Introduction
Pressure ulcers may be regarded as one of the major health problems all over the world. According to the definition formulated by the National Pressure Counseling Panel, a pressure ulcer is a localized wound on the skin or underlying tissue resulting from shear or pressure (Sayilan, 2019). In general, this condition strongly affects patients’ health and general well-being, reduces their life quality, may lead to death due to various complications and infections, and increases the costs of health care and the length of hospital stay (Sayilan, 2019). At the same time, pressure ulcer occurs frequently, may develop quickly, and some wounds are never healed completely despite treatment. In their study, Bergstrom and Braden showed that in a skilled nursing facility, 80 % of pressure ulcers develop within 2 weeks of admission and 96 % develop within 3 weeks of admission (Park et al., 2016). That is why it is highly essential for health care providers to implement efficient measures for time-sensitive response and the prevention of pressure ulcers.
In recent years, as pressure ulcer is a health condition associated with high costs and mortality, their prevention and management have become hospitals’ quality indicators. As a result, due to multiple risk factors, the majority of nurses find the use of risk assessment tools such as an evidence-based checklist helpful in the identification of patients at high risk of wound development. The majority of health care institutions apply the Braden Scale or the Norton Scale which provides highly positive outcomes when used appropriately regardless of the fact that there is no current agreement on how frequently the risk assessment should be done (Dalvand et al., 2018). At the same time, researchers should always work on the improvement of existing practices. That is why the purpose of this research is to create an evidence-based checklist that will enhance the quality of services in dealing with pressure ulcers and their prevention. According to the results, a new assessment tool should have a highly positive impact on the condition’s management.
Capstone Proposal
The title of the project is “Preventing Pressure Ulcers” – it may be regarded as comprehensive and informative in relation to its purpose. The project will answer the question of whether the implementation of an evidence-based checklist would help decrease pressure ulcers in the geriatric population. In general, evidence-based initiatives started to play an important role with risk assessment, nutrition, position changing, skincare, and education as the basis of care delivery (Sayilan, 2019). The focus of the research will be on the geriatric population, especially on those patients who are bed-bound or have limited mobility as they are more vulnerable to pressure ulcers in comparison with other groups (Boyko et al., 2018). Participants are located in a skilled nursing home, and they will not be exposed to any health risks.
The decision to conduct research is determined by the researcher’s experience of working as a treatment nurse for approximately four years. As a matter of fact, in medical facilities, there are a considerable number of patients with pressure sores that could be prevented. That is why it is essential to provide health care professionals with training and appropriate guidelines for the assessment of risk for pressure ulcer buildup. Thus, the objective of this research will be the evaluation of preventative measures’ efficacy through the implementation of a specifically built checklist and related training for the health care team. The checklist will include pre-and post-test to assess the risk of bedsores in senior patients.
The implementation of the project is planned for the next semester, and it will take 4-6 weeks. Its sustainability is determined by the fact that another person may be assigned to this project. In other words, the head of the nursing department or the representative of clinical management can make sure that the project’s measures are implemented and continued. There are no considerable limitations of this project, and it may be prevented from succeeding only in the case of the absence of the health care team’s support. Budget requirements imply $200 for the development of the checklist and pre-and post-test.
Background
In general, the focus of this project on pressure ulcers, their prevention, and management is determined by the severity of this problem. It may increase health care costs due to long stays in medical facilities, diminish patients’ life quality, and contribute to mortality. In the United States, around 1-3 million patients develop this condition each year, more than 2.5 million people in acute care services permanently suffer from it, and 60,000 die every year from bedsores’ complications (Saghaleini et al., 2018). A pressure ulcer is a type of injury that affects the skin and underlying tissue due to constant pressure under the area. This pressure causes tissue ischemia that stops oxygen and nutrients from reaching it and leads to the tissue’s necrosis.
There are multiple factors that traditionally contribute to the development of pressure ulcers. However, the distortion usually occurs when soft tissues are compressed or sheared between the skeleton and support, such as a bed or a chair when a person is constantly lying or sitting (Shi et al., 2018). The population mostly affected by pressure wounds are senior people who are between 60-80 years old and people with physical and mental health conditions that keep them immobile. In addition, other risk factors that impact blood supply and capillary perfusion are nutritional deprivation and type 2 diabetes (Saghaleini et al., 2018). Pressure injuries more frequently occur on trochanteric, sacral, and ischial tissues and less frequently in the malleolar, heel, patellar and pretibial locations.
Thus, the prevention of pressure ulcers in nursing settings through risk assessment is immeasurably important. This project is expected to decrease the cases of pressure ulcers through the implementation of a new assessment tool that will be efficient in disease prevention. For instance, it will help assess if the patient is sitting or lying in bed for long periods of time. In addition, the skin condition should be constantly evaluated – the skin should be kept clean and dry and checked for any damage or redness twice daily. If the risk is not assessed and if there is no continuous skin check, potential pressure injuries may go unseen until it will be late.
