CAP

Pressure Ulcers in the Hospital

Nissane Diao

Oak Point University

Professional Role Transition

Josette Cabatingan-Oribello

04/03/2022

Pressure Ulcers Prevention Protocol in the Hospital

Literature Review of the Solution

      Various articles have endorsed the effectiveness of pressure injury prevention (PIP) interventions in hospitals.

Mohamed and Weheida (2015) examined the effectiveness of a pressure ulcer (PU) control education program on the improvement of nurses’ knowledge and patient safety among immobilized patients. The intervention was implemented over two weeks with 8 education sessions, 4 hours per week. The education program was conducted in small groups of 3 to 5 nurses in each session. In the session, nurses were educated about pressure ulcers, including risk factors, symptoms, stages, sites, treatment, pressure care, and interventions to reduce pressure ulcers. The nurses received printed materials after their education. The results of the study showed improvement in nurses’ knowledge and a reduction in the incidences of pressure ulcers in the facility. The relevance of the article is that it provides evidence on the effectiveness of pressure ulcer prevention education in the reduction of pressure ulcers.

Zhang et al. (2021) implemented a pressure injury care bundle in the intensive care units (ICU) to prevent pressure ulcer development among ICU patients. The intervention involved training nurses on the care bundle, which involved identifying the patients at risk using the Braden scale, assessment of skin integrity, repositioning patients every 2 hours, pressure redistribution device, skincare, and nutritional assessments. After 24 weeks, the authors reported a significant decrease in the incidences of PUs from 13.86% to 10.41%, where the compliance rate was 60.15%, which had increased from 55.15% (Zhang et al., 2021). The authors concluded that the PU incidence rate could be reduced further with nurse training and increased compliance with the care bundle.

Implementation

The solution that will be implemented to address the problem of PUs in the hospital will be more nurses’ education on PU prevention. Yes, the hospital has many policies implemented for the prevention of PU but sometimes the nurses are forgetting to reposition the patients due to their work overload.

Nurses working in cardiac and telemetry will be trained for two weeks regarding the prevention of PUs. The education program will include group discussions and demonstrations led by physicians. The training contents will enclose risk assessment, repositioning, skincare, and nutritional assessment.

The program will be implemented for three months. Nurses will be instructed to assess the patients’ pressure risk within 24 hours after admission using the Braden scale, repositioning at least every 2 hours, and using paddings to reduce pressure on bony skin surfaces. The nurses should ensure the patients’ skin remains clean and dry and apply skin protectants if a patient has incontinence. Also, develop an individualized nutritional plan based on the patients’ nutritional status.

The physicians will use a care bundle checklist to ensure that all the dimensions of the care bundle are implemented. They will also determine the nurses’ compliance rate with the program. Nurses will be issued with a care bundle poster that will be placed at the nurses’ stations and patient rooms to enhance compliance. The physicians will collect data on the incidences of PUs after the implementation of the program.

The nurse manager and program committee will evaluate the effectiveness of the program after 3 months. They will examine the data on the cases of PUs reported after the program was implemented and compare it with the prevalence of PUs for three months before the program was initiated. They will then provide a report on their findings and provide feedback to the nurses on the majority of PUs as well as nurses’ compliance with the care bundle.

The PU care bundle is desired to lower PUs in the hospital by improving nurses’ knowledge of PU prevention and their compliance with the PIP interventions. The program is envisioned to enhance the safety of patients in the unit by reducing the number of patients that develop PUs and complications related to PUs. The nurses will be able to proactively identify the patients at risk, take the necessary measures to meet their care, and improve their treatment outcomes.

The hospital should implement a specialty bed to prevent pressure ulcers. There are many types of beds available in the market. The hospital should use one bed at a time to see the effectiveness of the bed on patients for 12 weeks. The hospital should begin by using silk-like mattress covers instead of cotton covers, called skincair. This type of bed will decrease the nurses’ support for repositioning the patients every 2 hours. It is made of breathable silk-like with 3 layers of ventilating mattress sheet. It helps reduce shear forces and it can absorb excess fluid which may result in better self-repositioning and enhanced pressure ulcer prevention resulting in smaller deterioration of the skin. Usually, repositioning a patient demands 2 nurses; however, with this new bed, one nurse or a PCT can do it.

If the patient pressure ulcer is only found on the heels, the hospital should use another type of mattress called the Apex Pro-care mattress. It has a heel area where one or more of the bottom five cells can be deflated under the patient’s heel to make a gap, which will allow the heel to “float” so that there is no pressure in connection with the heel area. The mattress would lower the expense of nursing care as repositioning times can be optimized according to need.

Turning team should be implemented if the hospital can’t afford new beds to prevent pressure ulcer. Nurses are sometimes forgetting or not having help turning the patients every 2 hours. Usually, the CNAs are often tied up with many duties such as patients care, stocking linens, cleaning patients, or too many patients. A turning team will be great to the unit. They will be able to do rounds on all the patients that are assigned to them. The turning team will have a checklist to make sure that each patient is repositioning every 2 hours using the appropriate techniques and materials. The nursing team will not always require an increase in staffing but if needed, the hospital should add more staff.

References

Tayyib, N., Coyer, F., & Lewis, P. A. (2015). A two‐arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients. Journal of Nursing Scholarship, 47(3), 237-247. https://doi.org/10.1111/jnu.12136 .

Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579

van Leen, M. W. F., van Ratingen, W. I. J., & Schols, J. M. G. A. (2022). Effects of a breathable silk-like, 3-layer ventilating mattress sheet on selfrepositioning, repositioning support and pressure ulcer incidence; a pragmatic observational study. Wounds International, 13(1), 38–45.

Shingfield, L., Carr, H., & Thomson, J. (2017). Apex Pro-care mattress: How can this advanced mattress assist in prevention of pressure injuries? British Journal of Community Nursing, 22, S20–S27. https://doi.org/10.12968/bjcn.2017.22.Sup9.S20 .