NURS 836 Week 8 Draft Dissemination and Implementation Plan Example

Draft Dissemination and Implementation Plan: Bringing Prophylactic Silicone Foam Dressings Into Every Surgery of Three Hours or More at a 350-Bed Hospital, and Telling Others What We Learn

Introduction

Pressure injuries acquired during surgery are common, painful and preventable. In surgeries lasting three hours or more, patients lie still on firm surfaces under anesthesia, unable to feel or respond to pressure, and injuries to the sacrum and heels often appear hours or days later on the surgical unit. Adıgüzel Akbaba et al. (2026) followed patients through operations lasting at least three hours and found device-related injuries alone in three of every ten. At our 350-bed hospital, prophylactic silicone foam dressings are stocked in the operating room supply room but are used inconsistently and without a protocol.

This plan describes how the hospital will implement prophylactic silicone foam dressings for eligible surgical patients and how it will disseminate the evidence and the project's results. It answers the refined PICOT question developed this term: In adults scheduled for supine, prone or lithotomy procedures with anesthesia expected to last three hours or more, does multilayer silicone foam covering the sacral area and each heel, placed before final positioning and kept on up to 72 hours, compared with standard prevention without prophylactic dressings, lower the number of patients who develop a stage 1 or worse sacral or heel injury in the three days after surgery?

Evidence Summary

The evidence for the intervention is strong and consistent. Fu et al. (2025) pooled ten randomized trials and showed fewer sacral and heel injuries wherever silicone foam was used. A separate meta-analysis of eleven studies found a risk ratio of 0.30, with similar benefit in intensive care and other settings and no significant difference between two common brands (Rahman-Synthia et al., 2023). Two surgical trials support use in our population: Wang et al. (2026) recorded intraoperative injuries in about one patient in thirty with a sacral dressing against nearly one in five without, and a sacral dressing applied after general surgery reduced injuries on surgical wards (Yeo et al., 2023). Johansson et al. (2026), pooling observational studies of surgical patients, linked injury to diabetes, obesity, low albumin before surgery and vasoactive infusions during it, findings that shape eligibility below. The international guideline supports prophylactic dressings for patients at risk (European Pressure Ulcer Advisory Panel et al., 2019).

Implementation Plan

Setting and Team

The project will take place in the hospital's main operating suite of fourteen rooms, which performs about 2,600 surgeries a year expected to last three hours or more, mostly orthopedic, spine, colorectal, gynecologic and urologic cases. The project lead is the DNP student, a perioperative nurse leader. The team includes the perioperative director as executive sponsor, a surgeon champion from orthopedics, an anesthesia representative, two circulating nurses, the wound care nurse, an informatics nurse and the supply chain manager.

Eligibility

Patients aged 18 or older with anesthesia expected to last three hours or more will be eligible, along with patients with diabetes or class III obesity regardless of expected duration, reflecting the risk factor evidence. Patients with existing skin breakdown at the sacrum or heels or a documented adhesive allergy will be excluded. Eligibility will be flagged automatically on the surgical schedule the day before, using booked procedure time and the problem list, so that the circulating nurse does not have to decide under time pressure on the morning of surgery.

Barriers Identified With CFIR

CFIR in its 2022 revision gives five lenses for finding barriers: the practice itself, conditions beyond the hospital, conditions within it, the staff whose practice must shift, and how the change is led (Damschroder et al., 2022). Interviews with eight operating room staff and a review of current practice identified barriers in each domain, consistent with those reported by operating room nurses in a qualitative study using the same framework, who described supply shortages, guidelines that did not fit operating room realities, poor communication between departments and uneven competence (Gao et al., 2026). In the innovation domain, surgeons worry that dressings shift during skin preparation. In the inner setting, no checklist prompt exists and the operating room's supply budget bears the cost while savings accrue to inpatient units. Among individuals, circulating nurses are unsure whether they may apply dressings without an order. In the process domain, no one has been assigned to lead the change.

Matched Implementation Strategies

Strategies are drawn from the Expert Recommendations for Implementing Change compilation of 73 named strategies (Powell et al., 2015). Because the fit between a barrier and a strategy is a judgment rather than a certainty, the matches below are treated as hypotheses and monitored through the fidelity and adoption measures.

