Part 3: Literature Review and Critical Appraisal

5

Introduction and Overview of the Problem

Introduction and Overview of the Problem

The project aims at implementing evidence-based practice repositioning techniques to prevent hospital-acquired pressure ulcers (HAPU) in inpatient acute care units over hospital stay. Over recent years, HAPUs’ prevalence has greatly increased, affecting patients' health outcomes and the cost of care (Gaspar et al., 2019). Developing effective interventions to address this problem is very important to improve the quality of care and avoid the costs associated with the problem.

Pressure ulcers involve injuries of the skin and the underlying tissues that usually happen over bony prominences because of pressure, friction, or both. Risk factors for pressure ulcers include generalized weakness, advanced age, spinal cord injury, and inadequate blood circulation in the skin. Pressure ulcers range from stage one, injuries without open wounds, to stage four, which involves advanced wounds with a breakdown of skin layers and muscles, tendons, and bone. At about 60,000 people are reported to lose their lives because of complications directly related to developing pressure ulcers (Smith et al., 2018).

HAPUs’ incidence is high and continues to become a big problem in health facilities. The problem is associated with poor patient outcomes and has some financial costs. About 2.5 million cases of pressure ulcers are reported every year. HAPUs can happen in all settings of healthcare, and their prevalence varies widely, with intensive care and long-term acute care demonstrating the highest risk of between 8% and 20% (Deng et al., 2017). HAPUs are among the the most concerning healthcare problems that must be addressed promptly to improve the population's health outcomes.

HAPUs complications lead to spending financial resources on circumstances that can generally be preventable and that it greatly affect patients. On average, the care cost per case of HAPU development is estimated to be about $43,412. Treating hospital-acquired pressure ulcers is estimated to cost the US care system between $9 billion and $11 billion (Deng et al., 2017). This cost is believed to be 250% more than the cost of preventing the problem. Additionally, HAPUs significantly affect patient outcomes through increased length of hospital stay, morbidity, mortality, and hospital readmission after discharge (Mervis & Phillips, 2019). Preventing HAPU has become a serious care concern, and its prevention is now a priority in our country.

Pressure ulcers are due to tissue hypoxia, resulting from the pressure that is exerted on the tissue that prevents the smooth flow of blood and oxygenation. Prevention of HAPU requires significant nurse's effort and time (Smith et al., 2018). The traditional way of preventing HAPU has been turning patients every two hours, which requires nursing resources. There is limited evidence on the efficiency of this prevention approach, which started in the nursing era of Florence Nightingale. Continuing to offer care that is considered ineffective and unnecessary is a misuse of the now-valuable nursing resources. The approach involves patient movements that increase the risk of injuries, including musculoskeletal injuries. Appropriate patient positioning in regards to techniques and timing is vital to decrease HAPU incidence and injuries but it is more effective if it is combined with other strategies to prevent HAPUs.

My project's intervention utilizes a bundle of evidence-based strategies to prevent HAPUs. The strategies include therapeutic positioning, event-based positioning, repositioning sheets that reduce friction, and standard pressure-relieving surfaces (Iveson et al., 2020). These strategies are effective for preventing and reducing costly hospital-acquired pressure ulcers. The project's intervention suggests that repositioning and safe turning strategies can involve triggers instead of repositioning based on the patient's clock and that the interval can be extended safely to be more than two hours when using surfaces for the relief of pressure.

The project intervention aims to incorporate prevention strategies for HAPU and focuses on decreasing the main risk factors for the problem: time and pressure. The event-based repositioning intervention will increase nursing efficacy in dealing with patients. The strategy can involve existing nursing activities like nourishment, assessments, rounds, and hand-offs. The intervention seeks to guarantee the longest time intervals between repositioning (about 3 hours) and utilizing pressure-relieving services. The project's implementation will help reduce the prevalence and impact of HAPUs.

HAPU’s prevalence is significant in the United States. HAPUs significantly affect patient outcomes by the prolonging length of stay, morbidity, mortality, and hospital readmission after discharge. The PICOT project aims at implementing evidence-based practice repositioning techniques to prevent hospital-acquired pressure ulcers in inpatient acute care units over hospital stay.

References

Deng, X., Yu, T., & Hu, A. (2017). Predicting the risk for hospital-acquired pressure ulcers in critical care patients. Critical care nurse, 37(4), e1-e11. https://aacnjournals.org/ccnonline/article/37/4/e1/20758/Predicting-the-Risk-for-Hospital-Acquired-Pressure

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review. International wound journal, 16(5), 1087-1102. https://onlinelibrary.wiley.com/doi/full/10.1111/iwj.13147

Iveson, A. M., Granat, M. H., Ellis, B. M., & Dall, P. M. (2020). Concurrent measurement of global positioning system and event-based physical activity data: a methodological framework for integration. Journal for the Measurement of Physical Behaviour, 4(1), 9-22. https://journals.humankinetics.com/view/journals/jmpb/4/1/article-p9.xml

Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology emy of Dermatology, 81(4), 881-890. https://www.sciencedirect.com/science/article/abs/pii/S0190962219300921

Smith, S., Snyder, A., McMahon Jr, L. F., Petersen, L., & Meddings, J. (2018). Success in hospital-acquired pressure ulcer prevention: a tale in two data sets. Health Affairs, 37(11), 1787-1796. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0712