Introduction
The acute care in-patient population is always found to trip, fall, lose balance, and cause injuries possibly daily. The falls mostly have the probability to prove fatal for the patients. Hence, it is essential to implement programs to improve quality, decrease the length of stay, and increase patient satisfaction by focusing on quicker emergency department throughput. The proposal deals with hospital pressure injuries resulting from falls and other factors among the acute care in-patient, investigating and examining the issue to offer a solution for hospital-acquired pressure injuries (HAPIs).
The Issue
Pressure injuries acquired in the hospital due to falls and other factors pose a critical risk to patients’ health, whose mobility has been affected. While there are many prevention approaches and practices in place, which are applied by different healthcare team members, pressure injuries acquired in the healthcare environment continue to be a major issue.
Explanation of the Issue
Pressure injuries acquired in the healthcare facility due to falls are a nursing quality indicator. Hence, hospitals need to track the occurrences and utilize the findings to help promote lower incidences and apply preventive measures and tools. The data may then be applied to determine where fallouts can happen, and what may be altered to prevent the injuries. I have knowledge of falls causing injuries, which have contributed to patients receiving treatment of casting, traction, and surgeries for bone and skull fractures that may lead to even mortality. Pressure injuries are risky to patients and financially taxed to the healthcare system. If they are noted to have occurred at the hospital, then the healthcare facility is now accountable for the cost of care associated with those injuries.
Investigation
My experience and knowledge on this issue have been evident since I started my nursing career. As a hands-on nursing practitioner, I have learned from the beginning the way it is essential to relieve pressure from at-risk areas of the body and skin and educated on how to practice it in my daily care. Several aspects are contributing to pressure injuries, for example, level of consciousness, mobility issues, length of hospital stay, quality of care given, and continence. However, other aspects comprising weight, perfusion, cognitive level, age, fragility, nutrition, moisture, and comorbidities like suppressed immune system or diabetes are critical things to consider when evaluating the risk of a patient. I had to speak to a nurse in the wound care group and one of the charge nurses on the floor. Further, I interrogated some of the nurses on the floor and certified nurse assistants on the ground to determine what responses they took to assist prevent and manage pressure injuries and how the incidents often were actively involved in the responses, and how accountable they felt in assisting prevent injuries from fall from occurring.
Evidence
Despite most hospital-acquired pressure injuries (HAPIs) being preventable in most cases. There are close to 2.5 million people in the United States (US) develop pressure injuries in acute care healthcare facilities yearly (Padula & Delarmente, 2019). HAPIs are dangerous to patients because they can result in mortalities. Further, to substantiate this figure, the costs to the American healthcare system for injuries are more than $11 billion annually (Vitale et al., 2021). The healthcare quality unit explored the cost of executing a HAPIs prevention program in association with the cost saving to hospitals by preventing pressure injuries. It was found that the cost of integrating HAPIs prevention into the annual capital budget is significant and prevents injuries (Singh et al., 2022). As seen from the evidence, the injuries reduce patients’ quality of life considerably. As noted above, the 2.5 million individuals annually and the $11 billion is a high cost to incur when experiencing injuries that are preventable in the healthcare system.
Analysis
Pressure injuries are a resource-intensive and common challenge for acute care healthcare facilities globally. Despite many preventive approaches having the potential to minimize the HAPIs cost, it is unclear which strategy is the most efficient, and effective in prevention plans (Ocampo et al., 2017). Preventive programs are set in place across our healthcare system to assist prevent pressure injuries that are acquired because of increased hospital stays and other factors. The mechanisms comprise assessment tools, for example, the Braden Score Assessment tool, in which risk factors of a patient are determined by an earlier set scoring chart. In addition, patient-turning schedules can also help to prevent injuries, in which nurses and CNAs are accountable for turning at-risk patients every two hours off pressure points. It aids in preventing falls, which is a key aspect that contributes to injuries among acute care patients. Further, the application of protective mepilex bandages on pressure boney areas or points may reduce the risk of pressure injuries. Pressure redistributing mattresses or low air loss is a resource that may be utilized when caring for patients at risk.
Contributing Factors
Most extrinsic and intrinsic aspects exist when looking at HAPIs. These comprise aspects such as length of hospital stay, level of consciousness, decreased perfusion, weight, severe illness, comorbidities like suppressed immune system or diabetes, poor nutritional status, continence, advanced age, and cognition. Other aspects, for instance, staff shortages may result in HAPIs because there is inadequate staffing to assure that patients are repositioned and turned appropriately (Alderden et al., 2020). In addition, patients may decline to be repositioned and turned, which may be an obstacle in the prevention approach.
Proposed Solution
My suggested solutions to HAPIs would be the implementation of the use of pressure redistributing and low air loss mattresses in all hospital wards, and the removal of regular mattresses. In addition, HAPIs can be prevented in healthcare facilities by following patient safety guidelines, improving healthcare quality, decreasing the length of stay, screening and classifying patients into cohorts, and public health surveillance (Wild & Makic, 2022). However, while other stated preventive approaches will play a critical role, mattresses may prove to be a significant mechanism in helping prevent injuries.
Justification for Solution
I trust that the utilization of funds to buy the low air loss and redistributing mattresses is validated as the cost of caring for the HAPIs is substantial. As earlier noted, the American healthcare system is accountable for using $11 billion yearly to care for pressure injuries. Hence, if healthcare facilities take the initiative of purchasing mattresses, it might reduce the cost of HAPIs over time. Data reveals that the utilization of mattresses along with other intervention guidelines lowered the incidence of pressure injuries in hospitals (Singh & Shoqirat, 2019). There is a need for the healthcare system to adopt the use of these mattresses for patients in acute care.
