Introduction
In both inpatient institutions and hospitals, the prevention of pressure injuries is an ongoing concern. Despite the remarkable efforts of healthcare professionals such as nurses, physicians, physical therapists, patient care technicians, and dietitians, pressure injuries continue to be a widespread concern. Therefore, there is a potential to improve patient outcomes by enhancing the efficacy of preventative interventions and decreasing the incidence of pressure injuries and wound healing complications.
Pressure Injuries: Prevalence, Impact, and Preventability
The prevalence of pressure injuries in nursing homes and hospitals may be attributed to immobility, severe sickness, and starvation. Tracking the progression of injuries and utilizing data to encourage prevention should be done as preventive measures. Further, it is crucial to target high-risk groups, such as the elderly and severely sick, who are the most susceptible to acquiring pressure injuries.
Pressure injuries are harmful to a patient’s health and may lead to extended hospital stays and financial loss. In 2008, the Centers for Medicare and Medicaid modified compensation for hospital-acquired diseases, although Medicare and Medicaid are available to cover medical expenditures for seniors (Fleck, 2009). Consequently, hospitals should monitor the development of pressure injuries using thorough skill evaluations, including the Braden and Norton skill assessment instruments. The majority of patients who get pressure injuries during their acute care episode are old, emaciated, and hospitalized for extended durations. These pressure injuries may cause considerable suffering, including persistent wounds and up to sixty thousand fatalities yearly (Padula & Delarmente, 2019).
Treatment costs for HAPIs have been estimated to cost anywhere from $3.3 billion to $11 billion yearly at the national level (Padula & Delarmente, 2019). Despite being responsible for comparable or even larger numbers of fatalities, pressure injuries have been given much less recognition as a public health concern. There is no doubt that pressure injuries are largely preventable. However, approximately 2.5 million individuals in the United States still develop these injuries in acute care facilities each year (Padula & Delarmente, 2019).
The majority of patients at the Neuro Unit are stroke patients, meaning they have weakness, restricted mobility, and, in the most severe instances, paralysis in one, two, or the whole body. Stroke patients may also have difficulty eating, resulting in a decline in nutritional status that may slow the healing of existing wounds and increase the likelihood of acquiring new ones.
Proposed Solution and Initial Implementation Strategy
Consciously or unconsciously, the majority of individuals change their posture whether they are inactive or sleeping. However, those who are extremely frail, unwell, disabled, or asleep move far less or not at all. One solution to prevent and reduce the incidence of pressure injuries is to encourage patients to get out of bed and sit in chairs during mealtimes (Institute for Quality and Efficiency in Health Care, 2018). This will provide patients with a more natural eating experience and provide some much-needed exercise by changing the patient’s position.
Various stakeholders, including the unit manager, charge nurse, nurse educator, nurses, patient care technicians, nutritionists, and physical therapists, will collaborate on the suggested solution. Unfortunately, the idea is not cost-effective for the hospital, and a new patient care technician cannot be employed due to budgetary restrictions. Therefore, existing resources and personnel must be used efficiently to obtain the intended result.
The physical therapist will collaborate with the designated nurse responsible for the patient to include chair transfer in the patient’s treatment. Since lifts have already been built in patient rooms and chairs are readily accessible, the procedure will be expedient. Given that they do not have an allocated group of patients, the charge nurse will be ready to provide extra help as a resource nurse.
The suggested strategy will be implemented over three months, with the first month devoted to the development of a small stakeholder group comprised of clinical and supporting personnel. This month’s purpose is to analyze the physical treatment schedule and establish the most efficient way to include the planned interventions. A tight working relationship will be created with the assigned nurse and patient tech to determine patient requirements, develop treatments, and assess results.
Stakeholder Approval and Strategy Integration into Daily Care
The unit manager is the first crucial stakeholder in the suggested strategy. The unit manager would need to approve the implementation of the plan. In my first encounter with the unit manager, I expressed my concerns over the rising frequency of pressure injury wounds on the unit. I explained to him that the majority of new pressure ulcers result from patients being in bed for extended periods without moving or shifting to a chair.
I also highlighted to him the significance of the patient’s nutritional health, which plays a significant role in healing existing wounds and preventing new ones. The unit manager agreed with the facts I shared and the approach I advised. To execute this plan, the unit manager spoke with the nurse educator and the charge nurse. I met with the nurse educator and the charge nurse to devise the most effective strategy for implementing and educating about the recommended plan.
The majority of the planned strategy can be implemented throughout the day. All meals are provided during the day shift, but that does not preclude the night shift from being on top of Q2H assessments and patient turns. First, the nurse identifies the patient at risk, and then she works side-by-side with the patient technician to get the patient out of bed, turn the patient Q2H while in bed, and record the patient’s food intake.
The nurse will conduct a nutritional and skin examination QSHIFT. If necessary, the nurse will communicate her concerns to the wound nurse and dietician. The nurse will also communicate with the physical therapist about the patient’s physical capabilities to provide adequate daily care.
As a scientist, I recognized an issue with the hospital’s present use of the audit tool and gathered data on the wound rates over the last year. Based on my observations, I enhanced the use of the audit tool and reduced the occurrence of pressure injuries. My strategy entailed assessing the acquired data and applying it to alter the present system.
I questioned what might potentially boost pressure injury audit compliance. I also assessed the relationship between the number of audits filed and the number of pressure injuries obtained in hospitals. Ultimately, I noticed a link between the total number of pressure injuries and the additional funds the hospital spent as a result of those injuries.
Conclusion
Pressure injuries are harmful to both patients and nursing personnel. As the manager of the Neuro Unit, I am dedicated to providing my team with the information and resources they need to avoid further pressure injury wounds. I will encourage my team to discuss fresh ideas and concerns via an open-door policy, and my guiding concept will be that there is no “I” in a team.
References
Fleck C. A. (2009). Implications of the new Centers for Medicare & Medicaid Services pressure ulcer policy in acute care. The Journal of the American College of Certified Wound Specialists, 1(2), 58–64. Web.
Institute for Quality and Efficiency in Health Care. (2018). Preventing pressure ulcers. Nih. 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.