NURSING RESEARCH

Running head: PREVALENCE OF PRESSURE ULCER IN ELDERLY/ AT RISK PATIENTS

PREVALENCE OF PRESSURE ULCER IN ELDERLY/ AT RISK PATIENTS 7

The Prevalence of Pressure Ulcers in Elderly/ At-Risk Patients In Acute Care Hospitals And Skilled Nursing Facilities

United States University

563

February 7, 2021

Part 2

The Prevalence of Pressure Ulcers in Elderly/ At-Risk Patients In Acute Care Hospitals And Skilled Nursing Facilities

Project Purpose Statement

Over the last two decades, there has been a “63 percent increase in pressure ulcers” (Lyder & Ayello, 2018). This is a huge problem because dealing with this condition is quite costly. On average, patients can be charged up to $37, 800 in extreme cases (Russo & Elixhauser, 2016). Also, pressure ulcers result consume a lot of healthcare resources that would have otherwise been redirected elsewhere, considering that these case are preventable. Patients also suffer from this secondary condition, which reduces the quality of their stay in acute hospitals and skilled nursing facilities.

The purpose of this research project is to offer and describe some interventions that may help in the prevalence of hospital acquired pressure injury (HAPI) or ulcer in the elderly adult population from 65years and above and in some patients who are at risk. At risk patients are those who are immobile, malnourished, have fragile skin, incontinent, or with physical or mental limitations, also patients who are on ventilators. In this paper, I will use evidence based practice (EBP) to implement the use of Braden Scale, repositioning, and the use of optifoam dressing on bony areas of these patients. Presently, most hospitals are faced with a clinical problem of acquired pressure ulcers. According to Chen et al (2016), “hospital-acquired pressure ulcers remain one of the persistent and relevant issues that need to be addressed in long-term hospital stay patients. Health care is attempting to implement evidence-based protocols, though patients continue to suffer from this prevalent and preventable injury”. Health care institutions are facing a big challenge for the patients with this acquired condition because hospital bills continue to balloon and at the same time insurance companies stopped paying for this condition.

Background And Significant

Presently, with the rise in hospital stay of the elderly population, there is persistent need in the prevalence of pressure ulcer, owing to this effect, there is need for assessment in both health service and nursing research (Rondinelli et al 2018). This study will go in length to offer a description of HAPI incidence, risk-adjusted hospital variation, and risk factors within the contemporary integrated healthcare system of America among hospital inpatient cohort. The focus was given to acute care hospital and skilled nursing facility with conceptual consideration of the elderly adult population and other at risk patients with problem of immobility, tissue intolerance, decreased activity, change in sensation caused by chronic illnesses. According to Rondinelli et al (2018) “Pressure ulcer (PU) is caused by multiple factors and its pathogenesis shows a multi-factorial process that involved hormonal changes, inflammatory aspects, impaired blood perfusion, degenerative changes, and reduced immune protection”. A persistently rising situation in HAPI cases among the elderly especially those who suffer from frailty and chronic illnesses calls for higher awareness of therapeutic and preventive measures like the use Braden scale, protecting the bony areas with pads and repositioning every 2 hours for pressure injury prevalence ( Engels et al, 2016).

In this regard, this project aims to explore the prevalence of pressure ulcers on elderly patients and other at-risk patients in acute hospitals and skilled nursing facilities. The project will review the challenges that these healthcare institutions face as they try to ease the pain and discomfort caused by pressure ulcers. It will also assess the viability of the current practices used to deal with pressure ulcers and the reasons behind their failures. Thereafter, the project will present several evidence-based practices (EBPs) that can be adopted by healthcare facilities to better deal with the cases of pressure ulcers in patients. Specifically, the project will discuss the use of three EBPs.

First, there is the Braden Scale. This scale is comprised of six subscales and can be applied in the identification of at-risk individuals in the context of pressure ulcers. It focuses on the individual’s nutritional status, friction and shear, mobility, skin moisture, sensory perception, and activity (Chen et al., 2017). Second, there is the repositioning of the patients. This entails moving a patient to assume a different position with the objective of relieving pressure from certain body areas. Finally, there is the utilization of optifoam dressing on bony areas of the patients. This dressing is renowned for its high-fluid handling capacity and waterproof characteristics (Woo, & Kasaboski, 2017). Thus, it can aid in the faster healing of pressure ulcers. There are several advantages that can be gained from the implementation of the project. First, the audience will receive comprehensive information regarding the prevalence of pressure ulcers in elderly patients and other at-risk patients in acute hospitals and skilled nursing facilities. Second, the audience will understand the diverse problems associated with pressure ulcers. Finally, the audience will understand the significance of the three evidence-based practices in effectively dealing with the problem of pressure ulcers.

PICOT Statement

P: Elderly Adults on Long term care and Acute Care floor

I: What could be Implemented

C: Standard Practice utilized Through EBP

O: Decrease in Hospital-Acquired Pressure Ulcers

T: During Hospital Stay

PICOT QUESTION: Does the required education on the prevalence of pressure ulcer and implementation of Braden scale, repositioning and use of optifoam dressing help adult patients on an acute care floor at risk of developing pressure ulcers during hospitalization?

References

Chen, H. L., Cao, Y. J., Zhang, W., Wang, J., & Huai, B. S. (2017). Braden scale (ALB) for assessing pressure ulcer risk in hospital patients: A validity and reliability study. Applied Nursing Research, 33, 169-174.

Engels, D., Austin, M., McNichol, L., Fencl, J., Gupta, S., & Kazi, H. (2016). Pressure ulcers: factors contributing to their development in the OR. AORN Journal, 103(3), 271-281.

Lyder, C. H., & Ayello, E. A. (2018). Pressure ulcers: a patient safety issue. In Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L.N., Liu, v. & Escobar, G.J. (2018). Hospital-Acquired Pressure Injury Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System. Nurs Res., 67(1), 16-25. doi:10.1097/NNR.0000000000000258

Russo, C.A., & Elixhauser, A. (2016). Hospitalizations related to pressure sores. Healthcare Cost and Utilization Project: Agency for Healthcare Research and Quality http://www​.hcup-us.ahrq​.gov/reports/statbriefs/sb3.pdf.

Woo, K., & Kasaboski, J. (2017). A Pilot Retrospective Study to Evaluate Two Multi-Layer Foam Dressings for the Management of Moderately Exudative Pressure Injuries. Surgical Technology International, 31, 61-65.