QI Report of Project: Written

Hospitalized Acquired Pressure Ulcer

Name

Institution

Background of the Problem

Referring to Omery et al (2014) a pressure injury is a wound to the underlying tissue often caused by pressure or moisture. Typically these ulcers are triggered by patient’s immobility. It’s important to note that some patient whole depend on care providers which means they can’t change position in bed without assistance. To have deeper insight it’s important to explore the depth of pressure ulcers. In the study Rondinelli et al (2018) explains that pressure ulcers are associated with other factors like age, presence of certain illness like diabetes or hematological measures to mention a few. More importantly, the problem is associated with prolonged stays in hospitals or infection. From a broader perspective, HAPI rates have decreased substantially especially in America. Conferring with Rondinelli et al (2018) reduction in pressure ulcers can be attributed to concerted efforts of healthcare workers.

This is particularly the case when health care workers provide supports and use of assessment not to mention preventative efforts to combat the problem. It’s almost impossible to understand the depth and breadth of the problem without looking at the numbers. According to a report by Clinical Excellence Commission. (2015) about 2.5 individuals are affected by HAPI. Shockingly more than 60,000 patients die in the U.S. as a result of pressure ulcers. That said this paper will explicitly look into the problem and recommend necessary actions. To facilitate this, the PICO question will be, for hospitalized patients with restricted movement, does the use of I.S.K.I.N bundles reduce the future rate of HAPU compared to the current hospital regulations?

Evidence

Our HAPU rates on Unit A have risen significantly over the past few months. In response, the Unit has a WSCN who has training in wounds. Although the nurse doesn’t have a Master’ degree or specialty certification, the nurse is well acquitted with work. The wound and skincare are scheduled to work from Monday through, 8a-5p. Moreover, patients are only evaluated once per shift, which should be assessed during every shift. Unfortunately, nurses on the floor don’t have skills and proper training leave alone education on assessment and treatment of pressure ulcers. As indicated in the case study the facility has no clear path in would care within the facility. This could hinder efficiency in operations. As emphasized by Rondinelli et al (2018) communication is very critical in a healthcare organization. Communication is what connects patients with care providers. This is something which is missing in the Unit. There is no proper communication between nurses for patients who need would care in case there is any technical issue and the patient doesn’t appear on the list.

PICO Question:  For hospitalized patients with restricted movement, does the use of I.S.K.I.N bundles reduce the future rate of HAPU compared to the current hospital regulations?

Root Cause Analysis

1 - There is only one WSCN for entire facility to provide wound care.

  2- The WSCN only provides care on Monday-Friday from 8am-7pm.

 3-The WSCN has no speciality certification or master’s degree in wound care.

   4- Patients are only assessed once per shift, which should be assessed during every shift.

   5-  Nurses on the floor don’t have skills and proper training or education on assessment and treatment of pressure ulcers.

  6- There is no clear path or protocol in wound care within the facility.

    7- Lack of effective communication between nurses for patients who need wound care in case for any technical issue it doesn’t appear in generated computer list.

 

No evening and WSCN has no No EBP for HAPU

Weekend coverage education or degree

Heavy workload Primary care nurse

Lack of wound care skill

Not enough One assessment

Communication between staff per day, not per shift Nurses are not

WSCN does all wound care accountable in

not accurate patient lis

List the steps or key pieces that your clinical practice guideline or systematic review suggest that should be in place to improve outcomes (these become your indicators):

	Process or Indicator	What data will be collected
1.	Assessment of all patients, whole body skin every shift	Any skin issues, redness, or skin break down
2.	Reposition patients with limited mobile activity every 2 hours	Helps monitor patients
3.	Mandatory staffs education about pressure ulcer	Knowledge of staffs regarding HAPU
4.	Continuing of education 3-5 times a year to up-date all staffs	Staffs Knowledge
5.	Close monitoring of patients who are at great risk of developing pressure ulcer like immobile patients	Condition of skin
6.	Use of barrier cream and emollient to protect the skin	Area of redness
7.	Collaborate all health care team and effective communication between staff	Newest patients situation
8.	Use of air mattress	Skin condition
9.
10.

Plan for Improvement

Indicator: _____Decrease the rate of developing Pressure ulcer among patients

_______________________________________________________________________________________________

This is key to improving outcomes because: By decrease the rate of PU, it proves that right intervention has been done.

Operational definition: perform EBP to decrease rate of HAPU

Numerator: All patients with PU who treated based on EBP

Denominator: All patients with PU or at risk to develop PU

Data collection method

Who	All health care team: doctor, nurse, PCT, PT,OT, dietitian
What	-Assess the patient with HAPU or at rick for HAPU -Do ISKIN bundle -Effective communication between staff - Proper patient’s education regarding pressure ulcer prior discharge
Where	In patients room, during shower time to closely observe all skin issues
Why	Prevent getting pressure ulcer and improve those who are already developed PU
When	-At the time of admission until being discharged. -skin care every shift or as needed
How	-Assessment every shift -Provide poster with indication of how PU develops and how take care of patients with skin issues

Goal for this indicator: No more pressure ulcer among patients during hospitalization or 100% PU free

Benchmark: 100% compliance

Factors Contributing to HAPU Rates Increase

:

Best Available Evidence Action Plan

-Frequent position changes (at least every two hours)

-Avoid friction and shear when repositioning.

-When repositioning, use proper technique.

-Implement pressure relieving mattresses or surfaces.

-Avoid turning patient on an area that is already reddened related to pressure.

-For pressure ulcer prevention, do not rub or massage area.

-Emollients can be used to hydrate the skin.

-Barrier creams to protect skin from increased moisture.

-Frequent skin assessments per protocol.

-Nutritional risk assessments with interventions.

-Additional protein supplements in additional to their regular diet  Alderden et al (2011) list the following best practices in preventing HAPU’s.

References

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. Nursing research, 67(1), 16.

Omery, A., Mussell, D., Rondinelli, J., Ecker, M., Baker, J., Shanks, H., & Kleinhelter, P. (2014). Under pressure: Nursing interventions help prevent HAPUs. Nursing management, 45(4), 36-43.

Clinical Excellence Commission. (2015). NSW Pressure Injury Point Prevalence Survey Report 2015. Clinical Excellence Commission: Sydney.

Environment

facility

Education

Fish bone diagram

Team work

Task/duty

Communication

Team Work

Communication

Facility

Poor Communication between staff

Nurses are not accountable

No EBP for HAPU

Increase in HAPU Rates

No evening and weekend coverage

Patients list errors

Shortage of staff

One assessment

Lack of wound care skill

WSNC has no education

Heavy workload

Education

Environment

Duty