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Quality improvement and pressure ulcers
Problem of pressure ulcers in hospitals
Case study pressure ulcer prevention
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Recommended: Quality improvement and pressure ulcers
Introduction
The aim of the Healthcare Quality Strategy (HQS) is to deliver excellent healthcare to the citizens of Scotland and brand NHS Scotland as a world leading care provider (Scottish Government, 2010). An improvement intervention examined in the HQS is the prevention of pressure ulcers (PUs). Using the Gibbs (1988) framework, this essay will demonstrate how I was involved in this intervention by applying my skills of compassion, person-centred care and teamwork. I have chosen PU prevention as the subject for this reflection; since, the majority of PUs are preventable (Watret and Middler, 2012) and the cost of treating them ranges from £1,214 to £14,108 (Dealey, Posnett and Walker, 2012). Supporting the Nursing and Midwifery Council (NMC) (2011) confidentiality guidelines, the pseudonym “Ruby” has been used.
Description
In my practice learning environment (PLE), I encountered Ruby, a ninety year old lady who had suffered a stroke. The rationale for choosing Ruby for this reflection is that she had a Waterlow score of eighteen on admission. The intrinsic factors contributing to the high Waterlow score included her age, skin integrity, nutritional status, mobility, faecal continence and special risk due to her left cerebellar stroke (Waterlow, 2005). Ruby’s post stroke symptoms included; weakness in her right limbs, frustration over losing independence and a right visual field deficit. Since, these symptoms can contribute to the development of PUs (Suttipong and Sindhu, 2012); I knew the nursing staff and I must make PU prevention a priority in Ruby’s care planning. Through showing compassion and taking a person-centred approach by involving Ruby and her family in decisions, as a team, we successfully put evidence based PU...
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...discussed by the team. However, I could have also given them the NHS QIS (n.d.) Preventing PU patient information leaflet; such information leaflets deliver written communication which can empower individuals to make the correct choices regarding their care (Garner, Ning, and Francis, 2012). When this situation arises again, I will ensure I follow identical prevention strategies, since, they are obviously successful.
Action Plan
Since, PU prevention is an integral part of nursing care; I will encounter it in my future practice. Therefore, to improve my understanding I will familiarise myself with the NHS QIS (2009) Best Practice Statement on PU management and prevention. Furthermore, I will search the Cinahl database for nursing journals relating to compassion and person centred care to enhance my knowledge, and subsequently meet the aims of the HQS in future PLEs.
Responding is the third phase of the Tanner’s (2006) model based on the nurse’s initial grasp, interpretation and applying clinical reasoning to respond with evidence based practice. Based on the assessment it recognised that in Mr. Devi several nursing interventions need to consider, these are reported to the appropriate medical practitioner about deterioration in his condition. Mr. Devi condition was reported to medical practitioner using an interdisciplinary communication SBAR tool (Situation, Background, Assessment and Recommendation). SBAR is a communication tool designed for the clinical team to transfer clear and concise information about a patient’s condition (Cadman 2016). Recovering after stroke he will be referred to a specialist
Building on the successful work of health care providers will help with the campaign of saving 100,000 lives. Through his speech, Dr. Berwick introduce six changes that every hospital needs to implement in order to save lives that will bring family together. The six changes Dr. Berwick wish every health care organization needs work on that will help save these lives are to deploy rapid response team, deliver reliable care for acute myocardial infarctions, prevention of ventilator associated pneumonia bundles, prevention of central venous line bundles, prevention of surgical site infection prophylaxis medication and prevention of adverse drug events with reconciliation. Even though the lives save may not know who they are, it will bring community and family together. According to Dr. Berwick “The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have
Due to an ageing population , The Francis Report recommends the introduction of a new status of nurse, the “registered older persons nurse”. One of the illnesses linked in with this is dementia, and multiple factors relating to dementia are having an impact on how nurses are trained and their deliverance of services. In 2013, the Royal College of Nursing (RCN) began a new development program to transform dementia care for hospitals. There aim is to develop skills and knowledge related to dementia, the roles of all those who are involved, understanding the development of action plans that identify key changes.
Frances Report (2013) gave a report of what led to the failure of the care Mid Staffordshire NHS Foundation Trust provided to patients. He reported that this failure is as a result neglect and of lack of good leadership and incompetence fundamental nursing care by health care professionals such this called for a major change in the culture of the NHS across the country. Hence, the innovation team cultivate the culture of transparency, honesty, tru...
...ssure ulcers can be preventable if there is a systemic and multi-professional approach to their prevention and continuing assessment of skin integrity. Mary was determined and worked well with the physiotherapist; she was up and on her feet within a week of returning. Staff had to prompt her to move around the ward, which at times was hard for her due to her anxiety. Mary was deemed high risk for falls, so was put on a prevention of falls chart in conjunction with the pressure area chart and repositioning chart.
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Patients often have complex care needs, and often present with multiple co-morbidities or problems. The process of conducting a comprehensive nursing assessment, and the coordination of care based on these findings is central to the role of the Registered Nurse (NMBA 2006). Evidence-based interventions must then be planned and implemented in a patient-centred approach in order to achieve agreed treatment goals and optimise health (Brown & Edwards 2012).
During my career as a registered nurse I have had the privilege of caring for my patients at the bedside and meeting their needs holistically. Additionally, the safety of my patients is one of the most important aspects of my current role. The experience of advocating for my patients during my nursing career has taught me to place my patient’s health and wellbeing first. The second most important aspect of nursing that I have learned during my career is how to meet my patient’s needs as a whole, not just physically but also emotionally and psychologically applying the holistic approach to each patient. I believe that the patient’s needs
" Journal Of The American Academy Of Nurse Practitioners 24.12 (2012): 726-734. Academic Search Premier -. Web. The Web.
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most resent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement from the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.
Poor care does not only result in bad press and public perception but also break the trust between the patient and nurse. Utilising the theoretical framework developed by Todres et all (2009) which explores eight central aspects of what it is to be human. Todres et al (2009). This model can be used to improve nursing care. Referring to the term ‘being treated as human beings’ not being treated as a number or object.
I believe that each patient deserves the highest quality of care, regardless of their life choices, gender, ethnicity, religion, sexual preference and socioeconomic status. Each patient, including their family is entitled to respect and honesty, despite the circumstances. Aspects of providing the highest quality of care are safety, competence, honesty, caring and continuous learning and improvement. Concepts that have been ingrained from a young age and molded by the SUCON mission and American Nurses Association Code of Ethics ("Baccalaureate Student Nursing Handbook 2012-2013," 2015; ”Code of Ethics for Nurses," 2015).
Nursing is a unique system that requires good collaboration with others and working together to reach the goal of providing good quality care based on evidence-based-practice. “The role of a colleague is a vital one in any profession. The status of colleague within the care generates pictures of nurses, doctors, pharmacists discussing, on an equal basis, problems and concerns related to healthcare” (Zerwekh & Zerwekh Garneau, 2015, p.144). If nurses can’t get along with other healthcare providers that will jeopardize the patient’s recovery and can take a huge turning point and guide nurses away from providing high quality
But more than this it encourages health professionals to work more closely together by enabling fluid communication when it comes to patients. By having a single and shared home for patient records, a multi-disciplinary staff can integrate services, streamlining care, eradicating work silos and making it easier for healthcare professionals to manage patient illnesses more effectively. With an expected NHS funding gap of £30m forecasted between 2020-2021, there is a need for cost-effective healthcare; lowering patients’ reliance on the system, taking care out into the community, is an effective means of achieving