A hospital-acquired pressure injury (HAPI) is a localized injury of underlying tissue or skin that some patients suffer during their stay in a hospital. HAPI is typically a result of prolonged immobility of patients, leading to unrelieved pressure upon bony prominences. In combination with shear, this pressure is linked to other variables such as age, perfusion, nutritional status, hematological measurements, sickness severity, and diabetes (Rondinelli et al., 2018). Despite the recent decline, the number of patients who acquired pressure injury during their stay is still over a million in the USA (Tschannen & Anderson, 2020). The development of HAPI increases patients’ risks of dying during the hospital stay by 2.8 times and dying within 30 days after leaving the medical facility by 1.69 (Tschannen & Anderson, 2020). Additionally, hospital-acquired pressure injury is accompanied by substantial pain and suffering, delayed functional recovery, as well as extended time for healing and hospital stay (Tschannen & Anderson, 2020). Even though much research has been done on the subject, HAPI remains a significant issue for elderly patients and a costly challenge for hospitals.
During the patients’ time at the hospital, the primary care for them is provided by and the responsibility of the nurse practitioners. Since pressure injuries are proven to be preventable, the early recognition of the modifiable causes of the development of HAPI and taking corrective measures can stop the progression of the disease (Rondinelli et al., 2018). As such, working directly with patients enables nursing professionals to identify the symptoms and stop pressure injuries from developing. Failing to assess and prevent HAPI in patients accurately can lead to a severe impact on their lives and delay the healing process (Rondinelli et al., 2018). Furthermore, slow healing results in even longer hospital stay, which in turn facilitates the worsening of HAPI and increases healthcare costs.
Within the framework of the assignment, for constructing a PCIOT question, each of its elements is further identified and described. The patients suffering from hospital-acquired pressure injuries are typically considered to be the older generation. The injury is acquired during their prolonged stay in a hospital, affected by their immobility, nutritional status, and sickness severity. One of the evidence-based solutions that can be applied to reducing the rates of acquiring and developing pressure injury in elderly patients is the minimization of shear and friction. It can be achieved by using low-friction slide sheets and air-assisted transfer devices, reducing the risk of skin injuries. Another solution for HAPI prevention is the appropriate usage of pressure redistribution surfaces, such as pressure-reducing mattresses. The outcomes of these measures can be evaluated by calculating and comparing the rates of HAPI development in patients. The time frame involved in the evidence-based practice initiative can be set to a year.
As a result, the PCIOT question can be constructed as such:
- P = elderly patients within the risk of developing a hospital-acquired pressure injury
- I = minimization of shear and friction
- C = usage of pressure redistribution
- O = reducing the rates of HAPI development
- T = a year
- PICOT Question: In elderly patients with the risk of acquired pressure injury during the hospital stay, how effective is the minimization of shear and friction compared to the usage of pressure redistribution surfaces in reducing the rate of HAPI development a year?
References
Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: risk-adjusted comparisons in an integrated healthcare delivery system. Nursing research, 67(1), 16.
Tschannen, D., & Anderson, C. (2020). The pressure injury predictive model: a framework for hospital‐acquired pressure injuries. Journal of Clinical Nursing, 29(7-8), 1398-1421.