Project Purpose Statement, Background & Significance and PICOt Formatted Clinical Project Question 2

11/25/20

Improving the Healing of Pressure Ulcers in Older Patients

The subject for research:

Effectiveness of negative pressure wound therapy in improving the healing of the pressure ulcer in older patients aged above 60.

PICOT Question;

For elderly patients above 60 years with pressure ulcers (P), will negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the healing of the pressure ulcer (O) during their two-week stay at the hospital (T)?

Project Purpose Statement: Improving the Healing of Pressure Ulcers in Older Patients

In general, older adults are prone to having pressure wounds because they are not as active as younger people. Many people over 60 years spend their days sitting or resting in bed. (this is opinion so remove as it is not true of the majority. Keep this focused on hospitalized or long-term care older patients)This causes pressure ulcers, which form on their skin due to applied pressure on the skin.

Older patients, age 65 and older, hospitalized or in long term care facilities, are at risk for the development of pressure ulcers secondary to Ssitting in similar one positions and lying in the same positions for an extended period of time is a major cause of pressure ulcers in older people (Bauer, Rock, Nazzal, Jones, & Qu, 2016). When in hospital, patients are mostly lying in bed, not moving around, and therefore many can develop pressure wounds. Causes of such ulcers are …(cite the causes such as friction, pressure, etc and cite references).

It is the nurse’s responsibility to assess the skin for any evidence of pressure ulcers and to provide care that can ensure such ulcers do not occur. Taking care of them is very important, and the method used to care for the wounds is a great determinant of how long the wound takes to heal. Negative wound pressure therapy and standard moist wound therapy are among the methods of taking care of a wound. This paper will highlight the benefits of using negative wound pressure therapy over standard moist wound pressure therapy to heal pressure wounds in patients aged above 60.

Background & Significance

Older people suffering from pressure ulcers may be unable to take care of them the ulcer themselves. Lack of care has been shown to lead to …(discuss the problems of lack of care and cite references) , and they, therefore, take longer to heal. This exposes the wounds to infections, which can be harmful to the body and sometimes deadly. They can cause other complications like blood poisoning if they are left unattended. Many of the people over 60 years may not be able to take care of their pressure wounds, causing other problems for them (opinion). Therefore, they may require the help of a caregiver.

Pressure wounds or ulcers mostly occur at the joints, why?. If not well taken care of or go a long time before closure and healing, they can cause infections in joints and lead to osteomyelitis, hospitalization, necrosis, and other severe complications amputation or harmful bone infections (Bauer, et al., 2016). They can cause cancer, and sepsis, a condition characterized by inflammation of internal organs due to the release of chemicals to fight infections in the body (Bauer, et al., 2016). (this comment needs to be better explained – how does it cause cancer? So develop this paragraph more about the consequences of lack of care) This is very likely for a person who tends to getting pressure wounds and not treating them fast and properly.

People who are over 60 years of age, as earlier mentioned, are at risk of having pressure wounds due to their immobile state. Therefore, they are likely to have multiple pressure wounds or recurring ones, depending on their activities and postures. Because of the risk for pressure ulcers in the older population who are immobile because of hospitalization of in long term care facilities, it is important that wound care be appropriate so as to prevent the aforementioned complications. This project aims to find a faster solution for pressure wound treatment to avoid the risk of infection, cancer, and sepsis in older patients aged over 60 years. Over 60,000 people die every year from pressure wound infections (Bauer, et al., 2016).

The standard moist wound therapy is a method of care for pressure ulcers whereby the wound is washed using water and soap to remove any dirt; for moisture retention, petroleum jelly may be used. Then the wound is left to heal over a period of time (Atkinson, & Cullum, 2018). Negative pressure wound therapy is the process of applying a vacuum on the wound through the dressing, which is completely sealed. A vacuum pump is attached to the dressing, which then works on healing the wound by sucking out any fluid in the wound area, thus prompting better blood flow for faster healing (Atkinson, & Cullum, 2018). It stimulates granulation tissue formation, hence speeding up the entire healing process. This helps the wound close much faster, reducing the risk of infection and reducing any swelling chance. If the patient is discharged, this vacuum-assisted closure VAC machine can be switched to a smaller one that the patient can use at their home's comfort (reference).

