pressure ulcer final

Table of Contents

 Define an improvement goal and explain how you would measure the change.Create a project plan. Consider: Pressure ulcerResources neededSupplies and equipmentPeopleTimeframe for implementationData collection mechanismsChange and leadership theories to ensure successCite a minimum of 3 scholarly/peer reviewed articles/sources Pressure Ulcer decrease With precise routine practice of using of multiple types of Foam Dressing with available improve and innovation of technology, pressure ulcer remains to be a primeval in the health care practice. Avoidance of pressure ulcer are the still significant issue in the health care organizations .Pressure ulcer are critical issues in caring for adults in all type of setting ,The major target patients are seriously ill ICU patient, Elderly who are significantly debilitating after hospitalizations ,and the acute care individuals are the major focus of ths disease. Prevention and promotion are the still persists issue of this issue. Most of health care organizations and health care facilities have specified guidelines and internal policies and procedures for control and prevention and protections of pressure ulcers. However the guidelines and protocol and stander policies and procedures most of the time not been implemented and keep on by nursing staff.The decreased and reduction of pressure ulcer occurrence is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer impact significant increased of medical coast and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer development revealed that risk assessments such as the Gosnell Scale, Norton scale, and Braden scale are made available for use by nursing staff at the majority of medical facilities (Lahmann et al., 2010). However, only 10% of nurses actually complete accurate inspections of the skin during their initial physical assessments of the patients (Lahmann et al., 2010). As a result, patients who are at risk of developing pressure ulcers are often overlooked by nursing staff. Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their family members concerning the development of new pressure ulcers. Patients and family members have expressed dissatisfaction because of the increased stress and prolonged hospital stay often associated with the treatment of pressure ulcers.The Institute of Medicine (IOM) committee created six “Aims for Improvement” that healthcare should embrace in order to provide the best care for the people of the United States (Berwick, 2002). These aims stated that patients should receive care that is safe, timely, effective, equitable, efficient, and patient-centered (Berwick, 2002). The problem of pressure ulcers relates to the aims of safety, timeliness, and effectiveness. The IOM committee describes the aim of safety by stating that patients should be as safe in health care facilities as they are in their own homes (Berwick, 2002). The aim of keeping patients safe is not met when their risk of death increases from the development of new pressure ulcers while in the hospital. Secondly, the aim of timeliness reduces delays in the patient receiving care and the nurse providing care (Berwick, 2001). This aim is not met because new pressure ulcers form as a result of a major delay in adequate and complete physical assessments. Lastly, the aim of effectiveness states that the health care system should use evidence-based practice proven by science to care for patients (Berwick, 2001). Patients lack effective care when they develop new pressure ulcers that compromise their health status while under the supervision of a medical facility. Improvement ProgressResearch is overflowing with information related to decreasing the occurrence of new pressure ulcers in patients. Many research studies are organized on the basis of finding the appropriate structures to support the appropriate processes of care that will eventually lead to desired outcomes (Lahmann et al., 2010). The main structures discussed in the available literature begins with a referral to the healthcare institution’s guideline and chosen risk assessment on all new admissions (Lahmann et al.,2010). After a patient is identified as at-risk for the development of pressure ulcers, certain evidence-based processes should be implemented. Preventive measures/devices need to be added to the plan of care immediately. The following are proven to prevent the development of pressure ulcers in patients: frequent repositioning, adequate nutrition, additional skin inspections, special beds/mattresses, special pillows, and elbow/heel protectors (Lahmann et al., 2010). After performing these interventions, research suggests that pressure ulcer prevalence rates decrease dramatically for healthcare facilities which is the desired outcome (Lahmann et al., 2010).The tool that I would use to better clarify this problem is a histogram. Histograms provide a visual depiction of data that makes it easier to understand. The histogram would include the total amount of newly identified pressure ulcers every week at the healthcare facility. Nurses would be able to visualize