One finished NUR 490 Module 3 pre-implementation plan for an intraoperative pressure injury prevention bundle, with baseline data, gap analysis table, readiness assessment, stakeholders, resources, training, go-live criteria and references. Searches like "nur 490 module 3 assignment", "nur490 module 3 pre-implementation plan" and "nur 490 module 3 example" land here.
The NUR 490 Module 3 example, in full
Before the First Incision: A Pre-Implementation Plan for Preventing Intraoperative Pressure Injuries
[Student Name]
Southern New Hampshire University
NUR 490: Transformational Capstone
Capstone Pre-Implementation Plan
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Before the First Incision: A Pre-Implementation Plan for Preventing Intraoperative Pressure Injuries
The Change and the Baseline
The capstone change proposal recommended an intraoperative pressure injury prevention bundle for adult patients undergoing procedures expected to last three hours or longer in a composite 14-room operating suite. The bundle includes a documented skin and risk assessment before surgery, preventive multilayer silicone foam placed over the sacrum and both heels in patients judged high risk, pressure-redistributing surfaces on every operating table, careful positioning with padding at bony prominences, and a skin check and handoff at the end of surgery.
Baseline data were collected over six months. Of 1,420 adults who had procedures of three hours or longer, 38 were found to have a new pressure injury within 72 hours after surgery that the wound care team judged to have begun in the operating room, a rate of 2.7 percent. Most were on the sacrum or heels, and 9 were stage 3 or deeper. Only 22 percent of the sampled records documented a preoperative skin assessment. Pressure injuries that start during surgery often appear hours to days later on the inpatient unit, which is why they are easily missed as operating room events (Engels et al., 2016).
Gap Analysis
Current practice was compared with recommendations from the international pressure injury guideline and with published evidence on prophylactic dressings.
Table 1
Gap Analysis for Intraoperative Pressure Injury Prevention
| Recommended practice | Current practice | Gap |
|---|---|---|
| Risk assessment before surgery, including duration and patient factors | Not standardized; documented in 22 percent of records | Large |
| Pressure-redistributing surface on operating tables | Available in 9 of 14 rooms | Moderate |
| Preventive foam over sacrum and heels in high-risk patients | Used only at individual surgeon request | Large |
| Heels offloaded and positioning checked during long cases | Varies by team | Moderate |
| Skin check and handoff of skin findings after surgery | Not included in handoff tool | Large |
Note. Recommendations drawn from the international pressure injury guideline and published evidence on prophylactic dressings.
The recommendations for risk assessment, support surfaces, positioning and prophylactic dressings are consistent with the international guideline on pressure injury prevention (European Pressure Ulcer Advisory Panel et al., 2019). Evidence for prophylactic dressings comes partly from a randomized trial in trauma and critically ill patients, in which patients who had soft silicone multilayer foam placed over the sacrum and heels on arrival developed fewer pressure ulcers than those given usual care (Santamaria et al., 2015). Although that trial was not conducted in the operating room, the mechanism of reducing shear and pressure at bony prominences applies to long surgical procedures as well.
Organizational Readiness
Readiness was assessed through a brief survey of perioperative nurses and surgical technologists, informal conversations with surgeons and anesthesia providers, and a review of resources. Of 52 perioperative nurses surveyed, 44 agreed that pressure injuries can begin in the operating room, but only 19 could describe the risk factors for surgical patients, and many believed that injuries appearing days later could not be linked to surgery. Surgeons were generally supportive but concerned about adding time to room turnover. Anesthesia providers raised the practical question of repositioning during long cases. The perioperative director supported the project and agreed to fund dressings for a pilot. The overall assessment was that motivation was moderate, knowledge was uneven and resources were partly in place, so education and supplies must come before implementation.
