Pressure Ulcers (PUs) Assignment

Introduction

The prevention of pressure ulcers (PUs) has proven to be challenging in acute and long-term care facilities. Apart from being painful and debilitating, PUs are associated with a poor quality of life, which can result in premature deaths, and septic infections. In the United States, PUs are also associated with litigation and high costs of treatment ranging from $20,900 to $151,700 (Yap et al., 2016). Besides, an estimated 11% of hospitalized patients develop a PU during admission and in other long-term care facilities, the incidences of PUs exceed 20%. Pressure Ulcers (PUs) Assignment

Gill (2015) highlights stakeholders’ participation through multidisciplinary collaboration as a vital strategy to increase successful outcomes after implementing an evidence-based practice change. Stakeholders comprise of corporations and individuals who engage in decision-making and play an integral role in promoting the performance of a healthcare organization. However, nurses are the key primary stakeholders who play an integral role in the translation of evidence into practice in clinical care. The support and participation of nurses are vital since nurses understand care processes and spend most of the time providing direct care to patients. This guarantees the availability of the necessary skills, resources, and knowledge for decision-making.

This paper discusses the strategies to involve major stakeholders when implementing a practice change to prevent PUs during hospitalization, describes ways to overcome implementation barriers, and identifies an indicator to measure outcomes of the proposed practice change. This information provides nurses with the knowledge to make informed decisions and improve health outcomes.

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Practice Change

Does turning patients reduce the risk of pressure ulcers than pressure mattresses?

How to Involve Stakeholders In implementing Change in Practice

Encouragement, Inspiration, and Motivation

Gill (2015) acknowledges how involving different stakeholders as members of a multidisciplinary team when implementing PUs prevention practices can be difficult and challenging to coordinate but results in better and more successful outcomes. Their study reveals how staff compliance to turning patients two-hourly was poor at the start but after educating staff to improve their knowledge and skills on the prevention of PUs, reviewing and updating  PUs prevention policies and guidelines, the compliance rates increased from 50%  to 95%. In clinical practice, the senior management must devise strategies to encourage, and motivate interdisciplinary team members to increase compliance with changes in practice. One such perfect strategy is educating members of multidisciplinary teams, reviewing and updating PUs prevention policies. Pressure Ulcers (PUs) Assignment

Using an EBP Interdisciplinary Approach

Dang et al (2018) emphasize the need to use an EBP interdisciplinary approach when implementing new practices. An EBP approach provides a platform to conduct staff training after performing a learning needs assessment using a staff survey where each member rates his/her proficiency level in performing a specific intervention (turning patients) that targets a given outcome (preventing PUs).  Based on the identified needs, an implementer can organize training using a small-group mentored approach where each member of the multidisciplinary team takes part in searching, appraising, critiquing, and synthesizing literature that supports a specific intervention-(turning patients) before the actual implementation. Therefore, an EBP approach allows an implementer to assign each stakeholder in the PUs prevention implementation team with specific roles and responsibilities.

Forming Wound-Care and Unit-Based teams With Defines Roles and Responsibilities

According to the AHRQ (n.d.), having a wound care team and a unit-based team is the best strategy to implement interventions for PUs prevention during hospitalization. It further emphasizes on assigning members of each team-specific roles and responsibilities as this helps to hold each member accountable for their actions. However, during the process, an implementer must consider the way roles interact and the most significant ongoing reporting and communication to shift focus on how the PU prevention practices will work in everyday practice (AHRQ, n.d.). Members of the wound care team will provide daily skincare and address any wound care needs while the unit champion team members will liaise with staff members in a unit to provide daily care and address patient’s needs (Loewenthal, 2016). In this case, nursing education and members of the hospital management form part of the Unit-based team while staff RN are members of the wound care team. Apart from turning patients, other roles of staff RN in the wound care team can include:

• Conducting rounds on high-risk and pressure ulcer patients
• Educating families and patients about PUs
• Developing hospital-wide procedures and policies on the prevention and management of PUs
• Taking part and organize PUs incidence and prevalence audits, making care plans, and documenting care
• Conduct accurate assessments and document head-to-toe skin assessments and risk of PU using the Braden risk or scale assessment upon admission, and daily during hospitalization (AHRQ, n.d.).
• Collaborate with other staff for accurate and timely reporting  of any skin issues
• Perform or supervise the performance of the treatments and procedures of a care plan Pressure Ulcers (PUs) Assignment

Loewenthal (2016) recommends the roles of unit-based champions (nursing education and hospital management) to be liaising between the units’ staff, members of the implementation team, and wound care team. This implies that the unit champions must familiarize themselves with the goals of an intervention, or care practice (turning patients) and expected outcomes data since they are the first to go to people when staff have concerns or have to seek clarification. The most promising strategy would be having two champions; a nurse manager, and clinical nurse educator, for every shift to ensure continuity in practice and assist with succession planning. This role might be temporary at the initiation of the program but once integrated into routine practice, the unit champion might not be needful.

