465 Worldviews on Evidence-Based Nursing, 2020; 17:6, 465–475. © 2020 Sigma Theta Tau International Original Article Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study Josephine Lovegrove, RN, BN (Hons) ● Paul Fulbrook, PhD, RN, MSc, BSc (Hons), PGDip Educ ● Sandra Miles, PhD, RN, RM, MN (Ch., Adol.), BN, CCYPN ABSTRACT Background: Formal assessment by nurses of a patient’s pressure injury (PI) risk level is often highlighted as being key to PI prevention. However, if no action is taken to address the de- termined risk (i.e., if appropriate preventative interventions are not implemented), the patient remains vulnerable to PI development, and the assessment process is rendered pointless. Aim: To explore the relationship between the prescription (planning) and implementation of PI preventative interventions by nurses following formal risk assessment. Methods: Using an exploratory, descriptive design, the charts and bedside areas of 200 adult patients admitted across four hospital wards were examined. Data collected included PI risk level, documented prescribed preventative interventions, and interventions for which there was evidence of implementation. Results: Of the final sample (n = 187), 66.8% of cases were categorized as being “at-risk” or above. As the risk category of patients increased, proportionately more patients in each cat- egory were prescribed each intervention. However, in most cases, significantly fewer interven- tions were actually implemented than were prescribed, except for several interventions that were implemented in more cases than were prescribed. There were 14 cases, including four at-risk and three high-risk patients, in which no preventative interventions were prescribed, while 88.7% of not at-risk patients had (unnecessary) preventative interventions prescribed. Discussion: These results indicate that intervention prescription increased relative to as- sessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. The results indicate a significant mismatch between these two steps of PI prevention. Linking evidence to action: These results indicate that intervention prescription increased rel- ative to assessed level of risk; however, the rates of intervention prescription and actual imple- mentation were suboptimal. A significant mismatch between these two steps of PI prevention was evident. Following patient risk assessment, there should be a greater focus on appropriate preventative intervention prescription (planning) with regular review and audit to help ensure that interventions are implemented as prescribed. Improved implementation of preventative interventions should, in turn, help to reduce hospital-acquired pressure injuries. BACKGROUND International consensus is that hospital-acquired pressure injury (PI) is predominantly preventable with the provi- sion of appropriate preventative care (Edsberg, Langemo, Baharestani, Posthauer, & Goldberg, 2014). Having a PI is painful, and thus, it negatively affects a person’s qual- ity of life (Jackson et al., 2017), increases hospital length of stay, and increases the costs of health care (Nguyen, Chaboyer, & Whitty, 2015). The development of a PI, also known as pressure ulcer, is therefore considered to be an indicator of the quality of care, particularly the nursing care, provided to hospital inpatients (Kottner, Hahnel, Lichterfeld-Kottner, Blume-Peytavi, & Büscher, 2018). A recent meta-analysis of 35 PI prevalence studies and 49 datasets from 19 countries found a global overall pooled PI prevalence of 12.8% (95% CI 11.8%-13.9%) and an adult hospital-acquired PI prevalence rate of 8.4% (95% CI 7.6%-9.3%) pooled from 15 studies (Li, Lin, Thalib, & Key words pressure injury, pressure ulcer, prevention, patient care planning, implementation