Education appears once, for the one barrier that is about skill. The others concern authority, workflow and money, and education would not resolve them. A plan that answers every barrier with an in-service has not looked closely at its barriers.

The Protocol

For each eligible patient, after induction the circulating nurse covers the sacrum and both heels with multilayer silicone foam and before final positioning, after agreeing placement with the surgeon when the sacrum is near the prep field. The dressings are documented on the intraoperative record, remain in place for up to 72 hours and are lifted for skin assessment each shift on the inpatient unit. Inpatient nurses assess the skin using a structured method that examines tone, temperature, texture and pain rather than color alone, an approach developed to improve early detection in all skin tones (Neu et al., 2026).

Evaluation Plan

Design

The project will use a hybrid type 2 approach, giving equal weight to whether the dressings reduce injuries in our operating rooms and to how well they are implemented, because the evidence is strong but our protocol has not been tested exactly in this setting (Curran et al., 2022). Outcomes for six months before implementation, drawn from incident reports and wound care consultations, will be compared with outcomes for months 4 through 12.

Clinical Outcomes

The primary outcome is how often new stage 1 or higher injuries appear on the sacrum or heels in the 72 hours after an eligible surgery. Because stage 1 injuries are easily missed in dark skin, rates will be reported by skin tone category, and in the first month the wound care nurse will use the hospital's subepidermal moisture scanner on a sample of patients, since in prone-position surgery such measurements detected more damage than visual assessment (Bates-Jensen et al., 2024). Secondary outcomes are injury stage, device-related injuries and length of stay.

Implementation Outcomes

Four of the eight implementation outcomes proposed by Proctor et al. (2011) will be measured. In month 2, circulating nurses and surgeons will rate acceptability on a short questionnaire. Adoption is counted by surgical service: how many of them follow the protocol at the end of month 3. Fidelity will come from a weekly audit of ten cases checking that all three dressings were in place before the patient was positioned. Penetration will be the proportion of eligible surgeries in which dressings were applied, with a target of 90% by month 6.

RE-AIM Summary

In RE-AIM terms, reach is the proportion of eligible patients who receive dressings and their representativeness by age, body mass index and skin tone; effectiveness is the change in injuries; adoption is the number of services and teams using the protocol; implementation is fidelity and cost; and maintenance is penetration at month 12 and after (Glasgow et al., 2019). The team will review each measure monthly as a run chart.

Dissemination Plan

Dissemination is planned for four audiences, each with its own message, channel and timing (Brownson et al., 2018).

Operating Room Staff

Circulating nurses and anesthesia staff will receive the message that applying dressings before positioning prevents the injuries they see in recovery. Channels are morning huddles, a one-page visual guide in each room and the monthly dashboard of use and injuries.

Surgeons

Surgeons will hear that placement has been agreed with them and that trials show fewer injuries. The surgeon champion will present the evidence and early results at the surgical department meeting in months 1 and 6.

Leaders

The perioperative director, chief nursing officer, finance and the board quality committee will receive a report at months 6 and 12 framing the dressings as a low-cost supply that prevents injuries that must be reported and that extend stays.

The Profession

Results will be shared through a poster at a regional perioperative nursing conference, a manuscript to a perioperative nursing journal and the scholarly project presentation. Evidence can take many years to reach routine practice, and sharing a community hospital's experience, including barriers and strategies, may shorten that lag for others.

Evaluating Dissemination

Dissemination will be judged, like implementation, by evidence of action rather than effort: the proportion of operating room staff briefed by month 3, attendance at department meetings, completion of board reports and acceptance of the poster and manuscript.

Timeline

• Month 1: charter, surgeon consensus meeting, baseline data
• Month 2: checklist change, standing protocol, budget change, education begins
• Month 3: launch in all fourteen rooms; audits and feedback begin
• Months 4 to 12: monthly run charts; board reports at months 6 and 12
• Months 12 to 15: poster, manuscript, portfolio revision

Budget

Dressings are the main new cost. At about $14 for three dressings per patient and 2,600 eligible surgeries a year, the supply cost is about $36,400. Staff education will require about 120 paid hours, roughly $5,400, and audits about four hours a week of the project lead's time, absorbed within the role. Conference costs are estimated at $1,500. If the dressings prevent even fifteen pressure injuries a year, the avoided treatment costs and extended stays are expected to exceed the supply cost, an estimate the project will test with the hospital's own cost data.