Cost-Benefit Analysis
HAPIs emerge from a series of in-patient therapy and are mostly applied as a sign of hospital quality. Nurses may prevent most pressure injuries by persistently implementing international best practice guidelines such as the use of low air loss and redistributing mattresses over regular or traditional mattresses (Ocampo et al., 2017). After searching through various suppliers on the internet, I discovered that the mattresses’ cost varies between $1450 to $1750 per mattress. The healthcare facility I work for has 300 patient beds capacity. Hence, if every bed was transformed into a low air loss and redistributing mattress, the total cost could amount to approximately $480,000. As earlier noted, the cost of care associated with pressure injuries that were acquired during patients’ stay at the hospital may be up to $11 billion. Therefore, the cost of changing the beds and mattresses might reduce the cost over time to a minimal level. Standard care aims at preventing injuries at the healthcare facility without initiating a given quality enhancement approach to standardize as prevention protocol among the patient population in the acute care setting.
Timeline
The change from regular beds to pressure redistributing mattresses might take place over the next three years, commencing when the new hospital budget is developed for the next financial year. It is due to the funds being already allocated for the current year. If it was carried out in three years, the cost of the transition for my healthcare facility would be approximately $160,000 yearly. Changing to low-air loss mattresses beds must happen first in the areas of the healthcare facility where the need is highest, for example, acute care and units in which patients are admitted for a longer period.
Stakeholders/Importance
Stakeholders influenced by the change would be everybody from the hands-on employees, nurses, and CNAs, to management and the board of directors (BOD). However, I failed to speak to the members, management, and BOD is significant to get on board with the initiative as they are the ones who can assist directly with where the healthcare facility funds may be allocated for the next financial year. CNAs and nurses are critical stakeholders as they are the ones tasked with the responsibility of managing the beds and patient care, for instance, evaluating skin integrity and turning and repositioning patients. In addition, patients are essential stakeholders as they are the ones at risk for HAPIs.
Stakeholder Engagement/Feedback
I have spoken with CNAs and nurses in my department and discussed ways in which the pressure of redistributing mattresses might influence their daily workflow. They agreed that the utilization of pressure redistributing mattresses could be essential in injury prevention, mostly concerning patients who cannot turn or often decline repositioning efforts by employees. Further, I had to speak with some patients using the regular beds concerning the bed’s comfort and if they were eradicating pressure from some areas of their skin and body. Furthermore, I spoke with the nurse in charge about the concept of changing all beds to pressure redistributing mattresses, and she believed this might be beneficial to our acute care patients at risk and offer the comfort level for all patient populations who are an in-patient in the hospital.
Success
Therefore, involving patients and my co-workers was successful in the idea of transition to low-air loss mattresses. The charge nurse encouraged me to take the findings and proposal of my idea of changing all regular beds to pressure redistributing to my leader. The manager will assist me in formulating the proposal on ways to convince management to initiate this costly change.
Implementation and Evaluation
The proposal implementation must begin at the start of the new financial year budget; hence, the funds may be utilized appropriately. Generally, the proposed change would take at most three years or less. It would equivalently need close to 100 beds being transitioned to pressure redistributing and low air loss mattresses annually. Assessment of the change might be traced over three months period to spot if there is a decline in pressure injuries that were acquired in the hospital had dropped before executing the mattress across the entire healthcare facility.
Role as Scientist
The scientist’s role is met when the data collected is analyzed and interpreted concerning HAPIs. In addition, I am a scientist when analyzing and interpreting the data concerning the utilization of low air loss and pressure redistributing mattresses in association with injuries.
Role as Detective
The detective role is achieved when I interrogated what else could be implemented to prevent HAPIs in acute care. Inquiry concerning the utilization of pressure redistributing and low air loss mattresses in our hospital units needed me to take a detective role and interview and question patients and healthcare staff.
Conclusion
By taking up the initiative to spot other areas that, need improvement regarding the HAPIs. I had taken the responsibility of being a manager of the healthcare setting. In line with recognizing improvement areas, suggesting new ways to prevent and manage the issues could also be seen as the management of the hospital environment for my patients.
References
Alderden, J., Cowan, L. J., Dimas, J. B., Chen, D., Zhang, Y., Cummins, M., & Yap, T. L. (2020). Risk factors for hospital-acquired pressure injury in surgical critical care patients.American Journal of Critical Care, 29(6), e128-e134. Web.
Ocampo, W., Cheung, A., Baylis, B., Clayden, N., Conly, J. M., Ghali, W. A., Ho, C. H., Kaufman, J., Stelfox, H. T., & Hogan, D. B. (2017). Economic evaluations of strategies to prevent hospital-acquired pressure injuries. Advances in Skin & Wound Care, 30(7), 319-333. Web.
Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States.International Wound Journal, 16(3), 634-640. Web.
Singh, C. D., & Shoqirat, N. (2019). Pressure redistribution crib mattress. Journal of Wound, Ostomy & Continence Nursing, 46(1), 62-64. Web.
Singh, C., Shoqirat, N., & Thorpe, L. (2022). The cost of pressure injury prevention.Nurse Leader, 20(4), 371-374. Web.
Vitale, N. A., LFACHE, & Dzioba, D. A. (2021). Why investing in hospital-acquired pressure injury prevention technology makes financial sense. Web.
Wild, K., & Makic, M. B. (2022). Reducing hospital-acquired pressure injuries during the COVID-19 pandemic. Critical Care Nurse, 42(2), 82-84. Web.