the progression toward or the digression away from the overall goal of having no patients with new pressure ulcers. All levels of nursing staff would have to be involved in order for this improvement project to be successful. Members of the nursing administrative staff (L. T. and J.B. ), nurse managers (K.K. and L.H.), team leaders (I.R. and E.L), and charge nurses (A.W., D.S., and C.H.) would help implement the needed changes related to patient care and emphasize the importance of accurate and timely skin assessments. Most importantly, the staff nurses would be instrumental to this project because they provide direct bedside care to patients. Staff nurses would be responsible for initial skin assessments of patients, planning skin care, implementing new orders or following protocols, and reevaluating the plan of care as needed. Lastly, I would include nurse educators (J.T. and S.L.) who would teach the staff nurses the correct way to perform skin assessments, provide wound care, and operate new equipment.In addition to the nursing staff, I would also include physicians, nutritionists, and data analysts. Physicians are important to this project because they have to be willing to order the necessary treatment plans for pressure ulcer prevention. Nutritionists (T.P. and P.W) can assist with the most effective diet plan for the patients based on their caloric needs. According to Andrychuk (1998), low protein intake in compromised patients is a significant risk factor in skin breakdown and pressure ulcer development. Lastly, I would include data analysts (G.H. and K.Y.) to examine the statistical outcomes of any new nursing interventions incorporated into patient care and compare them with the previous interventions. According to Berwick (2002), quality improvement is data driven, and care processes must be measured for effectiveness. As a result, the staff involved in this project will have evidence that certain interventions are more effective than others.The Plan, Do, Study, and Act (PDSA) cycle is a problem-solving model that uses small tests of change to determine if different interventions will improve care (Institute for Healthcare Improvement, 2014). For this project, the Plan stage would involve determining which area of the hospital has the greatest number of new pressure ulcers after admission. Then, a plan to educate the nursing staff on skin assessments, hospital guidelines/protocols, and equipment use would be developed. Afterwards, a bedside competency evaluation process would also be established. Lastly, overall goals and target dates would be discussed. During the Do stage of the cycle, the nursing staff would be educated on the necessary topics and evaluated at scheduled competencies over the course of three months to determine their ability to apply the knowledge at bedside. During the Study stage of the cycle, a comparison between pressure ulcer prevalence before and after the extensive nursing education would be performed. Also, an analysis of the accuracy of skin assessments and rate in which they are completed after admission would be completed. During the Act stage of the cycle, the plan would be modified if necessary with any appropriate changes for improvement.Contribution to the Future of HealthcareAccording to recent literature and research, pressure ulcer remains one of the problems confronted by hospitals and other health care facilities around the countries. Intensive care patients are the largest group of patients who end up with pressure ulcer during their stay in hospitals. Taking care of patients with pressure ulcer consume a large part of hospitals budget. Prevention of pressure ulcer is not only the job of bedside nurses, but also the responsibilities of nurse educators as well as administrators. Prevention of pressure ulcer will contribute to the future of healthcare by allow hospitals management to save money on pressure ulcer and therefore leaving more money Change Model OverviewChange in nursing practice is necessary to increase the likelihood of success. For this project, I will be using Havelock theory as a guide. This theory is based on planning and monitoring. The steps in this theory involve diagnosis, gathering, choosing a solution, gaining acceptance, and self renewal.Step1: Assess the Need for ChangeDue to recent changes in healthcare reform, Medicare and medical insurance will no longer pay for pressure ulcer acquired during hospital stay because bedsore can be preventable. According to Compton et al, (2008), 5% of ICU budget goes to the treatment of pressure ulcer. Courtney, Ruppman, & Cooper (2006) continue to say that an average of $4,000 is spent to take care of one patient with pressure ulcer. The price of treatment varies because there are different stages of pressure which range from stage 1 to unstageable stage which can lead to septicemia and death.Step 2 Link the problem, intervention, land outcomesThe problem is in the critical care unit it is difficult to turn and reposition the patient due to dynamically unstable patient.Most patients who end up in intensive care unit are most of the time so