This study aimed to examine the implementation processes and system-level outcomes associated with the national adoption of the Registered Nurses’ Association of Ontario (RNAO) Pressure Injury Prevention Best Practice Guideline across high-complexity public hospitals in Chile, from a Best Practice Spotlight Organization® (BPSO®) Host Model perspective. This study universe included all institutions incorporated into the national BPSO Host Ministry of Health (MINSAL) program between 2018 and 2022 ( n = 29), integrating BPSO®s from all implementation stages that remained active during the 2023–2024 study period. Quantitative data were obtained from aggregated Nursing Quality Indicators for Reporting and Evaluation (NQuIRE®). Qualitative data were derived from annual institutional implementation reports and analyzed using directed content analysis guided by an implementation science framework. Eighteen high-complexity public hospitals submitted complete datasets, of which eleven reported indicators specific to the Pressure Injury Prevention guideline. Improvements were observed across all process indicators, including risk assessment at admission (+2.3 %), risk reassessment (+7.9 %), and use of pressure-redistributing support surfaces (+4.6 %). Although 30.75 % of patients were classified as moderate or high risk, pressure injury incidence remained stable at 1.2 %–1.3 %, well below global pooled estimates. Pioneer hospitals demonstrated consistently higher adherence to preventive processes and lower pressure injury incidence compared with later adopters. Qualitative findings identified leadership, stakeholder engagement, governance structures, and standardized monitoring as key enablers of implementation, while challenges persisted in sustaining bedside practice change and patient engagement. A Host-led national implementation strategy can strengthen adherence to evidence-informed pressure injury prevention practices, reduce system-level variability, and sustain low incidence across a public hospital network. The Chilean BPSO® Host model illustrates how coordinated governance, standardized indicators, and structured implementation support can scale evidence-based practice in middle-income health systems.
Hurtado et al. (Wed,) studied this question.