The Quality Of Health Care Research Paper

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Huston, C. J. (2024). Leadership roles and management functions in nursing: Theory and application (11th ed.). Lippincott Williams & Wilkins. The Quality Of Health Care Research Paper

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Quality health care is a critically significant yet underachieved goal in the United States. The prevalence and scope of medical errors are one of the most important threats to the achievement of quality healthcare care. after heart disease and cancers, medical errors are the third principal cause of death in the US, with 400,000 deaths occurring each year due to medical errors (Marquis & Huston, 2020). Pressure ulcers/ pressure injuries are a significant health issue.  It is approximated that around one and a half million hospitalizations in the US are a result of pressure ulcers.  Pressure ulcers are associated with pain, infection risk, prolonged hospital stay, additional treatment, and increased health care costs(Borojeny et al., 2020)The Quality Of Health Care Research Paper. The purpose of this quality improvement paper is to analyze the incorporation of wearable sensors in pressure injury prevention intervention to meet the Institute of Medicine (IOM) six aims of improving the quality of care

The Problem

Pressure ulcers are a main concern for healthcare facilities because their frequent occurrence is in both pediatric and adult inpatients, diminishing patients’ quality of life of patients. Nutritional status, continence, age, mobility, and activity are factors that increase the risk of an individual developing a pressure ulcer. Also, pressure ulcers increase the costs of health care (Triantafyllou et al., 2021). Padula and Delarmente (2019) posit that pressure ulcers occur in around two and a half million Americans receiving care from acute care facilities each year. The majority of people who develop pressure injuries include the malnourished, the elderly, and those who have been hospitalized for a long time.  Pressure injuries cause severe harm to patients, including the development of chronic wounds. Pressure injuries result in up to 60, 000 deaths each year. Compared to around 63,000 overdose deaths in 2016, 44,000 deaths due to suicide in 2015, and almost 56,000 deaths resulting from influenza from 2015 to 2016.  Despite pressure injury-related deaths being the same and even greater, pressure injuries have not received much attention as a public health crisis.

Hospital-acquired pressure ulcers (HAPIs) increase mortality and morbidity for millions of individuals annually. Internationally, the prevalence of HAPIs is 12.8 percent, and the incidence of HAPIs is 5.4 per 10,000 days spent in the hospital.  HAPIs adversely affect both patient and organizational outcomes. Patients who suffer from HAPIs spend more days in the hospitals (6.7 days) compared to patients without HAPIs who hospital stay in the hospital for 4.5 days on average.  Also, HAPIs are connected with pain, increased infection, and high rates of mortality. Pressure injuries increase the cost of care as a result of lengthy hospital stays, treatment costs, and decreased reimbursement from third parties (Crotty et al., 2023)The Quality Of Health Care Research Paper.

IOM Aims for quality

The IOM classified aspects of care delivery with its six aims of improvement to meet the healthcare needs of the patient and preserve the safety of the patient. the six aims are safety, effectiveness, efficiency, patient-centered care, timing, and equity (IOM, 2001). In addition to the IOM, other organizations focus on improving health care quality and patient safety including the Joint Commission, CMS, and American Nurses Association (ANA). According to Marquis and Huston (2020), the Joint Commission provides accreditation to over 21, 000 healthcare programs and organizations in the United States and has had a significant effect on planning for quality control in hospitals that provide acute care. Also, the Joint Commission maintains databases of serious adverse events/ sentinel events by healthcare providers along with their underlying causes. The Joint Commission defines sentinel as a patient safety event (a condition, incident, or event that could have led or did lead to patient harm) that reaches the patient and leads to severe temporary harm, permanent harm, or death, and intervention needed to sustain life. Such events are termed as sentinel since they are an indicator of the necessity to be immediately investigated and responded to.  All organizations that have obtained accreditation are encouraged, but not mandated to report sentinel events to the accrediting body (Marquis & Huston, 2020)The Quality Of Health Care Research Paper.

The CMS actively participates in setting standards for and gauging quality in health care.  In 2001, the CMs introduced the Medicare Quality Initiative (presently known as the Hospital Quality Initiative (HQI) which targets health outcomes as a source of data. HQI encourages physicians and consumers to discuss and make informed decisions on the way to get optimal care, support public accountability, and incentivize hospitals to improve care. Also, through Medicare, the CMS developed pay-for-performance programs to align quality and payment incentives and to decrease costs via improved efficiency and quality (Marquis & Huston, 2020).