unstable that any little movement will put them at risk for further complications which can lead to death. However, finding a way to prevent pressure ulcer in the most critical ills patients in the healthcare system is very crucial. Braden scale (Braden & Makelburts, 2005) use in hospitals allows nurses to identify patients at risk for pressure ulcer based on their sensory perception, mobility, activity, moisture and nutrition. Although the Braden scale is a useful tool but healthcare administrations has yet found the best method to eliminate pressure ulcers or bedsore in intensive care units. The use of foam dressing will be introduced to the intensive care patients in one of the critical care units at Stroger hospital as a pilot project. Due to the low cost of foam dressing, the goal of this project is to figure out whether or not the use of foam dressing can decrease the rate of pressure ulcer in intensive care units without the need to constantly turning those patients who are unstable. P = Patients(s) or problemPatient, patient population or presenting issue | Adult patient who is critically ill in ICU units |I = Intervention under Consideration | Apply foam dressing to bony permanent on admission as a preventive measure |C = ComparisonWhat is the current practice you are comparing to “I”? (This element may be implied or missing) | Compare incident of pressure ulcer before using the foam to the number of incident of pressure ulcer after use of foam in the ICU patients |O = OutcomeWhat is the effect of the “I” on “P?” What is desired outcome? | No Hospital acquired pressure ulcer |T = TimeIs there a need to limit the timeframe for the intervention? | Will monitor the critical care unit for 30 days. |Step 3: Synthesize the Best EvidenceSix articles that were found to be applicable for this project were reviewed. Evidence from these six articles support the issue of Pressure ulcer is high risk patients. The propose change is to assess patient on admission and applied a foam dressing for prevention of pressure ulcer.Step 4: Design Practice Change Once the implementation of the pilot study that involved the use of foam dressing is done and the result is analyzed, I will design a practice change. The practice change will be presented to management. The design will contain not only data on reducing pressure ulcer in intensive care units but also the cost saving associated it.Step 5 Implement and Evaluate the Change in PracticeMy credential as a certified wound gives me an advantage on creating trust among hospital management and administration for the implementation of the foam dressing. I will first set up a meeting with the appropriate personnel to present the data I gathered during the pilot study. I will volunteer to work extra hours on my off time to make sure the implementation and evaluation of the project goes smoothly. In addition, I will go around the intensive care units and educate the bedside nurse on the important of preventing pressure ulcer and what role they can play in it. For evaluation purposes, transfer patients or nursing home patients will not take part in this pilot study because I want to avoid the fact that those patients were admitted with a bedsore.Steps to Maintain ChangeTo maintain the change, my focus will be in educating the bedside nurses. Without their collaboration, my pilot study will not reveal the right result and therefore maintain the change will be extremely difficult. I will provide the nurses with a summary of my research that show s the cost of pressure ulcer to hospitals. Since the nurses already know me as one of the certified wound nurse in the hospital, I will take advantage of any interaction I have with them to educate them on how valuable they are in preventing bedsore in even the most unstable patients. I will also ask my certified wound nurse co-workers to join me in this fight of reducing pressure ulcer in intensive care units. My goal for the first year will not to eliminate pressure ulcer but to reduce the rate by 50% and to create awareness among the bedside nurses on their role on preventing bedsore.ConclusionProvide a conclusion summarizing the key prints of the paper. Pressure ulcers are by far the most common causes of patients’ length of stay in hospital. Caring for patients with pressure ulcers take a big part of hospital budget. This project will focus on using foam dressing in patients admitting in intensive care units because those patients spend more time in bed with little movement. Once the pilot study is done and evaluate, the result will be share with management so implementation can take place.ReferencesCourtney B, Ruppman J, Cooper H., (2006). Save our skin: Initiative cuts pressure ulcer incidence in half. Mitchell, G. (2013) ‘Selecting the best theory to implement planned change’, Nursing Management, 20, (1), pp. 32-37.American Psychological Association (2001). Publication manual of the American Psychological Association (5th ed.). Washington, DC: American Psychological Association.Template, A. (2008, February 5). Apa-template-5.0611. Retrieved February 5, 2008, from APA template: