NIP3803 Consolidating Knowledge in Adult Nursing Assessment Answer

Formative Assessment

The following formative assessment presents a comprehensive framework for quality improvement in healthcare, emphasising the prevention of pressure ulcers, which will significantly impact patient well-being and healthcare costs. Based on the Model for Improvement (MFI), the strategy will offer a defined technique for coming up with, trying out, and implementing changes in healthcare procedures. This technique promotes an intentional approach to change and is science-based (NHS England, 2022). Identifying what needs to be improved is the initial critical step. The project aims to improve nurses' knowledge of pressure ulcer prevention, patient outcomes, healthcare cost reduction, and overall care quality. It emphasises how crucial it is to provide doctors with the knowledge and abilities to change and enhance their clinical practices.

Measuring the success of a quality improvement initiative will be equally crucial. The plan suggests pre- and post-assessments of nurses' understanding of preventing hospital-acquired pressure ulcers. The effectiveness of the quality improvement project will be evaluated by comparing the baseline knowledge with post-assessment results. Additionally, surveys, examination of HAPU prevalence, and patient outcome observations will be used to assess the project's success (Alshahrani et al., 2023). The ultimate goal is to enhance nurses' knowledge and improve patient satisfaction, thus raising the quality of care.

The plan will recommend several changes to achieve these objectives, including introducing an evidence-based awareness program. This program will focus on training and education on the causes and prevention of pressure ulcers in clinical settings. It also will advocate making resources like training sessions, educational materials, and peer-to-peer mentoring available to healthcare professionals participating in the initiative. Another essential change will be adjusting clinical procedures and guidelines to reflect the latest evidence-based techniques. Furthermore, implementing a monitoring and evaluation system will ensure ongoing success and the ability to address any challenges during implementation (Antony et al., 2023).

In addition to the MFI, the Plan-Do-Study-Act (PDSA) cycle will be introduced as an organised and iterative approach to problem-solving and continuous improvement (Agency for Healthcare Research and Quality, 2020). The PDSA cycle consists of four phases. It begins with identifying the problem, setting measurable improvement goals, and creating a strategy. The next phase will involve implementing the plan and collecting data and observations to assess the changes. The results will be analysed in the Study phase to determine if the objectives were met. Based on this analysis, the Act phase will decide whether to standardise, adjust, or reject the changes (McQuillan et al., 2016).

In conclusion, the presented framework provides a systematic approach to quality improvement in healthcare, specifically focusing on preventing pressure ulcers. By emphasising the importance of nurses' knowledge and skills, setting clear goals, and using structured improvement cycles like PDSA, healthcare organisations can work towards increasing patient outcomes, lowering expenses, and raising the standard of care. This approach acknowledges healthcare's complex and multifaceted nature and aims to fill knowledge gaps within the industry while offering a patient-centred and adaptable strategy for continuous improvement.

Enhancing nurses' understanding of how to prevent pressure ulcers acquired in hospitals through raising awareness

Abstract

Background: Hospital-acquired pressure ulcers (HAPUs), which cause patients pain and discomfort and raise healthcare expenditures, are a major concern. Despite the fact that nurses are essential in resolving this problem, knowledge gaps frequently exist. Increasing nurses' understanding and knowledge may be the solution to this issue.

Method: By enhancing nurses' understanding and comprehension of recommended practices, this quality improvement (QI) program seeks to lower the incidence of pressure ulcers developed in hospitals. The Plan-Do-Study-Act (PDSA) cycle serves as a roadmap for the intervention in this QI approach. The knowledge and understanding of the nurses will improve with the help of evidence-based training programs and HAPU prevention awareness.

Expectation: Based on pre-and post-test results, nurses are expected to significantly improve their understanding of HAPU prevention following the intervention. Additionally, a considerable decrease in HAPU incidence is anticipated, demonstrating the effectiveness of the intervention.

Conclusion: Using a systematic change management framework and a continuous improvement approach, this QI endeavour will show how educating nurses about HAPUs and increasing their awareness of them may considerably lower the incidence of HAPUs. It emphasises the need for system-level reform and ongoing nurse education in healthcare organisations to improve patient outcomes.

