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The high rate of pressure ulcers is the problem that is analyzed in this project. Bedsores are skin wounds that can appear in patients who cannot move by themselves or spend significant time in one position. In hospitals, pressure ulcers’ incidence and prevalence rates are considered to be the factors that affect the organization’s overall ranking score. Moreover, the treatment of pressure ulcers is challenging to both clinicians and patients since bedsores cause many complications, including dangerous infections.
On the other hand, prevention of pressure ulcers is much more effective in helping patients and improving their health. According to studies, it is easier and more beneficial to prevent ulcers from developing rather than treating them (Dealey et al., 2015). In order to design and implement the quality improvement (QI) program, the unit can utilize incidence rates of bedsores. Incidence is the number of patients who developed ulcers during their stay in the hospital in comparison to the overall patient load.
The purpose of this intervention is to offer an evidence-based practice initiative that aims to reduce the incidence of pressure ulcers in the discussed unit. The discussed program uses a FOCUS-PDSA model and considers education, visual aids, and leadership as the foundation for change. The intervention does not require significant resources apart from nurses’ time which should be redistributed and rescheduled to fit the new guidelines.
Evidence-Based Practice Plan Explanation
The FOCUS-PDSA model used for this project implies that, prior to the creation and implementation of the plan, the unit’s QI team should conduct extensive research of the problems in the department. The FOCUS part of the approach is fully focused on finding the causes and choosing the best possible ways of reducing the issue (Spath, 2013). Thus, the following plan is based on academic knowledge as well as collaboration among the members of the unit’s team.
The first step in the practice plan is education – nurses should be prepared to implement new strategies. According to Soban, Kim, Yuan, and Miltner (2017), staff training is vital to the success of the program. Thus, the first day of the intervention should be dedicated to educating nurses about future changes. Prior to this day, all nurses involved in the new program should complete a questionnaire that tests their knowledge about pressure ulcers’ prevention.
The Agency for Healthcare Research and Quality (AHRQ, n.d.) provides such resources as Pressure Ulcers Knowledge Test to be used for this purpose. After collecting the results, the QI team can examine the major knowledge gaps and highlight the solutions in the educational materials. On the day or days of training (depending on the nurses’ availability), the staff should discuss these concerns as well as learn about the new repositioning schedule and assessment criteria for patients. Some areas of knowledge that can be talked about include nutrition, pressure relief, skin condition, mobility, and pain.
The patient’s assessment should start with data gathering to learn how information about ulcers is recorded currently. Then, the Braden score should be implemented by nurses – patients are divided into three groups according to their risk of bedsores’ occurrence (Gill, 2015). While assessing patients, nurses should use their updated knowledge about pressure ulcers and mark patients according to the Braden score. As a result, each patient’s documents, bed, or room will be marked with green (more than 12 points), yellow (12 or less), or red (9 or less) color. Daily reevaluations will ensure the patient’s safety and lower risks (AHRQ, n.d.).
The schedules of turning or repositioning patients should be standardized for all members. Nurses should reposition every patient every two hours to avoid keeping the pressure on one side for too long. This period of time is flashed out in other academic studies such as the one by Gill (2015). Thus, nurses should devote time to perform this activity.
Finally, the plan includes data gathering and examination (Study) as well as the correction for further implementation (Act). During the period of implementation, the QI team will monitor nurses’ performance and compliance with the new guidelines. The incidence rates of pressure ulcers will be measured as well, collecting information from patient records on a weekly basis. Reassessments of patients should be used as a way if recording changes in patient’s risk and problems. After the completion of the pilot stage, the QI team will reevaluate nurses’ knowledge and awareness about ulcers’ prevention. Furthermore, leaders will collect feedback from the staff and patients about the new scheme and schedule and improve the project accordingly for future reintroduction.
As can be seen in the plan, both intangible and tangible resources are required for this QI project. First of all, personnel time is the primary resource that is vital to the intervention’s success. Nurses have to spend time on training, daily patient assessment, and two hourly patient repositioning.
Therefore, their schedules will need to be reorganized to fit frequent interactions with patients. This change is integral to the program – if nurses do not have sufficient time to perform new activities, the rate of compliance will be low, rendering the initiative ineffective (Richardson, Peart, Wright, & McCullagh, 2017). Nurses may also negatively view the proposed change if it interferes with their usual duties. This can lead to a substantial challenge of improving care in the future.
Tangible resources include educational materials and color-coded signs or stickers for patients. As for the training materials, they can be printed and shared with nurses in the digital form depending on their preferences. In this case, the costs are based on the access to the studies and questionnaires and the price of printing. Nevertheless, the use of printed or digital material is vital since it provides nurses with the knowledge that can be used or reviewed after the training day.
Furthermore, color-coded signs should not be expensive as well. They are essential to the intervention because they provide a visual aid to nurses and act as a reminder to check on patients or assess them accurately (Gill, 2015). Finally, the project does not require additional equipment, but the QI team may need to use specific software to calculate results. Here, the costs depend on the current availability of programs in the unit.
The incidence of pressure ulcers can be reduced with the help of a multi-faceted intervention. The FOCUS-PDSA model is used in the program because it combines practice and evidence analysis. Staff education should become the first step in the plan because the success greatly depends on the nurses’ knowledge. Next, visual aids and learning materials can be used to assist nurses is adjusting to the new activities. The new turning schedule is another approach that standardized the approach to patient assessment and focuses the attention on patients’ comfort. Personnel time is the leading resource that is vital to this QI project.
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Agency for Healthcare Research and Quality. (n.d.). Preventing pressure ulcers in hospitals: A Toolkit – Section 7, tools and resources. Web.
Dealey, C., Brindle, C. T., Black, J., Alves, P., Santamaria, N., Call, E., & Clark, M. (2015). Challenges in pressure ulcer prevention. International Wound Journal, 12(3), 309-312.
Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Open Quality, 4(1), 1-5.
Richardson, A., Peart, J., Wright, S. E., & McCullagh, I. J. (2017). Reducing the incidence of pressure ulcers in critical care units: A 4-year quality improvement. International Journal for Quality in Health Care, 29(3), 433-439.
Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organizational strategies to implement hospital pressure ulcer prevention programs: Findings from a national survey. Journal of Nursing Management, 25(6), 457-467.
Spath, P. (2013) Introduction to healthcare quality management (2nd ed.). Chicago, IL: Healthcare Administration Press.