From “On Paper” to “On the Floor” – How to Practically Implement PI Prevention

Trying to lower pressure injury rates in your facility?

Updating facility procedures is step one.

However, it is only step one.

Procedures on-paper may trickle down and change what happens on the floor, but only to a small degree. In order to see real change in pressure injury prevention, explains Prof. Lisette Schoonhoven, President of the European Pressure Ulcer Advisory Panel, you need to have a structured implementation program that includes:

  • Leadership
  • Education
  • Reminders
  • Feedback
  • Measuring Improvement



Change is dependent to a large degree on your lay leadership: the informal leaders of the caretaker staff. These are the people your caretakers look to as role models. These are the people whose words and actions have direct and indirect effects on the behavior of the staff. Get your lay leadership involved from the outset of the pressure injury prevention program and allow them to lead your people in the right direction.



If you want your staff to make a change, they need to understand not only the what, but also the why. What changes are they supposed to make to current practice – and why it is important to make those changes? The why is critical for giving staff motivation: intrinsic motivation based on understanding and desire to do the best thing for their patients’ health will carry them much further than extrinsic motivation based on pressure, threats, fear or even increased compensation.



It's all too easy to develop “sign blindness.” Reminders about pressure injury prevention need to be not only visual, but also verbal. You have to be careful with verbal reminders, however.  Signs that read “please wash your hands” or “reposition every two hours” rarely offend people. People saying the exact same thing, however, especially in front of colleagues, often does offend others.

In order to avoid resentment, all members of the team should be involved in the decision of how reminders are to be presented.  Some may be comfortable giving or receiving gentle, verbal reminders in public, while others may need to stick to more obscure signals in order to avoid the potential of public embarrassment.


Feedback and Measuring Improvement

A drop in your facility’s PI occurrences is obviously the most powerful, motivational feedback your staff can get.

In order to make sure your staff gets accurate feedback, spend the time at the outset to get a baseline. Then set up a consistent, ongoing system of monitoring and measurement.

The feedback system should also include an informal team review as a tool to handle and study any new pressure injury occurrences. This review team should be made up of the hands-on staff and lay leadership, and promote an open, supportive environment where all members of staff can learn from mistakes without guilt or fear.

With motivation-based education, empowering lay leadership, employing reminders and feedback, and a accurate system of measuring improvement, change can make it from paper… to reality.