Background

Pressure ulcers (PUs) developed in patients treated at a hospital or healthcare facility are called nosocomial, healthcare-associated, or hospital-acquired pressure ulcers (Rondinelli et al., 2018). Pressure or friction on the skin for an extended period can cause these pressure ulcers, which can happen when patients are sedentary or unable to shift their body weight. Hospital-acquired pressure ulcers can be a significant issue because they are considered preventable and indicate gaps in care. Each year, PUs afflict more than 700,000 individuals in the UK, with 180,000 newly developed cases. The National Health Service (NHS) loses more than 3.8 million daily due to pressure ulcers. PUs were expected to cost the NHS £1.4–£2.4 billion annually in 2014, accounting for 4% of all NHS spending (Wood et al., 2019). PUs commonly form when the skin and underlying tissues are crushed or torn against objects like beds or chairs (Zaidi & Sharma, 2020).

HAPUs frequently develop on the spine, heels, hips, and other areas of bone. HAPUs formed in a hospital can result in several issues, such as infection, slow wound healing, pain, and occasionally severe tissue damage (Zaidi & Sharma, 2020). Healthcare professionals frequently use preventive strategies to stop these ulcers, including routine repositioning of patients, specialised support surfaces (such as pressure-relieving mattresses), and skin examinations to spot at-risk patients (Mäki-Turja-Rostedt et al., 2019). Patient safety and the general standard of healthcare provided in hospitals and other medical facilities depend heavily on preventing hospital-acquired pressure ulcers (Wu et al., 2022). A significant risk factor for HAPUs is immobility. Because they cannot transfer their body weight to relieve pressure on sensitive areas, patients who are bedridden or have limited mobility, such as those recovering from surgery, are more vulnerable (Jaul et al., 2018). A critical factor in the development of HAPU is prolonged pressure, which occurs when body parts are subjected to constant pressure, typically from sitting or lying still for long periods.

The risk of HAPUs is increased by skin injury caused by friction and shear pressures. Skin damage can result from excessive skin-to-bedding or clothing friction, especially when shifting patients. Age also has an impact because elderly people frequently have less flexibility and blood flow in their skin, which makes their skin more prone to injury (Gillespie et al., 2020). The nutritional status is also essential since poor nutrition and dehydration can harm the skin's health and impede the body's natural healing processes. Excessive moisture, usually from incontinence or sweating, softens the skin and increases its susceptibility to injury (Saghaleini et al., 2018). The risk may also be raised by skin sensitivity, certain drugs, and medical disorders, including diabetes or vascular disease (Jaul et al., 2018). Pressure ulcers may develop due to medical equipment like oxygen masks, tubes, or splints applying pressure to the skin (Kim et al., 2019). Individuals with cognitive impairment may be unaware of the need to reposition or be unable to do so independently, making them more vulnerable to HAPUs (Young, 2021). The risk of pressure ulcers is increased by shear forces that might harm deeper tissues when patients slip down in a chair or bed (Al Aboud & Manna, 2018). Lastly, pressure ulcers can form due to surgical operations and anesthetics temporarily reducing mobility and feeling. It is critical in healthcare settings to screen patients for these risk factors at check-in and throughout their stay (Kim et al., 2018).

Literature Review

Pressure sores and bedsores, other names for pressure ulcers, have a clear pathophysiological development across several stages. The first and most crucial phase in the formation of a pressure ulcer is ischemia. Ischemia is brought on by persistent pressure on the skin, which prevents blood from flowing freely via the tiny blood vessels (capillaries) supplying the injured tissue (Mervis & Phillips, 2019). This decrease in blood flow prevents the tissue's cells of vital nutrients and oxygen, setting off a chain of adverse events. The tissue becomes hypoxic as ischemia worsens, which means it is oxygen-deprived. Cellular hypoxia damages the cells' metabolic functions, resulting in cell malfunction and cell death. As the body works to repair the tissue damage, inflammatory responses are set off, drawing in white blood cells and resulting in redness, heat, and swelling (Mervis & Phillips, 2019). The goal of inflammation is to eliminate damaged cells and speed up healing. However, in chronic pressure ulcers, the inflammation may persist for a long time and pose a problem, delaying recovery. The deepest layers of the skin begin to experience tissue necrosis or cell death when ischemia and inflammation are left untreated. The deeper tissues, such as muscle and bone, may become affected by this necrosis as it advances (Mervis & Phillips, 2019). Stages I through IV define the extent of pressure ulcers according to the depth and scope of tissue involvement. Infection is a frequent complication of pressure ulcers because, in addition to causing tissue injury, tissue breakdown fosters the growth of germs. If an infection is not adequately treated, it may develop into a systemic illness, endangering the patient's general health (Zaidi & Sharma, 2020).

