Barriers and facilitators to pressure injury prevention in acute care hospitals in Alberta, Canada: an interpretive description

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Abstract
Objective: Hospital-acquired pressure injuries (HAPIs) are adverse events that increase patients' pain, morbidity and length of stay. The aim of this study was to use an implementation science-informed approach to identify barriers and facilitators to HAPI prevention for adult inpatients from the perspective of different members of the healthcare team. Method: This interpretive description study used semi-structured interviews with healthcare assistants, managers, nurses, occupational therapists and wound care specialists in acute care hospitals across Alberta, Canada. A semi-structured interview guide queried perceptions of HAPI prevention practices, risk assessment, and perceived challenges and opportunities. Interviews were audio recorded, transcribed verbatim and independently coded by two researchers. Codes were deductively mapped to the Theoretical Domains Framework (TDF) and inductively themed; both deductive and inductive approaches were bridged into an overarching thematic conceptualisation by four researchers. Results: A total of 22 interviews, each lasting 30–60 minutes, were completed with staff from seven adult inpatient units. The themes and subthemes that emerged were: Patients (patient complexity, patient and family engagement); Staff (knowledge and skills, communication and collaboration); Resources (access and availability of equipment and devices; inappropriate use of products and resources); and Context (contextual differences, organisational culture). Most barriers were associated with the Environmental Context and Resources domain of the TDF. Conclusion: The identified barriers and facilitators to HAPI prevention in hospital spanned from patients to the organisational context more broadly, and may be applicable to diverse hospital settings. Further investigation should explore the causes of the barriers and facilitators to enable targeted implementation strategies to prevent the occurrence of HAPIs.

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