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Healthcare organizations have to deal with many patient-related problems on a daily basis. One of these concerns is the development of pressure ulcers – skin injuries that occur in patients who have limited mobility and cannot move while lying or sitting (Padula et al., 2015). Otherwise known as bedsores, these health conditions affect the health of patients who spend much time at the hospital or home. The issue of the rising rate of pressure ulcers’ occurrence is essential to my practice and healthcare facilities in general because the presence of bedsores leads to adverse patient outcomes.
Notably, the development of ulcers increases the risk of infections because they create open wounds and expose the body to bacteria and viruses. Moreover, the inflammatory response of the immune system to skin tears puts additional pressure on the patient who may be already affected by other conditions (Stansby, Avital, Jones & Marsden, 2014). Thus, clinicians should prevent pressure ulcers from occurring to avoid serious complications. The practice problem lies in reducing the incidence rate of pressure ulcers in the unit.
The practice problem of pressure ulcers can be measured by its incidence – the number of patients who developed bedsores in the unit during their stay in comparison to all patients. According to the AHRQ (Agency for Healthcare Research and Quality), the issue is especially pressing due to the lack of a reliable national benchmark (“How do we measure,” 2014). For example, in the state of New York, only some statistics are available for comparison to hospitals; they reveal that many units suffer from poor incidence and prevalence rates (NYS Health Profiles, n.d.).
While this problem may be difficult to analyze, it is solvable. Qaseem, Mir, Starkey, and Denberg (2015) state that the rate of bedsores can be reduced with a properly structured and implemented quality improvement plan. The combination of the ulcers’ significant effect on patients and the unit and its solvability outlines the need for a solution. The purpose of this project is to offer a researched plan which would improve the rate of pressure ulcer incidence in the unit.
Analysis of Existing Evidence
The effect of pressure ulcers on patients, nurses, and hospitals is outlined in academic literature. Qaseem et al. (2015) find that the prevention of bedsores is much more beneficial than their treatment. First of all, pressure ulcers are dangerous to the health of patients as it is described above. Skin damage and the following infections increase morbidity and mortality, putting patients at increased risk of complications and prolonged length of stay at the hospital (Gardiner, Reed, Bonner, Haggerty, & Hale, 2016).
Second, clinicians also encounter challenges in dealing with bedsores as the latter require adequate assessment and difficult treatment. Prevention, on the other hand, can be performed in steps that have been tested and documented. Finally, the rate of ulcers affects hospitals and units as it is one of the factors of healthcare organizations’ ratings. The high incidence of bedsores implies the poor quality of service, low rating of the unit, and decreased financial support.
In order to adequately address the issue, it is necessary to understand how pressure ulcers can be measured. According to Fletcher and Hall (2018), nurses may face many challenges due to hospitals having different records of patients with pressure ulcers. Some of the wounds may be called bedsores, while others may have names such as moisture-associated dermatitis or sacral and gluteal lesions (Berlowitz, 2014).
This difference implies that the lack of standard definitions in the unit or the low rate of compliance to the guidelines may increase the rate of pressure ulcers. If skin wounds are inappropriately recorded, they are less likely to be treated with needed measures, thus highlighting prevention as the best solution.
The approaches to prevention may involve equipment, strategic changes to the schedule, and staff education. Gill (2015) offers some ideas for intensive care units (ICUs), incorporating the PDSA cycle and utilizing nurses’ training, a colored scheme of patient assessment results, and frequent moving of patients. Richardson, Peart, Wright, and McCullagh (2017) also use new mattresses and updated technical ways of reporting and documenting the prevalence and incidence of bedsores. The amount of evidence provided by the authors suggests that a multifaceted program can lower the rate of ulcers and lead to better scores and higher patient satisfaction.
Quality Improvement Process
In order to function and yield successful results, the program requires a quality improvement model such as the FOCUS-PDSA approach. This strategy involves many preparatory steps that investigate underlying issues and causes as well as practical stages during which the collected knowledge is implemented into work. There are nine steps in this cycle: Find, Organize, Clarify, Understand, Select, Plan, Do, Study, and Act (Spath, 2013).
The first step deals with identifying the main concern that requires fixing. Here, the scope of the intervention should be found, along with the desired outcomes of the implemented change. Next, the task team should be organized in the second step to devote their time to collect existing patient data, guidelines, and other useful information. The third stage (clarify) deals with using the knowledge to define the measures which the unit has to undertake to resolve the problem.
Then, the team should pay increased attention to the underlying causes of the issue to understand why it is happening in the unit and what else can be altered to mitigate it. The final step in the introductory part involves selecting the activities based on gathered data.
After all possible knowledge-based activities were completed, nurses can start designing and implementing the intervention. Here, the PDSA cycle starts with turning information from the FOCUS part into a practical set of activities. Next, these procedures are proposed to a small part of the unit, and their results are assessed to see whether they are sufficient to use in the whole department (AHRQ, 2015). This quality improvement model includes a variety of theoretical and practical steps that allow nurses to analyze their work thoroughly.
There exists research on the same practice problem of pressure ulcers that supports the idea that PDSA is effective. Gill (2015) reports the successful use of PDSA with lectures, practice exercises, schedules, and color-coded assessments in the ICU. Richardson et al. (2017) also use a PDSA-based approach but use many cycles during which the researched facility increases the patients’ positive outcomes substantially. Thus, the use of FOCUS-PDSA with the mentioned above tools may prove to be adequate for the current practice setting.
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Pressure ulcers constitute a significant problem for healthcare organizations. They are difficult to assess, documents, and measure, and the comparison of their prevalence is unreliable. However, bedsores can and should be addressed because their treatment results in much more severe complications than timely prevention. It is vital for the current practice setting’s staff to analyze and reduce the incidence of pressure ulcers using the FOCUS-PDSA model of quality improvement. It offers nurses a chance to focus on underlying causes and find a solution that is practical and based on the latest evidence.
Agency for Healthcare Research and Quality [AHRQ]. (2015). Plan-do-study-act (PDSA) directions and examples. Web.
Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In D. R. Thomas & G.A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 19-26). Totowa, NJ: Humana Press.
Fletcher, J., & Hall, J. (2018). New guidance on how to define and measure pressure ulcers. Nursing Times, 114(10), 41-44.
Gardiner, J. C., Reed, P. L., Bonner, J. D., Haggerty, D. K., & Hale, D. G. (2016). Incidence of hospital-acquired pressure ulcers – A population-based cohort study. International Wound Journal, 13(5), 809-820.
Gill, E. C. (2015). Reducing hospital-acquired pressure ulcers in intensive care. BMJ Open Quality, 4(u205599.w3015), 1-5.
How do we measure pressure ulcer rates and practices? (2014). Web.
NYS Health Profiles, (n.d.). Pressure ulcer. Web.
Padula, W. V., Makic, M. B. F., Mishra, M. K., Campbell, J. D., Nair, K. V., Wald, H. L., & Valuck, R. J. (2015). Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States. The Joint Commission Journal on Quality and Patient Safety, 41(6), 246-256.
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369.
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.
Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.
Stansby, G., Avital, L., Jones, K., & Marsden, G. (2014). Prevention and management of pressure ulcers in primary and secondary care: Summary of NICE guidance. BMJ, 348, g2592.