The National Committee for Quality Assurance (NCQA) assesses quality control in healthcare institutions. The NCQA provides accreditation to managed care organizations and has formulated the health plan employer data and information set (HEDIS) for comparing care quality in managed care organizations. Over 90 percent of the nation use HEDIS for measuring performance on significant dimensions of service and care (Marquis & Houston, 2020)The Quality Of Health Care Research Paper.

The ANA founded the National Database of Nursing Quality Indicators (NDNQI) whose purpose is to investigate the relationship between nursing and patient outcomes. Over 2,000 hospitals in the United States and 98 percent of facilities that have received Magnet recognized to take part in the NDNQI program via surveys to improve nurse satisfaction, measure nursing quality, evaluate staffing levels, strengthen the work environment for nurses, and improve how organizations are reimbursed under pay for performance policies. NDNQI provides hospitals with unit-level performance data, enabling them to develop more effective improvements as well as assisting them in understanding the link between staffing data, nursing-sensitive quality indicators, and resisted nurse survey data (Marquis & Houston, 2020)The Quality Of Health Care Research Paper.

Safety

IOM (2001) defines safety as preventing patients from being harmed from care that is aimed at helping them and neither should injury originate from healthcare workers.  Pressure injuries are a significant, frequently underrecognized patient safety problem and have a substantial effect on patients’ quality of life.  They expose patients to the risk of developing infections and sepsis, are associated with pain, and might result in lengthy hospital stays and mortality. Also, pressure injuries expose patients to the risk of psychological trauma and worsened quality of life including absenteeism from work (Gupta et al, 2020)The Quality Of Health Care Research Paper.

Effectiveness

The IOM (2001) defines effective as offering services based on scientific knowledge and desisting from offering services that are unlikely to benefit patients.  Evidence-based pressure ulcer prevention interventions greatly influence the occurrence of pressure ulcers, pressure ulcer prevalence, and pressure ulcer severity per patient. for instance, frequent repositioning of the patient decreases the risk of development of pressure injury, and supporting surfaces are regarded to decrease pressure ulcer incidence more than standard hospital surfaces. Nevertheless, single interventions, like repositioning alone or risk assessment, have not been demonstrated to be as effective as multiple intervention programs.  Also, it is not always easy to implement evidence-based interventions into practice and there is considerable variation in health care professionals’ competence and attitudes towards evidence-based practice and pressure ulcer prevention. Moreover, the self-efficacy of nursing staff in preventing and treating pressure ulcers might also significantly contribute to pressure ulcer prevention interventions (Haavisto et al., 2022)The Quality Of Health Care Research Paper.

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Efficiency

The IOM (2001) defines efficiency as avoiding waste.  An efficient healthcare system is one in which the utilization of resources is to get the best value for money spent. Pressure ulcers lead to a waste of resources and increase the costs of health care. In the US, the cost of pressure ulcer treatment and care is between 9.1 billion dollars and 11.6 billion dollars. Therefore, prevention of pressure ulcers is vital for improving outcomes for patients and lessening the economic burden on both patients and healthcare facilities (Scafide et al., 2020)The Quality Of Health Care Research Paper.

Patient-centered care

The IOM (2001) defined patient-centered care as care that is responsive to and respectful to the values, needs, and preferences of the patient and basing all clinical decisions on patient values. Porkarna et al. (2019) posit that patient-centered care primarily aims at achieving a partnership between patients and families concerning healthcare services delivery.  Health literacy is a crucial component of patient-centered care because it supports patients to become partners in their own health, and it improves the quality of interactions between healthcare systems and patients.  There is a positive association between health literacy and improved self-care practices, better patient experience, and better health outcomes.  For the management of pressure ulcers, health literacy is the extent to which patients can obtain, process, and understand pressure injury-related health information including symptomatology, prevention, and needed services to appropriately make informed decisions about health care.  As such, the involvement of patients is vital (Pokorna et al., 2019)The Quality Of Health Care Research Paper.

Timeliness

Timely is defined by IOM (2001) as reducing waits and harmful delays to both providers and receivers of care. Timeliness is a vital characteristic of a service and is a valued and legitimate focus improvement in the health care industry. (IOM, 2001). Timely repositioning is essential to pressure ulcer prevention. According to Cortes et al. (2021), repositioning is a practice used for pressure ulcer prevention, and its major goal is to lessen mechanical pressure on the skin.  Pressure ulcers occur when repositioning of an immobile patient is done at very low frequencies in 24 hours Clinical practice guidelines recommend that those who are in an altered state of consciousness need to be mobilized every two hours.