Objectives
The main objective of this capstone project is to assess if a structured and systemic pressure ulcer risk assessment tool used in a skilled nursing home will reduce the incidence of pressure ulcer development. Another objective is the evaluation of a new evidence-based checklist and the expediency of its use in a medical setting. The third goal of the project is to examine how the frequency of tools’ use impacts the prevention of bedsores as it is unknown despite the practical application of different pressure ulcer assessment tools in medical facilities (Moore & Patton, 2019). In the project’s nursing home, two skin checks are done – on admission (the Branden scale) and upon discharge – to access the patient’s risk of developing pressure-related wounds. In the present day, there is an increase in pressure ulcer development detected when the discharge assessment is done which leads to longer stays in a hospital for wound treatment (Etafa et al., 2018). Thus, the last objective is to find out what effects the use of a risk assessment tool has on the development of new pressure ulcers.
Literature Review
For such a serious medical condition as pressure ulcer that increases mortality and morbidity rates, the medical response should include the assessment of risk factors, treatment, and continuous management of injuries. In turn, inadequate knowledge, negative attitude, negligence, and a lack of attention lead to detrimental outcomes (Dalvand et al., 2018). On the basis of the nonpayment policy, many hospitals implement quality standards that increase the incorporation of evidence-based practices for time-sensitive and efficient prevention, especially for the geriatric community (Lozano-Montoya et al., 2016). Moreover, the research by Padula et al. (2016) showed that the practice of an evidence-based checklist’s use impacts the prevention and maintenance of pressure ulcers. At the same time, the efficiency of the measure’s application depends on the leadership board, employees in the hospital, level of technology and processing of information, performance, and other cultural-based attributes of a hospital’s internal environment. In general, the literature review demonstrated that adhering to evidence-based procedures led to the improvement of quality health care.
Methods of Searching
A literature review was conducted using both electronic and manual resources. For electronic resources, the search was conducted in databases with the use of keywords. These words included “pressure ulcer,” “pressure ulcer prevention,” and “pressure ulcer assessment tools.” All sources were conducted in the last five years and reflect modern findings. Subsequently, all information was analyzed and structured according to its relevance to the project.
Project Proposal Topic
The topic of the project proposal refers to risk assessment for the efficient prevention of pressure ulcers. Its expediency is determined by the fact that the number of bedsores cases in medical facilities is continuously growing (Boyko et al., 2018). Despite the fact that pressure ulcer prevention depends on multiple factors, health care providers require efficient assessment tools to minimize negative outcomes (Lozano-Montoya et al., 2016). Thus, the project aims to evaluate the effectiveness of risk assessment in practice. Moreover, its strategies, methods, and findings may be used for risk evaluation and prevention improvement in other medical facilities.
Review of the Literature
The majority of experts identify pressure ulcers, their reasons, risk factors, and vulnerable population groups. Also known as pressure sores, bedsores, or pressure wounds, pressure ulcers are injuries to the skin and the tissues below is caused by prolonged pressure (Saghaleini et al., 2018). These injuries are typical for people with limited mobility who spend most of their time in wheelchairs or confined to bed. In addition, as bedsores are associated with multiple comorbidities, a lack of activity, and age, the geriatric population may be regarded as the most vulnerable. In addition, the occurrence of pressure wounds is directly connected with the quality of nutrition, especially in the case of immobility (Saghaleini et al., 2018).
According to Bauer et al. (2016), pressure ulcers generally lead to an increase in mortality and morbidity. Moreover, the treatment of pressure injuries is a financial burden both for patients and the healthcare system as it is costly due to the associated healthcare services and long hospital stays. Therefore, health care providers pay particular attention to various measures that may help to prevent and manage pressure ulcers in a time-sensitive manner. In general, the health care services provided to patients with pressure injuries include assessing risk factors, treatment, and continue management of the injuries. In their works, scientists evaluate various strategies and approaches to the minimization of bedsores.
The study by Simon et al. (2016) indicates that separating patients suffering from pressure ulcers into a single room creates a significant difference in managing the disease. According to researchers, this act is highly beneficial as the usage of single-room accommodation had several advantages, including faster rates of patient recovery. In addition, the rates of infections associated with pressure sores are substantially reduced, the outcome of the patients is improved, and little to no medication errors occur. The advantages were facilitated by the fact that no personal contact is rendered between two patients. It also showed that the spread of disease by contact of either person or surface was reduced.
There are other strategies that were proposed and implemented into the health care system in order to prevent pressure wounds. Thus, multiple types of research indicate that the implementation of an evidence-based checklist positively impacts the prevention and management of pressure ulcers within medical facilities (Padula et al., 2016). However, the process of implementation imposes the challenge of whether the rates of disease infection are reduced due to improved health care services or the changes in the code of conduct. This challenge is yet to be evaluated, although the main point is that the spread of pressure injuries is reduced and treatment enhanced. Thus, the project aims to evaluate the efficiency of measures dedicated to the improvement of services in the facility where health care providers understand their responsibility in pressure ulcer management and prevention.