Stakeholder Engagement
Engagement will be tailored to each group. Perioperative nurses will be engaged through a unit meeting presenting the baseline data, including photographs of injuries used with permission, and by recruiting two nurses per specialty as champions. Surgeons and anesthesia providers will receive a short presentation at their department meetings from the perioperative medical director and the wound care nurse, focused on patient outcomes and on the minimal time the bundle adds. The wound care team will help design the skin assessment and provide education on staging. Inpatient unit managers will be informed so that their nurses expect the new skin findings in the handoff. Materials management will ensure dressing supplies, and informatics will add the risk assessment and skin check to the perioperative record.
Resources and Education
Resources needed before implementation include prophylactic dressings for the pilot, estimated at about 40 dressings per week; pressure-redistributing overlays for the five rooms without them; and informatics time to add documentation fields. Education will consist of a 30-minute session for all perioperative nurses and surgical technologists covering risk factors, dressing application, positioning principles and the new documentation, followed by a skills check on applying dressings in the correct positions. Brief materials will be posted in each room. Champions will receive additional training so that they can coach during the pilot.
Go or No-Go Criteria
Implementation will begin with a pilot in the orthopedic and general surgery rooms only when four conditions are met: at least 90 percent of perioperative nurses in those rooms have completed education and the skills check; dressings and overlays are stocked in every pilot room; the new documentation fields are live and tested; and the wound care team is prepared to review suspected injuries within 72 hours after surgery. Setting these conditions protects the project from starting before the team can succeed, which is the most common reason promising practice changes fail.
Anticipated Barriers
Three barriers are likely during the pilot and are addressed in advance. The first is time pressure at the start of cases, when the team is focused on induction and positioning; placing dressings during skin preparation, rather than as a separate step, keeps the added time to about two minutes. The second is inconsistent handoff of skin findings to inpatient units, which the new documentation field and a line in the post-anesthesia handoff script are designed to fix. The third is uncertainty about who owns the problem, since injuries appear after the patient has left the operating room. Agreeing in advance that the wound care team will classify suspected injuries and report them back to the perioperative champions each week gives the operating room team feedback it has never had and makes the outcome visible to the people who can change it.
Conclusion
This pre-implementation plan establishes a baseline rate of 2.7 percent for operating room-acquired pressure injuries in long procedures, identifies large gaps in risk assessment, prophylactic dressing use and handoff, and finds a team that is motivated but uneven in knowledge and resources. Engaging each stakeholder group, securing supplies and documentation fields, delivering focused education and meeting clear go or no-go criteria will prepare the suite for a pilot, which the implementation plan will describe.
References
Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure ulcers: Factors contributing to their development in the OR. AORN Journal, 103(3), 271-281. https://doi.org/10.1016/j.aorn.2016.01.008
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 (3rd ed.). EPUAP/NPIAP/PPPIA.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal, 12(3), 302-308. https://doi.org/10.1111/iwj.12101
How this NUR 490 Module 3 example is structured
Pre-implementation is about readiness, so the paper answers the questions a manager would ask before approving a start date. It restates the change briefly and presents the baseline data that later evaluation will use. A gap analysis table compares current practice with guideline recommendations. The readiness section assesses the team's knowledge, attitudes and resources, and the stakeholder section explains how surgeons, anesthesia, perioperative nurses and the wound team will be engaged. Resources and training follow. The paper ends with explicit go or no-go criteria, which show that implementation will begin only when the conditions for success are in place.
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NUR 490 Module 3 questions, answered
What does a NUR 490 pre-implementation plan include?
In capstones that break the change project into parts, the pre-implementation plan usually covers what must be ready before the change begins: baseline data, stakeholder engagement, organizational readiness, resources, education, approvals and potential barriers. It bridges the change proposal and the implementation plan. Your guidelines list the required elements.
What is a gap analysis?
A gap analysis compares current practice with a desired standard, such as a guideline or best practice, item by item. It shows exactly what needs to change and helps prioritize resources. A simple table with columns for the standard, current practice and the gap is often enough.
Why set go or no-go criteria before implementation?
They prevent a change from starting before the conditions for success exist, such as trained staff, supplies in place and data systems ready. Starting too early often leads to poor adherence and a failed pilot, which can make staff resistant to trying again.