Change Strategy and Implementation

Running head: CHANGE STRATEGY AND IMPLEMENTATION

Change Strategy and Implementation

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Institution

Biopsychosocial Concepts for Advanced Nursing Practice 1

Management and Prevention of Pressure Ulcers

Date

CHANGE STRATEGY AND IMPLEMENTATION

Change Strategy and Implementation

Research and Quality (AHRQ) guidelines on pressure ulcer management to decrease hospital-

acquired pressure ulcer development, and enhance the quality of life of the patients, as well as

their wellbeing (Soban, Kim, Yuan, & Miltner, 2016).

This assessment focuses on identification, practice of care, assessment, analysis, and

implementation of change strategies in order to improve patient outcomes related to one main

clinical goal, which is to improve the quality of healthcare in the hospital. In regard to the change

plan, this study proposes the implementation of AHRQ guidelines on pressure ulcer management

to decrease hospital-acquired pressure ulcer development, and enhance the quality of life of the

patients, as well as their wellbeing (Agency for Healthcare Research and Quality [AHRQ],

CHANGE STRATEGY AND IMPLEMENTATION

The data was collected in 2019 from Cleveland’s Clinic released the data on its Quality

and Safety Report 2017–2018, which was based on the hospital admission register (CMBD) data

recorded in 2017-2018. Therefore, the data is applicable because it was retrieved from the

Cleveland clinic patient’s database or registry on permission from the hospital management. The

data is also HIPAA compliant. The Clinic management data provided this data on condition that

it will maintain patient confidentiality and anonymity, and it will not be shared with other third

parties, but will be used only for this study.

The data provided was huge and was broken down or summarized in the table 1. The data

reflected the current state and provides a clear and accurate desired stated of the clinical outcome

assessed in this study. The data included risk assessment and patient readmission rates,

magnitude of pressure and shearing, etiology and development of pressure ulcer, and reduction

in the duration of shearing and pressure, as well as prevalence of pressure ulcers. Hence, it was

relevant to the specific a care setting that this study focuses on. Moreover, the data and the

outcomes is relevant and appropriate for the change strategy that this study will propose.

The data was analyzed to show or set the desired outcome state. Specifically, the data

collected was analyzed using SPSS version 25 to determine if the implementation of AHRQ

CHANGE STRATEGY AND IMPLEMENTATION

Table 1.1 Data table showing the underperforming outcomes in the Cleveland Clinic

Most of the patients in the Cleveland Clinic were assessed for pressure ulcer risk within

24 hours upon admission and 63.4% of patients were found to have a risk assessment upon

admission. Upon implementation the AHRQ guidelines for these patients, the patients were

reassessed for pressure related risk and only 29.3% of the patients did have a risk assessment and

CHANGE STRATEGY AND IMPLEMENTATION

were further readmitted for few more days. This shows that the AHRQ guideline

implementations significantly reduced patient risk assessment and readmission by approximately

34.1%; that is from 63.4% to 29.3% (AHRQ, 2011). Our study recommendations on change plan

strategy are consistent with the Qaseem, Mir, Starkey, and Denberg (2015) study proposals,

which stated that AHRQ plays an important role in risk assessment and prevention of pressure

ulcer.

Patients admitted in the in the Cleveland Clinic as well as those with pressure ulcer

(bedsores) were assessed to determine the magnitude pressure and shearing (AHRQ, 2011).

Approximately 74.5% of the patients were found to have higher magnitude of pressure and

shearing and AHRQ guidelines were implemented to manage their pressure ulcers and reduce the

magnitude of pressure and shearing (AHRQ, 2011). According to AHRQ (2011) guidelines,

after one week of AHRQ guideline implementations, these patients were reassessed and there

was a considerable decrease of magnitude of pressure and shearing, with only 30.3% of the

patients having relative magnitude or pressure and shearing, compared to 74.5% of the patients at

the start before the AHRQ guideline implementations, as shown in table 1. These patients

(30.3%) were then subjected to further treatment and care by implementing AHRQ guidelines on

guidelines on pressure ulcer management to reduce the magnitude of pressure and shearing and

improve the quality of life and health of patients. Our recommendation strategy is consistent with

Soban et al. (2016) study proposals.