Findings
The literature review has shown that the prevention and adequate management of pressure ulcers are extremely important. This condition has a highly negative impact on people’s life quality and may lead to multiple comorbidities and even death due to infection (Boyko et al., 2018). The geriatric population and people with limited mobility are regarded as the most vulnerable, and the implementation of evidence-based practices in relation to bedsores is highly important for them. Separating patients with pressure wounds, skin checks, appropriate nutrition and surfaces, and management of comorbidities are among preventative strategies (Simon et al., 2016). Through the implementation of evidence-based guidelines such as a checklist, health care has been improved for those who are at risk for pressure injuries.
From the research conducted on the basis of literature review, it is evident that an evidence-based checklist has brought a significant change to the provision of health care services and their quality. The evidence-based checklist has provided several guidelines that, when implemented and adhered to, have led to the improvement of quality in hospitals, especially in the section on treatment and prevention of pressure ulcers. The senior population is being helped in preventing pressure injuries by the implementation of evidence-based guidelines. Thus, for the project, it is essential to apply evidence to practice. In addition, the project’s innovations may contribute to existing knowledge and improve general practice as well.
Strategies
In order to address the project’s objectives, the existing assessment tools in a skilled nursing home will be evaluated in relation to their efficiency in pressure ulcer prevention. Later, a risk assessment tool much like the Braden scale will be created to assess the risk of every resident admitted. Then, the facility’s health care team will receive training on how to use this assessment tool. After the training is completed the risk assessment tool will be implemented as a weekly check on every patient for the six weeks that they stay at the facility. Thus, health care providers will receive the ability to access patients skin and related risks throughout their stay.
Budget
The project’s required budget is $200, and almost all expenditures are related to the training of the facility’s health care team to assess risks on the basis of a developed checklist. Thus, training is divided into several parts – pre-test on pressure ulcer prevention, teaching on how to use an evidence-based checklist for the prevention of pressure ulcers, and post-test on pressure ulcer prevention. In general, each part requires approximately $25 mostly for printouts. The proposed sources are OfficeMax or any other supply store.
Subsequently, three days will be dedicated to in-service training – staff will be split into three groups. First, group one will stay on the floor while group two will receive the in-service. The next day group two will receive training while group one will stay on the floor. On the third day, and the third group will be designated for those who missed the in-service for any reason. For in-service training that will take 45 min at the end of shift time, payment for health care providers will be provided from the department’s budget according to individualized paid rates. For the creation of the checklist, $25 is required, and the rest of the money will be spent according to unpredicted circumstances.
Evaluation
The evaluation of the project will be organized on the basis of the outcomes of a new assessment tool’s implementation. In other words, results will depend on how the rates of pressure ulcer development will change. The decrease in the condition’s cases will indicate the efficiency of new practices. However, the evaluation will be accurate only if the health care team follows guidelines provided by the project’s training. The subsequent evaluation may be controlled by the head of the nursing department.
Conclusion
Pressure ulcers may be regarded as a burden for a global health care system that affects people all over the world. In the United States, millions of people develop pressure ulcer every year and continuously suffer from this condition (Saghaleini et al., 2018). Pressure ulcer affects the skin and underlying tissue due to constant pressure. As a result, oxygen and nutrients stop reaching tissues, and their necrosis occurs. Thus, pressure wounds may lead to multiple comorbidities and death from infections.
The most vulnerable population groups are people with limited mobility and senior people (Park & Lee, 2016). They are progressive and are mostly found in bedridden, chair-bound, or immobile people. They also tend to develop in people who have been hospitalized for a long time (Sayilan, 2019). This increases the patient’s cost of hospitalization and decreases their quality of life. Thus, as the rates of this condition are continuously growing, it is essential to address it before it becomes the worst problem. The implementation of an evidence-based risk assessment will help prevent pressure injuries from developing and give patients who are at high risk the ability to prevent these injuries from occurring. The project will evaluate how the implementation of assessment tools helps health care providers prevent and treat pressure ulcers.
References
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2). 57-67.
Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: A systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clinical, Cosmetic and Investigational Dermatology, 11, 613-620.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(14).
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Moore, Z. E. H., & Patton, D. (2019). Pressure injury prevention: Early & targeted intervention kit. Arjo.
Padula, W. V., Gibbons, R. D., Valuck, R. J., Makic, M. B. F., Mishra, M. K., Pronovost, P. J., & Meltzer, D. O. (2016). Are evidence-based practices associated with effective prevention of hospital-acquired pressure ulcers in US academic medical centers? Medical Care, 54(5), 512.
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Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., & Ostadi, Z. (2018). Pressure ulcer and nutrition. Indian Journal of Critical Care Medicine, 22(4), 283-289.
Sayilan, A. A. (2019). Evidence-based practices for the prevention of pressure ulcers. Journal of Health Services and Education, 3(1), 7-10.
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLOS ONE, 13(2).
Simon, M., Maben, J., Murrells, T., & Griffiths, P. (2016). Is single-room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. Journal of Health Services Research & Policy, 21(3), 147-155.