Nursing Research Utilization: Literature Review and Solution in reducing pressure ulcers

Nursing Research Utilization: Literature Review and Solution

Problem and Solution

St. John’s Home Care Agency’s rate of pressure ulcer development during an episode of care is higher than national and state averages at x% for the past 12 months. A literature review of measures taken to prevent pressure ulcers was completed and the results point to the need to incorporate the use of a pressure ulcer risk assessment scale into St. John’s home care processes. The agency has chosen the Braden Scale as it is a comprehensive, validated tool for use in home care (Freitas & Alberti, 2013).

Goals, Objectives, and Outcomes

The main goal of St. John’s is to reduce the incidence of new pressure ulcer development to the national average of x% within six months of implementing the new evidence-based protocol. The first objective is for nurses to demonstrate understanding of the Braden Scale use by scoring at least 80 percent on the post-test given following education. The second objective is for nurses to apply the Braden Scale by using it to assess patients on. The first anticipated outcome is completion of the Braden Scale assessment on 90 percent of admissions as evidenced by admission reviews beginning 30 after implementation. The mail outcome will be a reduction in the rate of pressure ulcers by 10% at the end of 30 days and 50% by the end of 60 days.

Solution Feasibility Implementation

St. John’s Home Health Care Agency is committed to quality care and quality improvement. We also have a staff education department who will schedule team trainings to review the new protocol. All education meetings are mandatory and field nurses rotate attendance at meetings, so no extra time will be needed for education. Education sessions will be videotaped for those unable to attend at their regularly scheduled time. Additionally, the utilization review nurses currently audit 100 percent of admissions, so adding a check for completion of the scale is feasible and measurable. Approval is expected to go smoothly as well since pressure ulcers are a known issue.

Annotated Bibliographies

Amos, J., & Sons, L. . (201X). Application of the Braden Scale in the home setting: Incidence and factors associated with pressure ulcers. Journal of xxxxx, 26(6), 121-131. doi:10.1590/S0203-218060130602012

In this study, 246 home care patients were assessed using the Braden Scale risk assessment. The Braden Scale includes measurements for nutrition, sensory perception, mobility, shear and friction, moisture, and activity to determine risk for pressure ulcers. It has also been validated for use in home care patients. Patients studied were assessed one time a month for six months using the Braden Scale. The scale proved accurate (p <0.05) in predicting pressure ulcers. With a potential maximum score of 23, this study found those scoring below 18 were at risk for pressure ulcers and in need of prophylactic treatment.

Hii, P.,Loopman, M., (201X). Use of evidence-base practice for pressure ulcer prevention. Nursing Journal of Home XXXX, 17(12), 152-159. doi:10.1512/1453-7417-7-12

A pressure ulcer Quality Improvement Collaborative (QIC) was formed in a major US city consisting of 25 long-term settings including home care, nursing homes, and residential homes. Teams attended education sessions, learning evidence-based practices, risk assessments, and such tools as Plan Do Study Act (PDSA. They also learned evidence-based practice measures such as the use of risk tools such as the Braden Scale, along with preventative measures such as the use and value of pressure-reducing mattresses, turning the patients every two to four hours or more frequently, patient and family involvement in prevention, and the use of protective ointments. The percentage of all aforementioned interventions used increased from baseline to study conclusion and the total prevalence of pressure ulcers decreased from 38.6 percent to 22.7 percent.

Quain, L., Nortrdom, S., (2010). Implementation of pressure ulcer prevention protocols in home care. Journal of Nursing XXXXX, 8(18), 452-460. doi:10.1223/j.1241-2819.2010.11180.x

This study focused on the adherence to pressure ulcer prevention guidelines by home care patients and nurses after an education event. Targeted education based on a prevention protocol was presented to home care nurses in fifteen home care agencies. Pressure ulcer prevention guideline measures included the use of the Braden risk assessment tool, repositioning every 2 hours, use of floating heels, skin observation on each visit, educating and motivating patients and caregivers regarding the protocol on each visit, and bed and chair pressure reduction mattresses and/or cushions. Patients risk, pressure ulcer stage, nutrition, and dependency in activities of daily living were assessed. Pretest data was compared to data collected six and 18 months post implementation. Over 3,000 nurses were trained on the guideline/protocol and on how to collect data appropriately. Results showed adherence to recommended guidelines by nurses and patients increased from 9.4 percent at baseline before training to 15.8 percent at 18 months.

References

Hii, P.,Loopman, M., (201X). Use of evidence-base practice for pressure ulcer prevention. Nursing Journal of Home Health, 17(12), 152-159. doi:10.1512/1453-7417-7-12

Quain, L., Nortrdom, S., (2010). Implementation of pressure ulcer prevention protocols in home care. Journal of Nursing Care, 8(18), 452-460. doi:10.1223/j.1241-2819.2010.11180.x