NURS 716 Week 8 Assignment 5: Developing an Evidence-Based Practice Proposal Part 2 Example

Evidence-Based Practice Proposal, Part 2: Methods for a Twelve-Week Pilot of Prophylactic Silicone Foam Dressings in Long Surgeries

Section Three: Methods

Project Design

The project is a quality improvement pilot that compares an implementation period with the period just before it. Outcomes for patients receiving prophylactic dressings during a twelve-week implementation period will be compared with outcomes for patients undergoing similar surgeries during the twelve weeks before implementation. A pre-post design suits an evidence-based practice project because the effectiveness of the intervention has already been tested in randomized trials (Fu et al., 2025; Wang et al., 2026); the purpose here is to determine whether the practice can be implemented reliably in this setting and whether the expected benefit appears. The revised Iowa Model's steps of designing and piloting the practice change, then deciding whether to adopt it, structure the project (Iowa Model Collaborative, 2017).

Setting

The project will take place across a 350-bed regional medical center's twelve operating rooms and its recovery unit, with follow-up on the surgical units where patients recover.

Participants

Inclusion criteria are age 18 or older and a scheduled surgery with an expected anesthesia time of three hours or longer in the supine or lithotomy position. Exclusion criteria are an existing pressure injury on the sacrum or heels, a known allergy to dressing adhesives, surgery in the prone position and procedures in which the dressing site is within the surgical field. Based on the prior quarter, about 220 eligible patients are expected during each twelve-week period. Hooper et al. (2026) found that an anesthesia risk class of 3 or higher predicted perioperative pressure injury, so that class will be recorded for every participant to describe risk in both periods.

Intervention Protocol

The circulating nurse will carry out the protocol for every eligible patient:

• Inspect sacral and heel skin before positioning and record its condition
• After induction and before final positioning, place one silicone foam dressing over the sacrum and one over each heel
• Pad and inspect all device contact points, since many intraoperative injuries are device related (Adıgüzel Akbaba et al., 2026)
• At the end of surgery, lift the dressing borders, inspect the skin and document findings in a new intraoperative record field
• Leave dressings in place for up to 72 hours, with inspection each shift by unit nurses, unless soiled or displaced

Measures

The main outcome is any new sacral or heel pressure injury, of any stage, identified within 72 hours after surgery, staged with the revised National Pressure Injury Advisory Panel system (Edsberg et al., 2016) by nurses trained in staging and confirmed by the wound and ostomy nurse. Process measures are the percentage of eligible patients receiving all three dressings and the percentage of end-of-surgery skin inspections documented. Balancing measures are skin reactions under dressings and any reported delay to the start of surgery attributed to dressing application. Descriptive data include age, body mass index, anesthesia risk class, position and anesthesia time.

Data Collection

Outcome data for both periods will come from the hospital's incident reporting system and wound and ostomy nurse consultations, supplemented by a daily review of the electronic record for eligible patients during the implementation period. Process data will come from the new intraoperative record field. The DNP project lead and one trained perioperative nurse will abstract data weekly using a standardized form, and ten percent of records will be re-abstracted to check accuracy.

Data Analysis

Characteristics of the two groups will be summarized with counts, percentages, means or medians and compared to identify differences in risk. Injury rates in the two periods will be tested with a chi-square statistic, switching to Fisher's exact method if any expected cell count falls below five. Each week's adherence figures will be plotted as a run chart so drift in the protocol is visible early. Because the groups are not randomized, results will be interpreted cautiously and reported with their limitations.

Staff Education

Before implementation, every circulating nurse and recovery nurse will complete a thirty-minute session covering the evidence for prophylactic dressings, correct placement on the sacrum and heels, skin inspection at the end of surgery and staging of early injuries. Each nurse will then demonstrate placement on a manikin and stage three photographed injuries correctly to complete a competency check. Surgeons and anesthesia staff will get a short written brief and a five-minute update at their own department meetings, since their cooperation affects positioning and timing. Two perioperative nurses will serve as super-users during the first four weeks to answer questions in the rooms.

Limitations of the Design

A pre-post design cannot rule out other changes that occur during the implementation period, such as new support surfaces, changes in case mix or seasonal staffing patterns, so these will be recorded. Comparing a historical cohort may also be affected by better detection during implementation, because nurses will be inspecting skin more carefully, which could make the intervention look less effective than it is. Twelve weeks may be too short to detect a difference if injuries are uncommon, so the results will be treated as a signal for the adoption decision rather than definitive proof.