One of the most challenging parts of evaluating pressure ulcers is accurately diagnosing Stage I. Stage II or higher pressure ulcers and ulcers that cannot be staged are easily distinguished by open sores (Westby et al., 2017). Stage I pressure ulcers, in contrast, may not noticeably alter colour and continue to look red (NHS Inform, 2023). Frequently, ulcers are related to the patient's prolonged resting on the injured area. Deep-tissue injuries are frequently misinterpreted as superficial contusions even though they are simple to recognise (Black et al., 2016). Vigilance is necessary to diagnose appropriately and record pressure ulcers. Pressure ulcer progression must be stopped with proper training in assessing stage I pressure ulcers. A medical facility may reverse stage I pressure ulcers with minimal expenditures using effective prevention techniques, such as routine turning and customised air mattresses (Mäki‐Turja‐Rostedt et al., 2019). As a result, a thorough inspection of these areas must be done when a patient is turned or returns from a procedure like surgery, radiography or dialysis. During such procedures, patients must lie on hard surfaces for extended periods, which is ideal for developing pressure ulcers (Gefen et al., 2020). Annual skills give nursing professionals a solid foundation to identify pressure ulcers accurately. Nursing accountability and responsibility for environmental issues are crucial for the success of this strategy (Ebi et al., 2019).

Healthcare workers need pressure ulcer assessment measures to consistently evaluate and classify the severity and hallmarks of pressure ulcers. One widely known approach is the NPUAP Pressure Injury Staging System, created by the National Pressure Ulcer Advisory Panel (NPUAP). This pressure ulcer staging system provides a systematic method to categorise and follow the development of these lesions. It defines four primary pressure ulcer stages (Mervis & Philips, 2019). The initial stage of a pressure ulcer is Stage I, during which the skin appears healthy but has an unbleachable redness. Warmth, coolness, stiffness, softness, and even discomfort or itching in the affected area are all possible for patients to feel (Zaidi & Sharma, 2020). Moreover, a literature review by Gunowa et al. (2020) revealed that people with darker skin tones may have difficulty identifying stage I ulcers since they may not be visibly noticeable. These ulcers often show that the skin is injured, even though it is not ruptured, and if the pressure is released, it may heal quickly (Westby et al., 2017).

When a pressure ulcer reaches Stage II, the skin begins to lose some thickness, showing up as a shallow, pink or red incision resembling a crater. At this point, the wound could develop into an open ulcer, making the patient uncomfortable and perhaps infecting the patient (Zaidi & Sharma, 2020). In contrast to Stage I ulcers, Stage II ulcers may take longer to heal. Stage III Pressure ulcer involves full-thickness skin loss along with injury to or necrosis of subcutaneous tissue, which can reach but does not penetrate the underlying fascia, referred to as an ulcer (Zaidi & Sharma, 2020). These ulcers appear as deeper lesions with crater-like shapes with a yellow or necrotic base. At this point, infections are widespread, slows and complicates the healing process (Mortazavi et al., 2016). The most severe stage, Stage IV Pressure Ulcer, is characterised by substantial full-thickness skin loss and injury that may also affect supporting structures like muscles or bones. These ulcers are frequently deep holes that expose the muscles, tendons, or bone beneath. Stage III and IV ulcers require careful attention and, in certain instances, surgical procedures to heal because they are particularly prone to infection (Zaidi & Sharma, 2020).