Ethical Considerations

The project is a quality improvement initiative implementing an evidence-based standard of care, and the project lead will request the institutional review board's confirmation of that status before any data are collected. Data used in external products will be de-identified. Because the protocol involves applying dressings without a separate order, it will be approved as a nursing standing protocol through the hospital's policy process. Reporting outcomes by skin tone will use aggregate data only.

Sustainability

Sustainability is designed in from the start. The checklist prompt, standing protocol and budget change make the practice part of the system rather than dependent on the project lead. The wound care nurse will continue monthly audits after month 12, and dressing use and injury rates will remain on the perioperative quality dashboard reviewed by the director.

A Christian Worldview

Paul reminded the Corinthians that their bodies were not their own but bought with a price, and called them to honor God with them (English Standard Version Bible, 2001/2016, 1 Corinthians 6:19-20). For a perioperative nurse, protecting the skin of an unconscious patient is a way of honoring the body God made, entrusted for a few hours to the team's care. Sharing what we learn with other hospitals is an extension of the same love of neighbor, offered to patients we will never meet.

Conclusion

This plan brings strong evidence for prophylactic silicone foam dressings into a hospital where they have been available but unused. It addresses barriers of authority, workflow, cost and surgeon concern with matched strategies, measures both clinical and implementation outcomes in a hybrid design, reports results in a way that cannot hide missed injuries in dark skin and disseminates the evidence and results to the people who must act and to the wider profession. After instructor feedback, the revised plan will become the foundation of the scholarly project.

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

Bates-Jensen, B. M., Crocker, J., Nguyen, V., Robertson, L., Nourmand, D., Chirila, E., Laayouni, M., Offendel, O., Peng, K., Romero, S. A., Fulgentes, G., & McCreath, H. E. (2024). Decreasing intraoperative skin damage in prone-position surgeries. Advances in Skin & Wound Care, 37(8), 413-421. https://doi.org/10.1097/ASW.0000000000000186

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: Translating science to practice (2nd ed.). Oxford University Press.

Curran, G. M., Landes, S. J., McBain, S. A., Pyne, J. M., Smith, J. D., Fernandez, M. E., Chambers, D. A., & Mittman, B. S. (2022). Reflections on 10 years of effectiveness-implementation hybrid studies. Frontiers in Health Services, 2, Article 1053496. https://doi.org/10.3389/frhs.2022.1053496

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17(1), Article 75. https://doi.org/10.1186/s13012-022-01245-0

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

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. The international guideline (E. Haesler, Ed.; 3rd ed.). EPUAP/NPIAP/PPPIA.

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

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Frontiers in Public Health, 7, Article 64. https://doi.org/10.3389/fpubh.2019.00064

Johansson, V. R., Dahl, O., Falk, A. C., Nilsson, U., Dehara, M., & von Vogelsang, A. C. (2026). Risk factors for position-related injuries in adult surgical patients: A systematic review and meta-analysis. International Journal of Nursing Studies Advances, 11, Article 100676. https://doi.org/10.1016/j.ijnsa.2026.100676

Neu, C., Furtado, S., Dyck, R., Sheikh, F., Tremain, L., & Johnson, D. (2026). Early identification of pressure injury: An equity-informed initiative. Advances in Skin & Wound Care, 39(6), 288-293. https://doi.org/10.1097/ASW.0000000000000475

Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), Article 21. https://doi.org/10.1186/s13012-015-0209-1

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Rahman-Synthia, S. S., Kumar, S., Boparai, S., Gupta, S., Mohtashim, A., & Ali, D. (2023). Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis. Enfermería Clínica, 33(1), 4-13. https://doi.org/10.1016/j.enfcle.2022.05.002

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

Yeo, H., Hwang, J., Lee, M., No, D., & Jang, I. (2023). Effect of a prophylactic dressing for sacral pressure injuries in non-critically ill patients after general surgery: A randomized controlled trial. Worldviews on Evidence-Based Nursing, 20(3), 259-268. https://doi.org/10.1111/wvn.12651