Ethical Considerations

The project applies an evidence-based intervention to improve care and uses existing records without identifiable data leaving the hospital, so it goes first to the hospital's quality committee, with a request to the review board for a written ruling on whether it counts as improvement work, and to Liberty University's review process as the DNP Handbook requires. Patients will be informed about the dressings in preoperative teaching. Project files will stay on the hospital's protected servers, de-identified for analysis, and reported only in aggregate. Scripture calls believers to do justly and love kindness (English Standard Version Bible, 2001/2016, Micah 6:8), and protecting patients' privacy while protecting their skin is part of both.

Timeline

Budget

The main costs are dressings, about $9 per patient for three dressings, or roughly $2,000 for 220 patients; staff education time, about 60 hours at an average of $45 per hour, or $2,700; and printing, about $100, for a total of about $4,800. Avoiding even one stage III pressure injury would likely offset this cost, and the analysis will estimate avoided treatment costs from any reduction in injuries.

Sustainability

To keep the practice alive after the pilot, ownership will rest with the perioperative charge nurse role, dressings will be stocked through standard par levels, application will remain a field in the intraoperative record, and pressure injury rates for long cases will join the department's monthly quality dashboard. These steps reflect evidence that sustainment depends on factors that change over time and must be planned from the outset (Lai et al., 2026; Zonsius et al., 2025). A practice built into the record, the supply room and the dashboard does not depend on any one nurse remembering it.

Stakeholder Roles During the Pilot

The surgical services director will sponsor the project and resolve resource questions. The perioperative charge nurses will check each morning that dressings are stocked in every room. The wound and ostomy nurse will confirm the stage of every reported injury within 24 hours, and the quality analyst will pull incident data for both periods. The DNP project lead will coordinate the team, run the weekly audits and report progress to the sponsor every two weeks, flagging any week in which fewer than nine in ten eligible patients received all three dressings.

Dissemination

Results will be presented to the surgical services committee and the nursing practice council, shared with staff in a one-page summary, and submitted as a poster to a regional perioperative nursing conference.

Conclusion

Part 2 completes a proposal that moves from a local problem, sacral and heel pressure injuries after long surgeries, through strong evidence for prophylactic silicone foam dressings to a twelve-week pilot with a defined population, a written protocol, outcome, process and balancing measures, ethical safeguards, a timeline, a budget and a plan to sustain and share the results. If the pilot shows reliable implementation and fewer injuries, the Iowa Model's adoption decision will move the practice into standard care for every long surgery in the hospital.

References

Adıgüzel Akbaba, M., Uslu, Y., Aytar, F., & Eren, E. (2026). Intraoperative device-related pressure injuries in patients undergoing prolonged surgery. Advances in Skin & Wound Care. Advance online publication. https://doi.org/10.1097/ASW.0000000000000510

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing, 43(6), 585-597. https://doi.org/10.1097/WON.0000000000000281

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Fu, T., Wu, X., & Yu, B. (2025). Efficacy of silicone foam dressings in preventing pressure injuries in the sacral and heel areas of patients: A meta-analysis. Frontiers in Medicine, 12, Article 1644290. https://doi.org/10.3389/fmed.2025.1644290

Hooper, V., LaFond, C., & Perez, A. C. (2026). The performance of the Scott Triggers instrument in predicting perioperative pressure injury (PPI) development. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.06.012

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Lai, J., Zhang, Y., Chi, J., Miao, J., Lin, H., Luo, W., Fu, J., Deng, S., Guo, Z., Zhong, C., Tang, J., Guo, B., Yang, T., & Wu, Y. (2026). Perceptions of factors associated with sustainability of evidence-based nursing practice: A sequential mixed methods study. Journal of Nursing Management, 2026(1), Article e6680206. https://doi.org/10.1155/jonm/6680206

Wang, C. Y., Liao, H. H., Hsieh, M. Y., & Lee, C. H. (2026). Soft silicone foam dressing for preventing intraoperative pressure injuries: A randomized controlled trial. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.08.022

Zonsius, M. C., Milner, K. A., Farus-Brown, S., & Fineout-Overholt, E. (2025). Designing the implementation plan for success and sustainability. American Journal of Nursing, 125(12), 46-54. https://doi.org/10.1097/AJN.0000000000000203