Firstly, a thorough risk assessment is critical to preventing pressure ulcers. Patients at risk of getting pressure ulcers are often identified using instruments like the Norton or Braden Scale. Individual risk levels must be considered while developing preventative strategies (Moore & Patton, 2019). According to a systematic review by Gaspar et al. (2019), early risk assessment was found to lower the occurrence of pressure ulcers dramatically. Second, repositioning is crucial to preventing pressure ulcers. At least every two hours, the patient should be moved to relieve pressure on the bony regions and prevent tissue injury (Gillespie et al., 2020). Thirdly, another vital step is to use pressure-relieving support surfaces, like customised mattresses, overlays, and cushions. These surfaces uniformly distribute pressure and lessen the chance of developing ulcers (McInnes & Leung, 2018). Results from a randomised control trial by Nixon et al. (2019) reveal a statistically significant effectiveness of pressure-reducing support surfaces in preventing pressure ulcers. Fourthly, pressure ulcer prevention involves skin care significantly. Skin must be kept dry, clean, and moisturised at all times. Avoiding harsh soaps and excessive dampness is vital (Better Health Channel, 2021). According to Black et al. (2016), these procedures have been linked to a lower risk of pressure ulcers.

Additionally, a significant component in preventing pressure ulcers is a good diet. A balanced diet and careful monitoring of nutritional intake, especially of protein and vitamins, promote the health and repair of the skin (Saghaleini et al., 2018). A study by Taylor (2017) emphasises the value of nutrition in preventing pressure ulcers. Additionally, preserving skin suppleness and general health depends on enough hydration. Keeping patients well-hydrated is essential since dehydration increases the incidence of pressure ulcers (Saghaleini et al., 2018). Management of incontinence is yet another essential component of prevention. It is critical to address incontinence concerns immediately because continued moisture exposure raises the risk of ulcers. The skin can be protected by applying moisture-barrier lotions or ointments Hommel & Santy-Tomlinson, 2018). Furthermore, successful prevention relies on education. Patients, healthcare professionals, and their families should receive education regarding pressure ulcer prevention. This covers appropriate repositioning and turning procedures, the value of nourishment, and skin care (Moore et al., 2018). According to a review by Moore & Patton (2021), patient and caregiver education programs have been proven beneficial in lowering pressure ulcers.

Supportive equipment helps relieve pressure on delicate areas, such as elbow and heel guards (Greenwood et al., 2017). According to Greenwood et al. (2017), these devices benefit patients at a high risk of developing pressure ulcers. A pilot study by Higuchi et al. (2023) revealed that using sliding sheets or positioning tools to lessen friction between the patient's skin and the bed is beneficial in preventing pressure ulcers. Specialised beds, such as reduced air loss or alternating pressure mattresses, can be helpful for individuals who are at high risk. These mattresses aid in pressure distribution and skin integrity preservation (Shi et al., 2021). In addition, to identify early indications of pressure ulcers, routine skin examinations are essential. If any treatment plans are found, they should be implemented immediately to stop the wounds from worsening (Mondragon & Zito, 2020). In order to ensure that everyone on the healthcare team is informed of prevention techniques and their roles in patient care, effective communication is essential. Pressure ulcer incidence is decreased, and the overall quality of care is improved because of this collaborative approach (Hommel et al., 2017). Individualised care plans based on a patient's risk assessment are required to deliver the best possible care. To effectively prevent pressure ulcers, these plans should consider the patient's requirements and circumstances (Mitchell, 2018). Lastly, skin integrity in patients must be continuously monitored. As a result, healthcare providers can modify prevention methods to maintain continuing pressure ulcer protection (Al Aboud & Manna, 2018).

