Part 3: Literature Review and Critical Appraisal

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Background and Significance

Evidence-Based Repositioning Bundle for HAPUs

The rate of hospital-acquired pressure ulcers (HAPUs) is significantly increasing in many hospitals in the country, especially in the acute care departments leading to poor patient outcomes and increased care costs. Implementing evidence-based practice repositioning techniques will help prevent hospital-acquired pressure ulcers (HAPU) in the hospitals for improved quality of care and patient experience, thus further healthcare costs will be prevented.

Background and Significance

According to Smith et al. (2018), an estimated 60,000 deaths are directly linked to pressure ulcer development complications. The HAPUs' occurrence rate is high and keeps becoming a big concern in numerous hospitals. The problem is resulting in poor patient outcomes, experience, and increased cost of care. Nearly 2.5 million cases of pressure ulcers are reported annually (Deng et al., 2017). HAPUs can happen in all healthcare system settings, and their prevalence differs broadly, with intensive care units (ICUs) and long-term acute care showing the highest risk of developing the HAPU, between 8% and 20%. HAPUs occurrence needs to be addressed promptly to improve the population's health outcomes as it is becoming a concerning problem in the United States healthcare system.

HAPUs complication poses additional financial burden as the victims end up spending financial resources on complications that can be preventable and substantially impact the patients' status. On average, caring for HAPU development is estimated to be $43,412 per patient in a year. The treatment of hospital-acquired pressure ulcers is estimated to cost the healthcare system in the US between $9 billion and $11 billion (Deng et al., 2017). This treatment cost is 250% more than the cost of preventing hospital-acquired pressure ulcers. HAPUs greatly affect patient outcomes through the longer length of hospital stay, high morbidity rate, mortality rate, and increased incidence of readmission after discharge (Mervis & Phillips, 2019). HAPU prevention must be assigned the top priority as it has become a concerning healthcare issue in the US and in other parts of the world.

The PICOT change project involves using a bundle of evidence-based strategies to prevent HAPUs incidence among acute care patients. The approaches include therapeutic positioning, event-based positioning, repositioning sheets that reduce friction, and standard pressure-relieving surfaces (Iveson et al., 2020). These interventions are effective for preventing and reducing the occurrence of costly hospital-acquired pressure ulcers. The PICOT change intervention proposes repositioning and safe turning project's interventions to involve triggers rather than the repositioning based on the patient's clock and that the interval can be safely be increased to be more than two hours when utilizing surfaces to reduce pressure.

The PICOT change project will incorporate various prevention HAPU approaches and concentrate on decreasing the associated main risk factors for HAPU, which include pressure and time. The event-based repositioning strategy aims at improving nursing efficacy when dealing with patients in acute care units. The intervention can involve available nursing activities, including nourishment, assessments, rounds, and hand-offs. The project's intervention aims to ensure the highest time intervals between repositioning of 3 hours and utilizing pressure-relieving services. The PICOT change implementation will assist in reducing the prevalence and effect of HAPUs among patients in the acute care department. Through the intervention, acute care patients will achieve an improved quality of care and better health outcomes and satisfaction.

PICOT Project Question

PICOT question: In the acute patient (P), how does the implementation of evidence-based repositioning bundle strategies (I) compared to normal care (C) impact hospital-acquired pressure ulcers (HAPU) incidence and patient repositioning reliability (O) during acute care hospital stay (T).

Population (P): Acute care inpatients

Intervention (I): Evidence-based repositioning bundle strategies

Comparison (C): Normal care like patient's clock

Expected Outcomes (O): Reduced incidence of hospital-acquired pressure ulcers (HAPU)

Timeframe (T): Within patient's hospital stay

Conclusively, the HAPU's incidence is important in US hospitals and significantly impacts patient outcomes and experience by prolonging the length of stay, increasing the rates of morbidity, mortality, and leading to a high hospital readmission rate after hospital discharge. Prevention of HAPU is a serious subject of care today and should be assigned top priority. The project's objective is to implement evidence-based practice repositioning techniques to prevent HAPUs incidence among patients in inpatient acute departments with a 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