CHANGE STRATEGY AND IMPLEMENTATION

All the admitted patients in the facility were examined for etiology and development of

pressure ulcer, and majority of the patients (69.1%) did have etiology and development of

pressure ulcer, as shown in Table 1. These patients were selected for treatment and management

of pressure ulcer through implementation of ARHQ guidelines for a period of 7-14 days. After

14 days, the patients were then examined and assessed for etiology and development of pressure

ulcer, and only 23.6% of the patients had etiology and some development of new pressure ulcer,

as shown in Table 1. These patients were further put under specialized treatment, which

consisted of further implementation of AHRQ with high quality care. This finding demonstrates

that as change strategy and implementation plan, the implementation of AHRQ guidelines on

pressure ulcer management, compared to the current practice, will decrease the etiology and

development of pressure ulcer, and consequently improving the quality of life and health of

patients. This change plan strategy is consistent with what Soban et al. (2016) proposed in their

study.

Patient assessment revealed that 81.2% of the pressure ulcer patients had prolonged or

longer duration of shear and pressure (Soban et al., 2016). These patients were selected for

pressure ulcer management and AHRQ guidelines were implemented to enhance their treatment

on pressure management leading to reduction of the number of patients with high duration of

shear and pressure from 81.2% to 29.8%, as shown in Table 1. This demonstrates the AHRQ is

effective in reducing the duration of shear and pressure among the pressure ulcer patients in the

Cleveland Clinic. Therefore, this change strategy and implementation plan proposes the adoption

CHANGE STRATEGY AND IMPLEMENTATION

of AHRQ guidelines on pressure ulcer management, compared to the current practice, which will

play an important role in the reduction of the duration of shear and pressure hence improving the

quality of life and health of patients. This change strategy plan and implementation is consistent

with Cullen (2015) recommendations.

Lastly, all the patients (admitted) were also assessed for prevalence of pressure ulcer and

surprisingly, 56.0% of the patients had higher prevalence of pressure ulcer. These patients

(56.0%) were selected and put on pressure ulcer management care where AHRQ guidelines were

implemented for a period of 7-14 days. After 14 days the patients reported significant reduction

in the prevalence of pressure ulcer from 56.0% of the patients before AHRQ guidelines

implementation to only 19.1% of the patients after AHRQ guidelines implementation, as shown

in Table 1. These findings suggest that implementation of AHRQ guidelines as change strategy

plan before patient admission will significantly reduce the prevalence of pressure ulcer. These

findings were consistent with Cullen (2015) study findings.

In conclusion, this change strategy and implementation plan proposes the implementation

of AHRQ guidelines on pressure ulcer management in the Cleveland Clinic effectively to

address the underperforming clinical outcomes. The benefits of implementing this strategy and

2. Decrease in the magnitude of pressure and shearing

CHANGE STRATEGY AND IMPLEMENTATION

Proposed Change Strategies

In regard to the proposed change plan and strategy, this study recommends continuous

implementation of AHRQ guidelines on pressure ulcer management to decrease hospital-acquire

pressure ulcer development, and enhance the quality of life of the patients, as well as their

wellbeing, as shown in table 1. The proposed strategy is based on the research findings, which

are consistent with the findings from different, pertinent existing literature studies (Cullen, 2015;

Qaseem et al., 2015; Soban et al., 2016).

and management

effective implementation of AHRQ

improvement to oversee the

implementation of AHRQ

on AHRQ implementation to reduce,

manage and prevent pressure ulcers

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educated to ensure smooth AHRQ

implementation.

technological systems that will help in

tracking AHRQ implementation and its

effectiveness in reducing pressure

ulcers. Documentation systems will

also give insights on progress made in

pressure ulcer reduction or prevention.

patients.

Source: Adapted from Agency for Healthcare Research and Quality (AHRQ, 2011).

The implementation of AHRQ guidelines on pressure ulcer management will also lead to

quality improvement with regard to safety and equitable care. This is based on the assumption

that most patients have higher chances of developing hospital related pressure ulcer in the

Cleveland Clinic due to the state of existing facilities. Therefore, the implementation of AHRQ

guidelines on pressure ulcer management will help in management or reduction of prevalence of

pressure ulcer among hospitalized (or bedridden) patients, as well as prevent the development of

pressure ulcer on future patients in the facility. Hence, it will lead to quality improvement.