AIM

The objective of this research is to suggest a Quality Improvement (QI) strategy that emphasises nurses' knowledge of how to reduce pressure ulcers contracted in hospitals by increasing knowledge and understanding. Quality improvement describes a coordinated attempt by healthcare professionals to identify and remedy issues in clinical practice. Through the implementation of QI, clinicians can acquire, integrate, and apply their essential professional abilities to create initiatives to promote and manage change (Worsley et al., 2016). Evidence-based therapy and online awareness will be used to do this, and they will take up 3.5 hours of each study session over the semester. Pathophysiology, aetiology, and assisting patients in managing their illnesses will be the main topics of the educational campaign. The QI program seeks to improve nurses' knowledge of preventing hospital-acquired pressure ulcers by increasing awareness. This project team will also contain technical specialists, a team leader, an improvement consultant, and a sponsor responsible for the execution of processes to ensure it has the necessary leadership, experience, management and competence to succeed. Although team members can come from any area of healthcare, the primary stakeholders in this QI initiative will be healthcare professionals and patients/families (Silver et al., 2016).

Key Stakeholders

Stakeholders are interested individuals or groups who can negatively or positively affect the outcome of a project. Building relationships and managing any issues need early identification of these stakeholders. Addressing the concerns of those who oppose change as the project progresses could help prevent conflicts and delays. To find stakeholders, a stakeholder mapping and analysis approach will be used (UNC School of Medicine, 2023.).

This requires listing all prospective stakeholders, categorising, and specifying the connection to the project's primary quality intervention. After identifying stakeholders, the issues will be prioritised using a power versus interest grid that considers the stakeholders' political interests and organisational power. This grid will identify the stakeholder groups that qualify for inclusion in the project and the extent of engagement considering each group (UNC School of Medicine, 2023.).

Any quality improvement plan within the healthcare system must include healthcare professionals and patients as key stakeholders. The success of such projects depends on the cooperation of these two interconnected groups. Medical experts, such as doctors, nurses, and other clinical staff, bring extensive clinical expertise. They highlight problem areas, suggest evidence-based procedures, and are crucial in developing the quality improvement strategy (Melnyk & Fineout-Overholt, 2022). Additionally, healthcare personnel must implement the improvements the quality improvement plan suggests. The plan's effectiveness depends on their readiness to follow new standards, protocols, or practices (The Health Foundation, 2021). The efficient implementation of the plan is greatly aided by their knowledge and commitment to patient care (Gary et al., 2021). Healthcare professionals also assume the function of continuous monitors, continuously evaluating the effect of the approach on patient outcomes. Their attention to detail and feedback systems are essential for optimising the plan and ensuring it accomplishes its objectives (Brennan et al., 2017).

Similarly, patients are the centre of the healthcare system, and quality improvement relies heavily on their experiences and viewpoints. Patients share their perspectives on their medical experiences and point out areas that could be better. They provide vital feedback that helps medical practitioners better comprehend their needs and concerns (Kennedy et al., 2017). It is crucial to involve patients in their care; informed patients actively engage in their care, follow treatment plans, and considerably improve health outcomes (Bombard et al., 2018). Lastly, patients are crucial in advocating for both themselves and other people. In order to make decisions regarding their care in conjunction with healthcare experts, patients can also engage in shared decision-making (Galletta et al., 2022).

Method

Model for Improvement

The model for improvement offers a framework for creating, experimenting with, and implementing improvements. It is grounded in scientific methodology and tempers the urge to act right away with the wisdom of deliberate research. Individuals or organisations must grasp their aims and what they hope to accomplish when planning any reform or modification to work procedures (NHS England, 2022). This clarity is essential for determining the best action and ensuring the improvement aligns with the desired results. They also need to develop reliable criteria for gauging progress. These measurements operate as benchmarks, aid in assessing the degree of advancement made, and offer insightful information regarding the effects of the change. It is also recommended that persons engaging in process improvement be clear about the idea or modification they aim to test (NHS England, 2022). Establishing realistic expectations and evaluating the outcomes are made more accessible by clearly outlining the extent of the change and its anticipated impacts. Using this controlled process, it is possible to identify any unforeseen difficulties, modifications, or places for development without putting the entire firm at needless risk. It also offers a chance to improve the effectiveness of the improvement strategy (NHS England, 2022).

Figure 1: Model for Improvement

Source: https://www.ihi.org/resources/Pages/HowtoImprove/default.aspx

What are we trying to accomplish?