Negative pressure wound therapy helps the patient since they spend less time taking care of the pressure wound and, at the same time, without putting their lives in danger. This vacuum-assisted closure VAC machine can be switched to a smaller one that the patient can use at their home's comfort.

Standard moist wound therapy works well for wounds that are not too deep (reference). Treating deep wounds using the standard moist wound method can harm a patient since it may take too long to close and heal, exposing the patient to potential health consequences. the wound to infections and the patient to complications like bone and blood infections and later sepsis. Since pressure wounds occur mostly at joints and from tissue tears, they are sometimes deep and may take time to heal, especially if they keep recurring because the patient may keeps the same posture that contributes to the pressure wounds, especially if they are in a long term care facility (Atkinson, & Cullum, 2018).

Treating using standard moist wound therapy may expose the patient to the risk of infection and prolonged healing. Negative pressure helps reduce these risks by providing an alternative in which the wound remains covered and dressed. This ensures that the wound remains under the dressing and is not exposed to any infections. This will help other complications like sepsis. Negative pressure wound therapy also promotes faster healing for deep wounds than moist wound therapy since the wound closes up faster from within with the help of the VAC machine designed to close a wound without risking infection and at a faster rate (Atkinson, & Cullum, 2018). (I deleted this info since it is repetitive)

This project aims at finding a way to reduce the time required for an older person to heal from pressure wounds, which are a common occurrence in a shorter period of time, and by so doing, reducing the risk of infection and the complications that come with it like sepsis, and bone infections leading to the need for amputations. The PICOT project findings could show that negative pressure wound therapy promotes faster healing of the older patients compared to standard moist wound therapy. In this case, a big change can be anticipated in the number of reported cases of complications resulting from wound infections, which reduces the number of deadly complications like sepsis in older patients due to pressure wound infections. This will help in the reduction of pressure wound mortality from 60,000 per year (Bauer, Rock, Nazzal, Jones, & Qu, 2016).

PICOT Formatted Project Question

The PICOT study population would be adults aged over 60 years who are already in the hospital and suffering from pressure wounds. The intervention would consist of treating the pressure wounds using negative pressure wound therapy for some patients and standard moist wound therapy for others.

The group consists of 50 patients who are over 60, with deep pressure wounds; 25 using the negative pressure wound therapy for the treatment of their pressure ulcers while the other 25 use standard moist wound therapy to treat their wounds, to compare which of the two methods promotes faster healing of the pressure ulcers. The expected outcomes would be the healing of pressure wounds of the people using negative pressure wound therapy and delayed healing for the patients practicing the standard moist wound therapy to treat their pressure ulcers by the end of 2 two weeks.

Conclusion

Approximately 60,000 people die from complications resulting from pressure wounds. Infections on a pressure wound can increase the risk of mortality by 55% (Bauer, et al., 2016). Negative pressure wound therapy as a way of treating wounds reduces infection risk altogether compared to the standard moist wound therapy (Papp, 2019). Infections can cause death and other complications for the patient. Using negative pressure wound reduction reduces the time in which the wound heals, thus reducing the patient's time struggles with a wound. The longer a wound stay exposed, the higher the risk for infection, putting the patient's life in danger. This project will illuminate the difference in the time required to heal while using both the negative pressure wound therapy and standard moist wound therapy on older patients in the hospital, and consequently endorsing the method that allows faster healing of the pressure wound as a safer way of dealing with pressure wounds as it reduces infection risks.

Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56(3), 186.

Bauer, K., Rock, K., Nazzal, M., Jones, O., & Qu, W. (2016). Pressure Ulcers in the United States' Inpatient inpatient Population population from 2008 to 2012: Results of a Retrospective retrospective Nationwide nationwide Studystudy. Ostomy/wound Wound managementManagement, 62(11), 30-38.

Black, J. M., & Kalowes, P. (2016). Medical device-related pressure ulcers. Chronic Wound Care Management and Research, 3, 91-9.

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in wound Wound careCare, 7(2), 57-67.

LIMA, R. V. K. S., COLTRO, P. S., & FARINA JÚNIOR, J. A. (2017). Negative pressure therapy for the treatment of complex wounds. Revista do Colégio Brasileiro de Cirurgiões, 44(1), 81-93.

Papp, A. A. (2019). Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction. International wound Wound journalJournal, 16(2), 394-400.