponnudurai, G., Chung, K. P. Y., & Amirthalingam, S. D. (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: A scoping review protocol. BMJ Open, 10(1), e028061. http://dx.doi.org/10.1136/bmjopen-2018-028061
Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission rates and their impact on hospital financial performance: A study of Washington Hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386
Veith, J. P., Collier, W., Kim, J., Agarwal, J., & Kwok, A. (2019). A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database. The American Journal of Surgery, 217(4), 658-663. https://doi.org/10.1016/j.amjsurg.2018.12.013
Wassel, C. L., Delhougne, G., Gayle, J. A., Dreyfus, J., & Larson, B. (2020). Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. International Wound Journal, 17(6), 1924-1934. https://doi.org/10.1111/iwj.13482
Wensing, M., & Grol, R. (2019). Knowledge translation in health: How implementation science could contribute more. BMC Medicine, 17(1), 1-6. https://doi.org/10.1186/s12916-019-1322-9
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