The project aims to raise awareness and help nurses learn how to prevent pressure ulcers from developing in hospitals. The purpose of this project is to develop and implement a QI initiative that will address this issue by improving nurses' knowledge of pressure ulcer prevention and treatment. By doing this, it is anticipated that the incidence of HAPUs will decline, improving patient outcomes, reducing healthcare costs, and generally enhancing the standard of care. Giving clinicians the knowledge and skills they require to modify and improve their clinical practices is crucial for it to be helpful considering patients and the healthcare system (Nilsen et al., 2020)

How will we know a change is an improvement?

Evaluating the QI initiative's efficacy is critical to determine whether the project's goals have been attained. One way to measure the performance of a QI effort in this project is to conduct pre-and post-assessments of the nurses' understanding of preventing HAPUs. The pre-assessment will establish a foundational parameter for assessing the nurses' prior knowledge, and the post-assessment will evaluate how much their prior knowledge has changed due to implementing the QI effort (Alshahrani et al., 2023). Through surveys of the nurses, examination of the prevalence and incidence of HAPUs, and observation of patient outcomes relating to PU management and prevention, the success of the QI project will also be evaluated. The evaluation of the QI endeavour will show whether the project successfully enhances nurses' knowledge of preventing HAPUs, ultimately improving patient satisfaction and the calibre of care provided (NICE, 2022).

What changes can we make that will result in improvement?

One of the changes advised for this project is introducing an evidence-based awareness program to enhance nurses' understanding of the prevention and management of HAPUs. It is planned to offer training and education on the etiology and pathophysiology of pressure ulcers, as well as methods for preventing and treating them in clinical settings. For the healthcare professionals who will participate in the awareness campaign, study sessions will last 3.5 hours per week. More tools, including training sessions and workshops, peer-to-peer mentoring and educational materials, will be available to promote the awareness campaign constituting the specific modifications to assist the QI project. Current clinical procedures and guidelines must also be modified to reflect better the most recent evidence-based techniques for preventing and treating pressure ulcers (Antony et al., 2023). Additional adjustments that will benefit the QI project include creating a system for ongoing monitoring and evaluation of the program's success and identifying and resolving any challenges that may arise during implementation.

The PDSA cycle

The Plan-Do-Study-Act (PDSA) cycle is an organised and iterative method for problem-solving and ongoing improvement. Through four phases, it offers organisations and people a methodical framework for improving processes, goods, or services (Agency for Healthcare Research and Quality, 2020). The first step in the "Plan" phase entails determining the issue at hand and creating precise, quantifiable goals for improvement. Setting SMART goals is essential to guaranteeing their clarity and viability. Afterwards, a strategy is created to put the difficulties highlighted into practice (Reed & Card, 2016). The strategy is implemented during the "Do" phase, frequently in small doses or as a test project. In order to assess the consequences of the adjustments, data and observations are gathered during this phase. The data and observations are analysed in the "Study" phase to assess whether the changes produced the desired improvements(McQuillan et al., 2016). Trends or patterns are found by comparing the results to the planned goals. This stage aids organisations in evaluating the efficacy of their efforts and determining whether their objectives have been met. Based on the "Study" phase analysis, organisations finally decide whether to implement, adjust, or reject the "Act" phase changes. If the modifications are successful, they are standardised and implemented on a larger scale. If not, adjustments are performed, and a new PDSA cycle is begun (McQuillan et al., 2016).

Figure 2: PDSA cycle

Source: https://wharaurau.org.nz/quality-improvement/pds

The program aims to increase nurses' knowledge of pressure ulcer prevention, evaluation, and management to enhance patient outcomes and reduce healthcare costs. Bedsores, also known as pressure ulcers, can severely affect a patient's health and cost of care. It is crucial to increase nurses' knowledge in this area. The program's specific goals are designed to do this by focusing on essential pressure ulcer prevention strategies. Increasing the number of nurses with the abilities and knowledge required to avoid pressure ulcers successfully is one of the main goals. This is important because training guarantees that a more significant proportion of the nursing staff can recognise and address the risk factors related to pressure ulcers (Ebi et al., 2019). The program also attempts to lower the incidence of pressure ulcers in patients. Increasing nurses ' collective knowledge and skill makes patients less likely to experience these excruciating and possibly fatal sores throughout their hospital stays (Awoke et al., 2022). Improved outcomes for patients and higher-quality healthcare are the results of this.

