Pressure Ulcers – Change in Practice

Student’s Full NameWalden University

Example: NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice

Month, Day, Year

Introduction

Pressure ulcers among patients who are hospitalized is a significant problem to healthcare. Incidence of pressure ulcers continue to rise despite the modern technological advancement and development of strategies that are aimed at handling the ulcers. The purpose of this assignment is to find a recommend a practice change that would help handled pressure ulcers and reduce their rate of occurrence.

The Problem

Pressure ulcers or bedsores are a condition that occurs in patients that have been hospitalized for long periods of time. They are a product of staying immobile for long periods of time and mostly occur in places that experience enormous pressure when patient lays in one position for a long period of time (Magnan & Maklebust, 2009). They occur when subcutaneous tissues are compressed leading to impediment of perfusion and development of tissue necrosis. In humans, the normal capillary blood pressure ranges between 20 and 40mm Hg, therefore 32mm Hg is considered as average pressure. In this regard, maintaining the external pressure bellow 32mm Hg should adequately prevent pressure ulcer development. Unfortunately, comorbid condition and hemodynamic instability in critically ill patients can reduce the capillary pressure to far below 32mm Hg. As a result, any slight external pressure can lead to formation of bedsores. Ulcerations can develop in as few as two hours. With this in mind, the key to preventing formation of bedsores is promptly and accurately indentifying high risk patients and implementing preventive measures as quickly as possible.

Pressure ulcers are a significant nursing problem. They cause a lot of pain, reduces the rate of recovery and result in disfigurement. Pressure ulcers also interfere with the patients daily activities. Pressure ulcers have also be reported to cause death in patients. In most cases, the ulcers do not lead to death directly, but lead to development of other fatal ailments that claims the patient’s life. Mortality rate is noted to be high in elderly patients. According to Lyder & Ayello (2008) motility rate is as high as 60% in older patient who have been hospitalized for about a year. Postsugery skin breakdown in the old people can lead permanent impairment. The ulcers are costly. Over $11 billion are spend on treatment and management of pressure ulcers yearly (Gill, Reddy, & Rochon, 2006)

Practice Change

In order to minimize the prevalence of bedsores, nurses need to change the way they handle the condition. Evidence suggests that, even though there are attempts to prevent patients from suffering pressure ulcers, these prevention efforts are not consistent. According to Lyder (2003) if a change in the way the handling of pressure ulcer is done, it could radically reduce the suffering patient have to endure. Unfortunately, pressure ulcer prevention has been left on the nurses alone and this needs to change.

Evidence based procedures for prevention of pressure ulcers encourage programs that have been developed and refined. Unfortunately, there mere existence does not guarantee results. Despite positive results from some programs, such as reduced rates of occurrence, and reduced care cost, incidences of pressure ulcers continue to rise in several quarters. This is a clear indicator that the preventive approaches in place are not consistent. Therefore, there is need to change or improve the current evidence based practices. The implementation of the preventive mechanism needs to be bolstered through administrative support and participation of all hospital staff, the patients and patients’ family.

Inconsistencies are a product of shortcoming in the implementation of evidence based practices (Holmes 2011). For instance, nurses fail to conduct comprehensive skin analysis of patients before admission. Some nurses are not well trained on how to use the Braden scale reliably and accurately. Finally, it is sometimes difficult to have all the necessary resources required to deliver at least three preventing practices within a day of admission. To rectify this nurse need to change their approach to bed sore. Skin analysis should be emphasized before hospitalization, nurse should be trained on how to use Braden scale effectively and the administration should support nurses by providing adequate resources.

Rationale for practice change

Evidence-based nursing care plans or programs make use of several evidence-based strategies that serve to complement each other. In implementing evidenced based prevention of pressure ulcers risk assessment is important. This assessment is supposed to be done immediately a patient receives recommendation for hospitalization. This first procedure necessary for risk assessment is skin analysis. Skin analysis is supposed to be conducted on patient to determine their vulnerability to pressure ulcers. However, nurses fail to conduct this simple but important procedure. However as Holmes (2011) reports nurses sometime, due to various reasons fail to perform comprehensive skin assessment immediately a patient is admitted. This is detrimental since as Holmes (2011) notes, “ability to identify area of skin breakdown acquired before hospitalization is a significant aspect of nursing assessment.”