Alternatively, a unit might have numerous staff (RN staff, clinical nurse educators, and nurse managers) who serve as resources for PUs prevention without the champion title. This would require the engagement of more frontline staff, particularly RN staff in prevention efforts. According to Latimer, Chaboyer & Gillespie (2015), this strategy promotes the engagement of more stakeholders and embeds knowledge of good PUs prevention practices in every unit

Creating Paths for Communication and Reporting

Successful outcomes after implementing a PUs prevention intervention are highly dependent on clear communication between all staff at all levels. This requires a careful analysis of potential communication breakdowns and weaknesses before addressing them. AHRQ (n.d) suggests healthcare teams conducting multidisciplinary patient rounds or having well-laid processes to exchange information during every shift change using the least amount of effort and time. According to Jacobson et al. (2016), communication paths should include strategies and channels to communicate with families and patients, particularly patients at high risk of PUs, or those whose skin deteriorates gradually. In this case, members in bot teams should establish the need for new processes and potential consequences. The most significant areas to include in communication and reporting are;

• Information about turning patients, skin and risk assessments in all shift reports
• Maintaining daily documentation of the patient’s risk of PUs on a unit’s flowsheet
• Conducting daily five to ten standup meetings to communicate vital   issues regarding patient safety and changes in care plans
• Providing staff RN with tools and guidelines to report new risk or skin problems for specific patients
• Providing respective families and patients with information on PUs prevention upon admission, and notifying them of any skin changes
• Providing all members of the multidisciplinary team with pocket cards to remind them of the clinical practices that they should follow Pressure Ulcers (PUs) Assignment

Determining lines of Accountability and Oversight

According to Yap et al. (2016), holding all multidisciplinary members of the implementation team accountable for their actions is key to successful post-implementation outcomes. During the implementation of the proposed intervention, a representative from the hospital’s management should devise ways to ensure the accountability of every staff to care guidelines, policies, and procedures. Perfect examples of strategies that a nurse manager can use to ensure accountability are:

• At the unit level, posting the most recent PUs audit results and collaborating with staff RN in the wound care team to educate other staff on areas that call for improvement.
• The nurse manager will ensure individual accountability by holding routine supervisory meetings with staff to review PUs prevention practices and conduct annual competence tests.

Addressing Potential Barriers

The most notable barriers to implementing the proposed intervention are time constraints and lack of supportive leadership. Even though evidence from literature supports turning patients at scheduled times as an effective strategy to prevent HAPUs, staff understanding, and willingness to implement this intervention determines the likelihood of successful outcomes. This implies that staff will require adequate time to think about the EBP project, search, appraise critique, and synthesize evidence. This process is not only demanding but also challenging for most nurses and restricts the time set aside for work. Besides, nursing staff can hardly do it in stolen moments away from patients. The best way to address the time constraint barrier is by developing a timeline of events and obtaining approval from the organization’s leadership (Dang et al., 2018). The timeline should be practical and clearly outline the dates and specific activities to perform by whom.

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Concerning the lack of supportive leadership, an organization’s leadership might fail to support the proposed evidence-based intervention, which hinders the creation and maintenance of an EBP environment. As a result, the purpose of the intervention might also fail to reflect in the organization’s philosophy, vision, strategic plan, and mission. As suggested by Jacobson et al. (2016), the best approach to addressing this barrier is by educating members of the organization’s leadership about the proposed EBP intervention, its benefit to patients, staff, and the healthcare organization. It is also recommendable to suggest ways that the top leadership can help to incorporate the proposed intervention in practice in their normative behavior and roles, organization culture, day-to-day language, and organizational values.

The last barrier is the lack of motivation among staff to implement and sustain the proposed intervention in practice. The best way to address this barrier is by urging the leadership to provide rewards or incentives to staff. Since implementing and maintaining an EBP practice for good outcomes is challenging, providing rewards or incentives is a sign of commitment from an organization’s leadership. According to Gill (2015), leadership can address the issue of incentives in the areas of mentoring and continuous education, evaluation tools, or job descriptions. These are crucial discussion areas during each phase of an EBP process. Pressure Ulcers (PUs) Assignment

Indicators to Measure Outcomes

There will be direct and indirect indicators to measure the outcomes of the proposed practice change (turning patients to prevent PUs). The first direct measure will be incidences of PUs described as the percentage of patients who will develop a new PU during hospitalization. This indicator will only account for any PU that may develop after hospitalization (Loewenthal, 2016). This incidence rate will be a direct indicator of the quality of PU prevention care provided by staff.

Staff will calculate the incidence rate by taking the number of patients who may develop a new PU after hospitalization (numerator) dividing by the number of all patients hospitalized during that period (denominator) and multiplying by 100 to obtain the percentage. Following the implementation of the proposed practice change, the author expects that there will be no incidences of PUs among hospitalized patients during admission. Therefore, there will be a zero incidence rate. The author ill disseminate this data to other stakeholders and staff within the respective units where they can see. The author will also send reports about the outcomes to leadership for performance evaluation, which is an integral step when implementing a change in practice.Pressure Ulcers (PUs) Assignment

References

AHRQ (n.d.). Preventing Pressure Ulcers in Hospitals: How do we implement best practices in our organization? Retrieved from https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu4.html

Gill, E. C. (2015). Reducing hospital-acquired pressure ulcers in intensive care. BMJ Open Quality, 4(1).

In Dang, D., In Dearholt, S., Sigma Theta Tau International, & Johns Hopkins University. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines.

Jacobson, T. M., Thompson, S. L., Halvorson, A. M., & Zeitler, K. (2016). Enhancing Documentation of Pressure Ulcer Prevention Interventions. Journal of nursing care quality, 31(3), 207-214.

Latimer, S., Chaboyer, W., & Gillespie, B. M. (2015). The repositioning of hospitalized patients with reduced mobility: a prospective study. Nursing Open, 2(2), 85-93.

Loewenthal, A. V. (2016). Reducing the Incidence of Hospital-Acquired Pressure Ulcers by Enhancing the Role of Unit-Based Skin Champions.

Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016). An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care. Journal of nursing care quality, 31(1), 75–83. https://doi.org/10.1097/NCQ.0000000000000128

Pressure Ulcers (PUs) Assignment