Additionally, the program aims to enhance pressure ulcer patient outcomes by lowering infection risks, reducing hospital stays, and providing improved pain treatment. This all-encompassing approach acknowledges that pressure ulcers can significantly affect a patient's health and healing. The program ensures that care is more thorough and patient-centred by targeting these secondary outcomes. This program has many beneficiaries, including patients, nurses, healthcare support staff, and healthcare organisations. Patients will receive better care, feel less pain, and spend less time in the hospital. Nurses will obtain valuable knowledge and skills; healthcare support staff will help the care team work more efficiently. Pressure ulcer treatment costs will be lower, and patient satisfaction will increase for healthcare organisations.

An innovative nurse education program that emphasises pressure ulcer prevention will be implemented to accomplish these goals. This curriculum includes online workshops, role-playing exercises, and practical use of prevention strategies and recommendations. Effective pressure ulcer prevention techniques will depend on the cooperation of many stakeholders, including nurses, healthcare support personnel, and healthcare organisations (Li et al., 2022). The program will stay adaptable to the changing demands of patients and healthcare providers with ongoing assistance and input. Data gathering for the multidimensional program evaluation will include quantitative and qualitative information. The program's effectiveness will be evaluated using surveys, interviews, and clinical data. The current methods for managing and preventing pressure ulcers will also be assessed against criteria. This thorough evaluation will offer insightful information that will enable the creation of focused interventions to improve pressure ulcer outcomes and fill knowledge gaps within the healthcare industry (Furtado et al., 2022).

ESTABLISHING MEASURES

The nursing consultant in critical care will provide overall leadership for the improvement program, while a PU task group will be formed to supervise and assist in its execution (Richardson et al., 2017). The task group will comprise at least one charge nurse, a critical care medication specialist, a critical care nurse advisor, and a data monitoring specialist. The committee will meet periodically for discussion, evidence assessment, and generate suggestions. The task group will choose pressure ulcer prevention solutions after carefully examining non-technical and technical standards, process measures, and metrics to monitor improvement (Richardson et al., 2017). The team will revise the nursing care plan and documentation, the pressure ulcer risk assessment training tool, the prevention recommendations, and the provision of novel pressure-relieving mattresses for patients with elevated risk. In order to execute the interventions, which will additionally include strengthening the interventions and focussing on the program's initial goals, staff will be trained in the project's later stages (Richardson et al., 2017). The awareness tool will be modified to help people better understand the fundamental aspects. The number of days without pressure ulcers will be recorded, and adherence to the pressure ulcer awareness tool will be checked. Information on pressure ulcer frequency will be routinely gathered and publicised to lower incidence and provide harm-free care (Richardson et al., 2017).

Since a patient's vulnerability may alter throughout hospitalisation based on the severity and complexity of their condition, performing daily pressure ulcer risk assessments is essential (Gaspar et al., 2022). Facilities should develop a standardised, proven reassessment approach that is easy to use and document, involving check boxes and concise words, to ensure that pressure ulcer risk is assessed daily (NMC, 2018). The facility's legislation and procedures should state which shift is responsible for daily evaluation. The likelihood of acquiring a pressure ulcer should be reviewed if the patient's condition changes. The patient's pressure ulcer risk should be communicated to the entire healthcare team, together with information on the causes and remedies for the illness (Mitchell, 2018). Visual cues like labels in the patient's medical record or coloured signs on the patient's ID band should alert staff to pressure ulcer risk. Patients with a high risk of developing skin damage should pay particular attention to this (Maryniak & Garrett, 2022).