Assessment of the skin cannot be done without knowledge of what to look for and indicators of vulnerability (Wilkins, 2011). It is unfortunate the large number of nurses do not know how to use the Braden scale appropriately. Holmes (2011) encouraged training of nurses in 65 institutions where he conducted studies on evidence based prevention of bedsores. He noted positive result from the training of nurses.

Finally, inadequacy of resource for evidence-based practices in prevention of pressure ulcers is also an issue of great concern. Holmes (2011) noted that most supplies in many hospitals are locked away. To access them nurses require administrative authorization. Perhaps this is one of the reasons that inhibit comprehensive skin assessment upon admission. However, corporation between the administrative staff and the nursing staff proves to be an effective solution to this problem (Wilkins, 2011). In a study conducted between 2005 and 2007, Holmes (2011) reported a reduction in the incidences of pressure ulcers by 70% through the correction of the above three sub practices of evidence based pressure ulcer prevention practices.

Evaluating Change

Implementation of the above correction practices is expected to reduce incidences of pressure ulcers. In order to evaluate the productivity of change in practices, the rates of occurrence of pressure ulcer in hospital A where the changes will be implemented will be recorded alongside the rate in a different institution, hospital B where the changes will not be instituted. The rate will be recorded after every three months for a year and afterwards compared. The rate of hospital A at the end of every three months and after a year will be compare with the rates before the implementation of the changes. The rates will also be compared with those of hospital B. If we find positive results from hospital A then the changes have worked. If the results are negative then the changes have not yielded any fruits. If there is no change and the result of A and B show similarities that the results are neutral and the changes ineffective.

Conclusion

Pressure ulcer is a significant problem to health care. Despite adoption of evidence based practices to deal with the problem man patient continue to suffer from pressure ulcers. These ulcers lead to pain, impairments and sometimes death. Evidence based practices fail due luck of proper skin assessment during hospitalization, inability of nurse to use Braden scale which is the best scale for indicating vulnerability, and lack of adequate resources to conduct risk analysis in the shortest time possible.

References

Gill, S. S., Reddy, M., & Rochon, P. A. (2006). Preventing pressure ulcers: a systematic review. JAMA.296(8)974–984

Guy, H. (2007). Pressure Ulcer Risk Assessment and Grading. Nursing Times 103(15);38 Retrieved from HYPERLINK “http://www.nursingtimes.net/nursing-practice/clinical-specialisms/wound-care/pressure-ulcer-risk-assessment-and-grading/201872.article” http://www.nursingtimes.net/nursing-practice/clinical-specialisms/wound-care/pressure-ulcer-risk-assessment-and-grading/201872.article

Holmes, A. M. (2010). Evidence-based nursing Another look: Best practices for pressure ulcer prevention. Nursing Management. 41(1); 15 – 16

Lyder . C. H. (2003). Pressure ulcer prevention and management. JAMA.;289(2): 223–226.

Lyder, C. H., & Ayello, E. A. (2008). Pressure Ulcers: A Patient Safety Issue. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2650/

Magnan, M. A., & Maklebust, J. (2009). The Nursing Process and Pressure Ulcer Prevention: Making the Connection. Advances in Skin & Wound Care: The Journal for Prevention and Healing. 22 (2) Pages 83 – 92.

Wilkins, E. (2011).Preventing Pressure Ulcers. Retrieved from HYPERLINK “http://thewoundcentre.com/a/366/preventing-pressure-ulcers-by-eileen-wilkins-for-the-wound-centre-february-2011/” http://thewoundcentre.com/a/366/preventing-pressure-ulcers-by-eileen-wilkins-for-the-wound-centre-february-2011/