Introduction
Development of Pressure ulcer (PU) has been a serious and the topic of concern in health care setting today. PU is defined as any breakdown of skin lesion that is caused by constant pressure, cutting blood flow and oxygen supply in the that area.
Problem
Do the implementation of pressure relieving mattress and protective heel protector in elderly patient with limited mobility reduces the risk of developing pressure ulcer during hospitalization? Several evidences -based studies have suggested the use of pressure relieving mattress along with heel protective devices have reduced the prevalence of hospital acquired PU (Beal, M. E., & Smith, K. (2016). Early skin assessment and identifying the risk factors in older adults decrease the length of hospital stay as well as speed up recovery.
Setting
The clinical setting for this project will be an acute care facility where surgical orthopedic patients, such as hip fracture is admitted in a higher ratio. The majority of the population admitted for surgical procedures are older adults between age 60-100 years old. The risk factor for PU on these age groups are age, fragile skin, bed bound, urinary or bowel incontinent, mobility issues, disease condition and mental disability.
Description of problem
Pressure ulcer compromises the quality of life in the older patient specially after hospitalization or any other surgical procedure. Not all the hospital beds meet the patient`s need and shoots their skin, therefore, health care providers should be educated on the identifying the patient that are at risk for developing pressure ulcer and early risk assessment is vital. When body tissue is compromised pressure ulcer can be developed any time. The use of appropriate bed after identifying the problem for skin breakdown and early prevention is the essential component in maintaining the health status of the patient.
Impact of the problem
More than 2.5 million people in the United States (US) develop pressure ulcers every year (WALTON-GEER, P. S. (2009). Even though evidence -based guidelines is present for PU prevention, there has always been a problem of pressure ulcer in healthcare. PU prevention is lacking in hospitalized patient for various reasons. “The cost of caring for these preventable pressure ulcers may now be as high as 60,000 dollars per patient (McInnes E et al., 2011). If appropriate action is not taken on time the quality of the patient`s life will be hampered as well as the cost for a hospital will be higher after pressure development during hospital stay.
Significance of the problem
Lack of nursing knowledge, workload and staffing issues, inadequate supplies can be some of the contributing factors associated with early identification and prevention of PU. All health care team providing direct patient care should be aware and educated on skin assessment, its prevention and management. Reporting skin breakdown or abnormal on time is crucial for PU prevention. Research Studies have also revealed that after implementing the preventive guidelines, the prevalence of PU has decreased Beal, M. E., & Smith, K. (2016). Therefore, to prevent PU collaborative team work, practicing Evidence -based practices (EBP), use of assessment tool, staff training can save hospital cost and quality of patient`s life.
Proposed solution
To decrease the incidence pressure ulcer in hospitalized older patient, health care workers must follow the EBP, be aware of the consequences of not following the guidelines of skin assessment. PU usually associated with lack of staff knowledge, workload, staffing issues and inadequate supplies associated in early identification and prevention of PU. Skills lab, in- services education to all staff on a pressure reducing bed types and its use, education and early identification of risk population will be done. A PUP team will be created who rounds on each patient twice a week in the unit and also audit on skin assessments documentation. A poster will be created to remind staff on skin assessment and its prevention into care board, break room and sink. A monthly audit will also be performed for the effectiveness, as well as rapid feedback from staff members will be accepted for improvement. In order to prevent PU, direct care provider will be accountable in maintaining repositioning patient every 2 hours, use pressure reducing pillow/mattresses, protective heel protector, maintain adequate fluid and nutrition, increase activity, daily exercise, keep dry and clean. The implementation of this proposal will be will be started immediately following the approval.
References:
Beal, M. E., & Smith, K. (2016). Inpatient Pressure Ulcer Prevalence in an Acute Care Hospital Using Evidence-Based Practice. Worldviews On Evidence-Based Nursing, 13(2), 112-117. doi:10.1111/wvn.12145
Beeckman, D., Schoonhoven, L., Kottner, J., Moore, Z., Meaume, S., & Fletcher, J. (2017). Meeting
report: pressure ulcer prevention and management: do we all agree? Wounds International, 8(3), 40-45.
FEECE, R. (2017). Educating and campaigning for pressure ulcer prevention. Wounds UK, 13(3), 58-61.
Pagnamenta, F. (2017). The provision of therapy mattresses for pressure ulcer prevention. British Journal Of Nursing, 26(6), S28-S33.
McInnes E, Jammali-Blasi A, Bell-Syer SEM, Dumville JC, Cullum NA. Support services for pressure ulcer prevention. Cochrane Database Syst Rev. 2011; 4. (Level 1)
Souza Galvão, N., Barbosa Serique, M. A., de Gouveia Santos, V. C., & Nogueira, P. C. (2017). Knowledge of the nursing team on pressure ulcer prevention. Revista Brasileira De Enfermagem, 70(2), 294-300. doi:10.1590/0034-7167-2016-0063
STANG, D., & BALLARD-WILSON, A. (2015). The role of innovation in heel pressure ulcer prevention. Wounds UK, 11(4), 106-110.
Takashima, A., Misaki, A., Takasugi, S., & Yamamoto, M. (2014). Characteristic analysis of an air cell for active air mattress of prevention for pressure ulcer. Advanced Robotics, 28(7), 497-504. doi:10.1080/01691864.2013.876937
WALTON-GEER, P. S. (2009). Prevention of Pressure Ulcers in the Surgical Patient. AORN Journal, 89(3), 538.
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