The skin around devices, masks and tubes that may cause ulcers, the patient's sacrum, back, heels, buttocks, elbows, and all other areas should be carefully inspected for evidence of skin damage in addition to other exposed body regions like the breast, abdomen, and knees. (Al Aboud & Manna, 2018). Moreover, obese people are more likely to get skin injuries from intimate skin-to-skin contact (Darlenski et al., 2022). Alteration in skin integrity should be informed immediately to the relevant staff member, and pressure ulcers must be recorded following the facility's policy (Al Aboud & Manna, 2018). In particular, if the patient is incontinent, keeping his or her skin dry and clean is essential. It is essential to use a mild cleanser that will not irritate or dry up the skin if incontinence, perspiration, or wound drainage causes the skin to become too wet. Various skin-care items can build moisture barriers (Karine Goh et al., 2021). Skin breakdown can be avoided by regularly washing and applying a topical moisture barrier. Since dry skin is more prone to injury, patients with dry, fragile skin should apply moisturisers (Purnamawati et al., 2017).

CONCLUSION

In conclusion, because they are largely avoidable and signify deficiencies in patient care, hospital-acquired pressure ulcers (HAPUs) are a severe issue in healthcare settings. These ulcers are caused by prolonged friction or pressure on the skin and can have several adverse effects, such as infections, sluggish wound healing, discomfort, and severe tissue damage. Age, inadequate nutrition, dehydration, skin sensitivity, immobility, and other medical issues are also risk factors for HAPUs. The risk of HAPUs must be reduced by preventative measures such as routine repositioning, customised support surfaces, and skin inspections. A Quality Improvement (QI) plan has been put forth to improve nurses' understanding of pressure ulcer prevention within medical settings in order to address this problem. This QI initiative includes a curriculum that primarily educates healthcare workers and is evidence-based. This quality improvement initiative aims to improve healthcare workers' knowledge, primarily nurses, on the pathophysiology, etiology, and prevention of pressure ulcers. Patients and healthcare providers are among the initiative's main stakeholders because they both play crucial roles in guaranteeing the program's success.

The Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle provides a structured framework for implementing and assessing the QI program. The initiative aims to enhance patient outcomes, cut healthcare costs, lower the incidence of HAPUs, and expand nurses' knowledge. Pre- and post-assessments, surveys, clinical information, and patient outcomes will all be used to evaluate the program's effectiveness and ensure it improves patient care. This QI program seeks to decrease the frequency of HAPUs, enhance patient care, and raise the standard of hospital care by increasing awareness and understanding among medical staff and patients.

References

Agency for Healthcare Research and Quality. (2020). Plan-Do-Study-Act (PDSA) Directions and Examples. https://www.ahrq.gov/health-literacy/improve/precautions.

Alshahrani, B., Middleton, R., Rolls, K., & Sim, J. (2023). Critical care nurses’ knowledge and attitudes toward pressure injury prevention: A pre and post intervention study. Intensive and Critical Care Nursing, 79, 103528. https://doi.org/10.1016/j.iccn.2023.103528

Antony, L., Thelly, A. S., & Mathew, J. M. (2023). Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer. Indian Journal of Palliative Care, 29(1), 75-81. https://doi.org/10.25259/IJPC_99_2022

NHS England. (2022). Plan, Do, Study, Act (PDSA) cycles and the model for improvement. https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf

McQuillan, R. F., Silver, S. A., Harel, Z., Weizman, A., Thomas, A., Bell, C., Chertow, G. M., Chan, C. T., & Nesrallah, G. (2016). How to Measure and Interpret Quality Improvement Data. Clinical Journal of the American Society of Nephrology : CJASN, 11(5), 908-914. https://doi.org/10.2215/CJN.11511015

Agency for Healthcare Research and Quality. (2020). Plan-Do-Study-Act (PDSA) Directions and Examples. https://www.ahrq.gov/health-literacy/improve/precautions.

Al Aboud, A. M., & Manna, B. (2018). Wound pressure injury management. https://www.ncbi.nlm.nih.gov/books/NBK532897/

Alshahrani, B., Middleton, R., Rolls, K., & Sim, J. (2023). Critical care nurses’ knowledge and attitudes toward pressure injury prevention: A pre and post intervention study. Intensive and Critical Care Nursing, 79, 103528. https://doi.org/10.1016/j.iccn.2023.103528

Antony, L., