Development of the revised pressure ulcer guideline in institutional healthcare organisations Facilitators and barriers that determine the decision of stakeholders who are involved in the implementation process of the revised guideline

Abstract

Rationale: The implementation of pressure ulcer (PU) guidelines is often not performed in daily practice and adherence is low. PUs represent a major burden to patients and have a negative effect on quality of life. The low level of adherence for PU prevention indicates a continued need for quality improvement. In 2019, the PU guideline was revised, and will be implemented in 2020. An essential first step of implementation is to assess barriers and facilitators, according to healthcare professionals (HCPs) working in institutional healthcare organisations in the Netherlands. Aim: To investigate the barriers and facilitators, according to stakeholders, for implementation of the revised pressure ulcer guideline in healthcare organisations in the Netherlands. Methods: The study had a cross-sectional design. We collected data from HCPs (n=89) based on the Measurement Instrument for Determinants of Innovation (MIDI) in healthcare organisations in the Netherlands. Descriptive statistics were used to explore participants characteristics. MIDI items to which ≥20% of participants (totally) disagreed were regarded as barriers and items to which ≥80% of participants (totally) agreed were regarded as facilitators for implementation. Applicability about the recommendations of the revised guideline were asked. Open-ended questions were analyzed by theme. Results: Reported barriers to implementing the PU guideline were related to the own organisation like time. Reported facilitators were mainly related to the user like knowledge. Additionally, HCPs expressed the need for clarity of the recommendation about the European classification system. Also the recommendation about changing body position every 4 hours was not feasible. Conclusion: An overview of the barriers and facilitators to the implementation of the PU guideline in the Netherlands is given. More barriers have been found. Implications of key findings: The results of this study will be used to develop strategies for implementation.