The plan for implementing the solution
The following is a four step plan in resolving the above mentioned problem and the first is assessing the risk. This is an effective way of evaluating each patient and deciding whether they have an increased risk of developing pressure sores. Consider all chair-bound people or those who cannot reposition themselves and decide their level of risk. Choose a criterion for risk assessment, such as the Braden scale or the Norton Scale and use the chosen scale to assess all at-risk patients at the time of admission and regular intervals thereafter. Use the results obtained, which will include factors like incontinence, moisture, decreased mental status and nutritional deficits to prescribe and apply specific preventive treatments. This results in tailor-made care for each patient. The second part of the plan involves early treatment and skin care (Torrence, 1983). Observe the patient’s skin daily; noting any changes. Bathe the patients often using a mild cleansing agent while avoiding excessive friction and hot water. Treat incontinence and if this is not possible, clean the skin after soiling. Encourage the use of moisturizer for dry skin while discouraging massaging over bony prominences. Use dry lubricants like cornstarch to cut injury by friction as this causes pressure sore susceptibility to increase. It would also be helpful to start a rehabilitation program to encourage mobility and an active general state as this will discourage immobility which is a major contributory reason to pressure sore development. Finally, documenting the interventions and their outcomes will help to check the plan to improve various aspects of its implementation.
The third part of the plan is support surfaces and mechanical loading. These are measures taken to cut the risk of pressure sore development, especially in immobilized patients. First, reposition bed-bound persons every two hours and at every hour for chair-bound persons. Use a written repositioning schedule to carry out the duties accurately. Place persons at risk on pressure reducing mattresses or chair cushions (Walker, 1971). Avoid using donut-type devices as these do not effectively cut the risk of pressure sore development. In relevant cases, consider postural alignment to balance the weight distribution, ensure stability and pressure relief when positioning persons in chairs or wheelchairs. It is also important to teach these persons to shift weight every 15 minutes if they are able. Encourage the use of lifting devices like a trapeze or bed linen to move persons and not drag them. When placing these persons on say a bed, use foam wedges or pillows to keep bony prominences such as ankles and knees from direct contact with each other or with hard surfaces. Additionally, do not place these persons directly on the trochanter when using the side lying position. Use the thirty degree lateral inclined position instead. The fourth and last part of this plan is education. Implement a program with an accepted level of organization structure and comprehensiveness and direct it to all levels of health care providers, caregivers, patients and their families. Information provided should range from skin assessment, use of support surfaces, risk assessment tools and their application to the etiology of and risk factors for pressure ulcers. To make education effective and useful, create built-in mechanisms to check the effectiveness of the program in preventing pressure ulcers.
Resources needed for implementation includes competent staff, appropriate compensatory mechanisms for this staff, medical supplies and an effective leader or manager to make sure implementation is on track. Monitor solution implementation using records as elucidated in the plan above. It is important to realize that the feasibility of this plan is its strength because most of the resources are easily available and all it takes for effective implementation is discipline and proper leadership skills.
Evaluation plan
The methods used to evaluate the solution include first, surveillance and evaluation of long-term goals. Surveillance could be described as continuous monitoring of routine data collection over a regular interval of time on various factors. These factors include the effectiveness of moisturizer on dry skin, the effectiveness of the education program, the effectiveness of pillows and foam wedges in reducing the incidence of pressure sores or the sum of cases treated or prevented as a result of implementation of the plan. Secondly, intermediate goals could be evaluated. These include factors such as patient comfort and reduced risk to pressure so development. Thirdly, the process could be evaluated. This describes implementation progress while assessing barriers and challenges to the implementation to guide future planning. After doing all this, how valid the outcome measure is could be assessed through comparison with available statistical data on pressure sores from various institutions. The outcome portrays improved patient care in that fewer of them are at risk of developing a pressure sore which is what this whole plan is about.
The evaluation data was collected through both qualitative and quantitative methods. Interviewing the staff and patients involved gave important information. We did these interviews face-to-face, through telephone interviews and computer assisted staff interviews. To elicit reactions through personal interaction we chose the above mentioned methods which helped us further gauge the effectiveness of the plan. We used questionnaires, both web-based and paper-pencil questionnaires, to enable us reach remotely placed participants who were part of the project. The evaluation plan helped us find the obstacles to progress, the advantages experienced and the overall impact of the project to those involved.
Reference list
Torrence, C. (1983). Pressure sores: Aetiology, Treatment and Prevention. Australia: Croom Helm Ltd.
Walker, K. A. (1971). Pressure sores: Prevention and treatment. The University of Michigan: Butterworths.