Equity

Equity is the provision of care that has no variation in quality as a result of personal characteristics like ethnicity, gender, socioeconomic status, and geographic location (IOM, 2001). The overall prevalence of pressure ulcers among residents admitted in United States nursing homes varies from 5 percent to 20 percent, but for racial/ethnic minorities, the prevalence of pressure is almost two-fold that of Whites. The higher proportion of minority nursing home admissions with a pressure injury might heighten the risk of a disparity in the treatment and help of pressure ulcers (Bliss et al., 2017)The Quality Of Health Care Research Paper.

Interdisciplinary teams

A unified – team-based approach towards prevention of pressure ulcers is endorsed as best practice while interprofessional teamwork is believed to promote interdependency among members of the team, improving staff satisfaction and optimizing patient care. individual interprofessional groups involved in pressure ulcer prevention and treatment include physicians, nurses, nursing assistants, physiotherapists, occupational therapists, podiatrists, and rehabilitation assistants.  To achieve an interprofessional team approach, there is a need for professional groups to be knowledgeable of the causative factors for pressure ulcers and positive attitudes towards pressure ulcer prevention. Assessing the knowledge and attitudes of the interprofessional teams in pressure ulcer prevention and providing pressure ulcer-related training for staff is of great significance in pressure injury prevention (Clarkson et al., 2019)The Quality Of Health Care Research Paper. Gedamu et al. (2021) posit that frequently providing health education and training staff on pressure ulcer prevention is regarded as an element of methods for preventing pressure ulcers.

Nurses input

As the largest group of healthcare providers, nurses are responsible for the delivery of pressure injury prevention care for patients.  According to Gedamu et al. (2021), nurses have the responsibility of providing a good process of nursing to hospitalized patients. Care quality in a specific patient is maintained by applying a good nursing process and it averts pressure ulcer incidence.  Attitudes and knowledge of nurses significantly impact the form of the nursing process along with interventions for patient outcomes. Pressure ulcer prevention can be regarded as intensive nursing which involves regularly assessing and effectively preventing pressure ulcers from developing.  Properly applying tools for assessing the risk of pressure ulcers as the Braden scale can prevent pressure ulcers from developing.  Also, repositioning the patient every two hours and using pressure-relieving mattresses decreases the pressure ulcer development.  If the development of pressure ulcers is occurring, nurses can offer a process of wound healing by changing dressing, continually assessing the wound, and providing appropriate nutrition for the maintenance of quality of care. prevention of pressure ulcers is an important challenge for nursing and its occurrence is regarded as a poor care quality indicator.

Technology

Patient repositioning every two hours lessens the duration of periods of exposure of body tissues to pressure, thus reducing the probability of the occurrence of a pressure injury.  The majority of guidelines suggest that patients at risk of developing a pressure ulcer should be turned to optimally offload bony prominences and maximize redistribution of pressure.  Conventionally, turn protocols necessitate adherence to a two-hour repositioning interval, yet this standard is hardly met (Nherera et al., 2021). Incorporating wearable sensors in pressure prevention programs sensors is one way of preventing pressure ulcers. Pressure injury prevention usually involves implementing bundles for pressure prevention.  There is the inclusion of turn protocols, which involve repositioning patients at set intervals to relieve pressure are included in the pressure prevention. wearable monitoring devices track patient turns and can increase compliance with pressure injury prevention interventions by using wearable monitoring devices that track tuns. The sensors are applied on the patient’s chest and utilized in tracking the time between turns as well as the quality of repositioning to augment repositioning protocol compliance (Crotty et al., 2023)The Quality Of Health Care Research Paper.

A wireless sensor and a computer/tablet are technologies. A wearable wireless sensor gathers data on body pressure over time and wirelessly transfers it to a computer at a control center.  After the sensor is connected to the patient, the tablet tracks the whereabouts of the patient.  The nurses need to select a cutoff from a preset array of degrees to differentiate a  turn from other forms of body movements. The default settings of the patient are modified to account for their motion level.   Through a color-coded system, the computer display notifies and automatically assists the health care provider through the repositioning task.  Green indicates that there is no scheduling of the patient for repositioning while amber signifies that a patient is about to make a turn.  Red indicates there is an urgent need for patient turn and the position needs to be changed (Deshpande et al., 2023)The Quality Of Health Care Research Paper.

