of data analysis very sketchy with no mention of specific statistical tests that will examine relationships between key variables. Presumably Ms. Canelo, a new study team member, will conduct the data analysis using STATA 11 but this is not clearly stated. ? Survey is to be emailed only to wound care specialists. One goal of the Handbook is to facilitate an interprofessional approach to pressure ulcer prevention. Because pressure ulcer development is multifactorial, prevention requires the collaborative preventive efforts of several disciplines. Obtaining information only from nurses, as mentioned by one of the initial reviewers, provides only one, potentially biased perspective of PU prevention at a facility 4. Human Subjects Protection (do not score - comment on any issues): No issues 5 Project Organization and Management (including qualifications of investigator team): Well qualified investigator team with roles on the study divided according to expertise although the role of Ms. Canelo is somewhat vague. 6. Budget (do not score - comment on any issues): Budget is primarily for salary for PI, one of Co-PIs, and members of the research team. 7. Likely Impact and Potential for Sustainability: In responding to the reviewers' comments as to how the end product of this study will be used, the resubmitted proposal provides some general examples of how the survey data may be used to inform policy and operational decisions. Addtitionally, the proposal offers some possible future studies building on the results of the survey. Overall Impression. In this grant resubmission, the PI provides clearer, more compelling rationale for examining organizational features associated with implementation of the Pressure Ulcer Handbook. If understanding organizational context-processes and structures-are critical to understanding variations in implementation of the PU Handbook, then administering the survey to only wound care specialists may be not only limiting and potentially biased, but also negates the interprofessional approach to pressure ulcer prevention advocated in the Handbook. The rationale for using nurse wound care specialists as the key informants is based on the study team's prior work in which they have found that the structural information reported by the wound care specialist lead has been consistent with the information provided by top leadership. o The PI's prior work, however, has been a study of only 6 sites and it is not clear if the wound care nurses at these 6 sites are representative of wound care nurses across the VA. o The role expectations of the wound care specialist vary among facilities as to 1) whether the position is the primarily job assignment or a collateral duty, 2) how long the wound care specialist has been in the position at the VA, and the role the wound care specialist assumes on the interprofessional team. o Recommend including other members of the wound care team in the survey. Key Strengths. 1. Expertise of study team 2. Potential for VHA to better understand the extent and characteristics of the implementation of the PU Handbook. 3. Strong support from the Office of Nursing Services Key Weaknesses. 1. Administration of survey to wound care specialists only. 2. Lack of detail regarding survey data analysis
This proposal involves the development of a survey and the collection of data which will describe how VA hospitals organize to deliver pressure ulcer preventive care. The findings from this study will inform VA policy, operational decisions, and future interventions to improve pressure ulcer prevention.
