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Initiating and managing change
Studies on prevention of pressure ulcer
Initiating and managing change
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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.
Discussion
Problem: Pressure Ulcers
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility 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 de...
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195968886?accountid=14472
Berwick, D. M. (2002). A user's manual for the IOM's 'quality chasm' report. Health Affairs, 21(3), 80-90. Retrieved from http://search.proquest.com/docview/204628853?accountid=
14472
Institute for Healthcare Improvement. (2014). How to improve. Retrieved from https://www.ihi. org/resources/Pages/HowtoImprove Lahmann, N. A., Halfens, R. J. G., & Dassen, T. (2010). Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals. Journal of Evaluation in Clinical Practice, 16(1), 50-56. doi:http://dx.doi.org/10.1111/
j.1365-2753.2008.01113.x
Thomas, D. R. (2001). Issues and dilemmas in the prevention and treatment of pressure ulcers: A review. The Journals of Gerontology, 56A(6), M328-40. Retrieved from http://search. proquest.com/docview/208635333?accountid=14472
The Braden risk assessment tool was deemed to be appropriate due to the patient’s comorbidity’s of peripheral vascular disease and lymphoedema with the addition of an arterio-venous leg ulcer of the right leg. This scale is universally accepted as a tool to help identify those most at risk with a goal of allowing health care providers to use their experience and judgement to consistently reduce the risk or to ensure preventive care is appropriately prescribed (Guy, 2012). Pressure ulcers are a risk factor for those who suffer from
Risk assessment scales have been in situ for over 50 years within the adult sector. These scales consist of several categories, which are thought to be associated with the potential occurrence of a pressure ulcer. Factors such as mobility and incontinence etc. are considered. Each category of the assessment is added up to give a total. The score then suggests whether a patient is at low, medium or high risk of developing a pressure ulcer. Higher-risk patients are therefore more susceptible to develop pressure ulcers and interventions are implemented such as, Air mattresses or nutritional support which is hoped to reduce the occurrence of pressure
...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.
Pressure ulcers development occurs in every hospital and it remains a major worldwide health problem for many years. However, pressure ulcers have received minimal attention when we talk about it as a patient safety issue. It is a patient safety issue as it can lead to serious damage such as life-threatening infections and pain (Richardson & Barrow, 2015). On a med/surg unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on regaining activities of daily living (Registered Nurses’ Association of Ontario, 2011). Therefore, assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO, 2011). Every client who is at risk needs to be assessed and educated regarding pressure ulcers and the subsequent skin breakdown (Cooper, 2013). During the hospital stay, clients may have limited movement and pressure ulcers can extend into the muscle, tendon, and bone (RNAO, 2011). In many cases, clients do not notice the formation of an ulcer and as it may be in areas that are out of sight such as the coccyx. Often,
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).
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Being a nursing student, I understand that Mr. John suffer hemiplegia resulting in weakness and also have limited ability to move, he cannot eat by mouth which restricts to have enough nutrition for the body, these are the some of the reason that make Mr John prone to have pressure injury as limited mobility and sickness causes the blood vessels to collapse easily so when for hours or days continuously pressure remains on the skin it leads to pressure sore and these pressure sore increases the risk of infection (Reddy, Cottrill, & Cansino, 2011). Usually, sustained pressure causes injuries over a bony prominent area especially in those who are malnourished and immobilized or limited mobilized. Routine assessment of skin is recommended to observe any sign of infection, 2 hourly position helps to relieve the pressure on the area (Barret, Kevin, James,
McGlynn, E, Asch, S, Adams, J, Keesey, J, & Hicks, J. (2003). The quality of health care delivered to adults in the united states. The New England Journal of Medicine, 248(26), 2635-2645.
middle of paper ... ... International Journal for Quality in Healthcare, 25(3), 261-269. Retrieved from http://intqhc.oxfordjournals.org/content/25/3/261.short Smedley, B., Stith, A., & Nelson, A. (2003). The 'Secondary' of the 'Secondary'.
Ormond, B., Spillman, B., Waidmann, T., Caswell, K., & Tereshchenko, B.. (2011). Potential National and State Medical Care Savings From Primary Disease Prevention. American Journal of Public Health, 101(1), 157-64. Retrieved February 23, 2011, from ProQuest Psychology Journals. (Document ID: 2233850141).
The field of nursing is an ‘in-demand’ profession that strives for excellence in patient care and positive outcomes. A nurse’s care is always patient-focused with the goal of helping patients reach maximum medical improvement. The job of a nurse can be physically, mentally, and emotionally challenging at times. This can lead to occupational burnout which has been linked to suboptimal medical care (Cimiotti, Aiken, Sloane, and Wu, 2012). The impact of sub par health care, results in a higher number of hospital-acquired infections (HAIs) and poor patient outcomes. Implementation of infection control practices and HAI prevention programs are two of the most important aspects of nursing care being utilized to improve patient outcomes. The effect of nurse staffing configurations and nurse-to-patient ratios have also been shown to play a significant role in the relationship between nurses and HAIs.
As reported by the nursing staff, the adequate nurse patient ratio (80%), was the dominant factor for the development for pressure ulcer in spinal cord injury patients.
This patient has several areas of skin breakdown. This is why the nurse should include impaired skin integrity in the plan of care. The first site of skin breakdown is located on his buttocks. It is a stage three pressure ulcer with sloughing and eschar present. While assessing this wound, the nurse should observe for any new signs of infection such as new odor, changes in discharge, and changing of wound appearance while informing the patient and care giver to report any of these symptoms. Wound care should be performed with dakin’s solution. Another wound is located on the upper back. This wound is from the thoracotomy that was performed on 08/05. The third wound is a small skin tear located on the left arm. The nurse should dress these wounds
CEA proponents believe that the country’s increased health care spending and desire for the best in medical technology will eventually force us to strongly consider using CEA as a possible solution to our problems. Perhaps a middle ground would be to use CEA as one tool of many when it comes to health policymaking. It does provide a tool to inform decision making in a clear, explicit way. In addition to the many countries that use CEA, medical journals here in the US routinely publish them. CEA would be able to help managed care organizations, insurers, and policy makers make informed decisions. Supporters are optimistic that the increased involvement by the federal government in comparative effectiveness research will eventually lead to increased acceptance and the use of QALYS as a
American Journal Of Public Health103.1 (2013): 27-31. Business Source Premier.