Quality improvement

Over the last numerous decades, the United States healthcare system has shifted from a quality assurance model to a model that focuses on quality improvement.  Quality improvement models target ongoing and continuously improving quality.  Total quality management/ continuous quality improvement, (CQI) is a model that emphasizes the continuing nature of quality improvement.  Dr. W. Edward Deming developed the CQI philosophy. CQI assumes that service and production focus on an individual and that quality can always be improved. Therefore, recognizing and doing the correct things, the first time, the right way planning and preventing but not inspecting, and reactively solving a problem can result in quality outcomes.  Since CQI is a non-stop  process all things and people   in an organization should be engaged in  continuous  efforts to improve quality (Marquis & Huston, 2020)The Quality Of Health Care Research Paper

Pressure injury is a disease that can be prevented with more room for improvement. However, despite medical advancements, the has been a slight increase in pressure injury incidence over recent years In 2020, the National Pressure Ulcer Advisory Panel reached a consensus that although all pressure ulcers cannot be prevented, the majority are preventable (Siotos et al., 2022).  A 2007 CMS ruling categorized pressure ulcers acquired in the hospitals as never events and in 2008, halted making reimbursements to healthcare facilities for the costs of offering treatments to patients with pressure injuries.   According to the CMS a HAPI, as a secondary diagnosis makes an additional 1,180 dollars to each stay at the hospital (Scafide et al., 2020)The Quality Of Health Care Research Paper.

Evidence-based research

Several research studies have demonstrated the effectiveness of wearable sensors in preventing pressure ulcers. The study by Crotty et al. (2023) which aimed at examining the impact of wearable sensors on healthcare organizations, nurses, and patients demonstrated that wearable sensors heightened patient repositioning compliance and decreased the rates of HAPIs and associated costs. Wearable sensors can improve the turning of patients as the sensors enable providers to swiftly recognize patients in need of repositioning. Another study by Nherera (2021) demonstrated that patient wearable sensors are effective in preventing HAPIs and improving compliance with patient repositioning. This implies that wearable sensors should be considered for their clinical effectiveness and potential to save resources since they are less expensive.

The study by Turmell et al. (2022) demonstrated that cueing technology such as wearables sensors has the potential to improve patient safety by enabling healthcare providers to comply with routine repositioning schedules. The wearable sensors offer staff visual indications about the positions and repositions needs of patients (Turmell et al., 2022). The study also demonstrates that a visual cue can prompt members of the staff to assemble resources and supplies including additional members to safely turn the patient.  Also, the study revealed that members of the nursing staff had the perception that the visual cues enhanced a feeling of improved teamwork.  Members perceived that there was improvement in teamwork when information about the repositioning needs of patients was displayed in the unit. Also, cueing was believed to influence communication and teamwork by facilitating the capacity of staff members to more easily share repositioning activities (Turmell et al., 2022)The Quality Of Health Care Research Paper.

Conclusion

Pressure injuries are an important patient safety issue and their prevention fits with the IOM’s six aims of improving quality.  Pressure injuries are associated with morbidity and mortality for hundreds of individuals in the United States and millions of individuals globally each year. HAPIs are connected with pain, prolonged hospital stays increased infection, and high rates of mortality. In addition to adversely impacting the quality of care, HAPIs increase the cost of care as a result of lengthy hospital stays, treatment costs, and decreased reimbursement from third parties.  Patient repositioning is a major strategy of pressure injury prevention, but health care providers do not frequently reposition patients as required.  Wearable sensors are a technology that prevents the development of pressure ulcers by enabling providers to comply with repositioning protocols. Studies have demonstrated that wearable sensors heightened patient repositioning compliance and decreased the rates of occurrence of pressure injuries and associated cost of care.

References

Bliss, D. Z., Gurvich, O., Savik, K., Eberly, L. E., Harms, S., Mueller, C., Garrard, J., Cunanan, K., & Wiltzen, K. (2017). Racial and Ethnic Disparities in the Healing of Pressure Ulcers Present at Nursing Home Admission. Archives of Gerontology and Geriatrics, 72, 187-194. doi: 10.1016/j.archger.2017.06.009

Borojeny, L. A., Albatineh, A. N., Dehkordi, A. H., & Gheshlagh, R. G. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International Journal of Preventive Medicine, 11,171. doi: 10.4103/ijpvm.IJPVM_182_19

Clarkson, P., Worsley, P. R., Schoonhoven, L., & Bader, D. L. (2019). An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation. Journal of Multidisciplinary Healthcare. 12, 377-386. doi: 10.2147/JMDH.S195366.

