Article Content

Welcome to the second annual pressure injury (PI)-focused issue of Advances! The response to last March's issue was so positive that we decided to repeat the theme for 2020. Of course, many of you are still busy reading and processing the 404 pages of the 2019 European Pressure Ulcer Advisory Panel/National Pressure Injury Advisory Panel/Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with its 115 evidence-based recommendations and 61 best practice statements, and indeed, that guideline informed much of our content this month.1 But this issue is not just about guidelines; what is also needed is a review of implementation science and knowledge translation literature to update your PI policies and procedures, educate staff, and facilitate the incorporation of new knowledge into practice.


It is well known that there is a huge gap between research publication and implementation into practice; it is generally believed to take about 17 years.2 Therefore, there is a need to accelerate the application of research to practice.3 The greatest obstacles for change are often a lack of interprofessional collaboration, poor healthcare system adaptability, or insufficient implementation strategies. Implementation strategies need to be clear, specific, and attainable.


Sustainable change requires transformative action from both individuals and organizations. It is not a single event that will sustain change, but the continuous integration of quality improvement in addition to the application of knowledge translation principles. The Plan-Do-Study-Act paradigm is one great facilitator for successful change.4 Some other helpful resources include the validated Agency for Healthcare Research Quality Tool Kit5 and published descriptions of successful PI reduction initiatives.6-8


There are also several articles in this issue that can provide you with some new insights, including


* a CE/CME on the role of nutrition in PI prevention and treatment based on the new guideline recommendations;


* our 2019 end-of-life terminology survey results to help inform discussions on terminal ulcers;


* studies in both pediatric and adult populations to match your care setting;


* a large data analysis of PI risk factors among 87,000 persons with a PI history and more than 1.1 million persons without a PI;


* a retrospective investigation into delayed healing in children with a tracheostomy device-related PI; and


* an important RTI International and CMS study examining PI in three post-acute care settings: long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. Quality measure differences included being male, advanced age, type of facility ownership, urban or rural location, and sociodemographic makeup. Controlling for health conditions reduced the racial disparity for black or African American individuals as a significant predictor of new or deteriorating PIs.



With all of these articles and resources, we have new scientific evidence and tools to improve PI prevention and treatment. Better healthcare does not need to cost more, but it requires the collaboration of healthcare professionals in a flexible healthcare system that can adapt to change through knowledge translation and quality improvement.


Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN


R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM




1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Haesler E ed. EPUAP/NPIAP/PPPIA; 2019. [Context Link]


2. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011;104:510-20. [Context Link]


3. Agency for Healthcare Research and Quality. Accelerating Change and Transformation in Organizations and Networks III. 2018. Last accessed January 14, 2019. [Context Link]


4. Reed JE, Card AJ. The problem with Plan-Do-Study-Act cycles. BMJ Qual Saf 2016;25:147-52. [Context Link]


5. Berlowitz D, VanDeusen Lukas C, Parker V, et al. Preventing Pressure Ulcers in Hospitals: A Tool Kit for Improving Quality of Care. Baltimore, MD: Agency for Healthcare Research and Quality; 2012. [Context Link]


6. Neiderhauser A, VanDeusen Lukas C, Parker V, Ayello EA, Zulkowski K, Berlowitz D. Comprehensive programs for preventing pressure ulcers: a review of the literature. Adv Skin Wound Care 2012;25(4):167-88. [Context Link]


7. Holmes A, Edelstein T, Ayello EA, Zulkowski K. A collaborative statewide multi-facility initiative reduces pressure ulcers: 1311. J Wound Ostomy Continence Nurs 2007;34(3S):S41. [Context Link]


8. Ayello EA, Zulkowski KM, Holmes AM, Edelstein T. New Jersey Pressure Ulcer Collaborative = results. Nurs Outlook 2010;58(2):e4. [Context Link]