Cortes, O. L.,  Herrera-Galindo, M., Villar, J. C., Rojas, Y. A., Paipa, M. P., & Salazar, L. (2021). Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nursing, 20, 121. doi: 10.1186/s12912-021-00616-0.

Crotty, A., Killian, J. M., Miller, A., Chilson, S., & Wright, R. (2023). Using wearable technology to prevent pressure injuries: An integrative review.  Worldviews on Evidence-Based Nursing, 20(4), 351-360. https://doi.org/10.1111/wvn.12638

Deshpande, B., Hanumanthayya, M., & Niwas, R. (2023). Development of a Wearable Technology for the Early Detection of Pressure Ulcers in Nursing Homes. Salud, Ciencia y Tecnología, 3(S1):458doi: 10.56294/saludcyt2023458

Gedamu, H., Abate, T., Ayale, E., Tegenaw, A., Birhanu, M., & Tafere, Y. (2021). Level of nurses’ knowledge on pressure ulcer prevention: A systematic review and meta-analysis study in Ethiopia. Heliyon, 7(7), e07648. doi: 10.1016/j.heliyon.2021.e07648 The Quality Of Health Care Research Paper

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Gupta, P., Shiju, S., Chacko, G., Thomas, M., Abas, A., Savarimuthu, I., Omari, E., A-Balushi, S., Jessymol, P., Matthew, S., Quinto, M., McDonald, I., & Andrews, W. (2020). A quality improvement programme to reduce hospital-acquired pressure injuries. BMJ Open Quality, 9, e000905. doi:10.1136/bmjoq-2019-000905

Haavisto, E., Stolt, M., Puukka, P., Korhonen, T., & Kielo-Viljamaa, E. (2021). Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study. International Wound Journal, 19(5), 1141-1157. https://doi.org/10.1111/iwj.13710

Institute of Medicine (2001).  Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.

Marquis, B., Huston, C., (2020). Leadership Roles and Management Functions in Nursing. 9th edition. Wolters Kluwer

Nherera, L., Larson, B., Cooley, A., & Reinhard, P. (2021). An economic analysis of a wearable patient sensor for preventing hospital-acquired pressure injuries among the acutely ill patients. International Journal of Health Economics and Management, 21(4), 457-471. doi: 10.1007/s10754-021-09304-7

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. doi: 10.1111/iwj.13071

Pokarna, A., Klugar, M., Kelnarova, Z., &  Kulgarova, J. (2019). Effectiveness and Safety of Patient-centred Care Compared to Usual Care for Patients with Pressure Ulcers in Inpatient Facilities: A Rapid Review. The Journal of the European  Wound Management Association, 20(1), 61-71.

Siotos, C., Bonett, A. M., Damoulakis, G., Becerra, A. Z., Kokosis, G., Hood, K., Dorafshar, A. H., & Shenaq, D. S. (2022). Burden of Pressure Injuries: Findings From the Global Burden of Disease Study. Eplasty, 22, e19.

Scafide, K. N., Narayan, M. C., & Aerundel, A. (2020). Bedside Technologies to Enhance the Early Detection of Pressure Injuries: A Systematic Review.  Journal of Wound, Ostomy, and Continence Nursing, 47(2), 128-136. DOI: 10.1097/WON.0000000000000626

Shenoy, A. (2021). Patient safety from the perspective of quality management frameworks: a review. Patient Safety in Surgery, 15,12. doi: 10.1186/s13037-021-00286-6

Triantafyllou, C., Chonrianopoulous, E., Kourkkouni, E., Zaoutris, T. E., & Kourlaba, G. (2021). Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis. International Journal of Nursing Studies, 115, 103843. https://doi.org/10.1016/j.ijnurstu.2020.103843

Turmell,  M., Cooley, A., Yap, T. L., Alderden, J., Sabol, V. K., Lin, J. A., & Kennerly, S. M. (2022). Improving Pressure Injury Prevention by Using Wearable Sensors to Cue Critical Care Patient Repositioning. American Journal of Critical Care, 31(4), 295-305. doi: 10.4037/ajcc2022701.  The Quality Of Health Care Research Paper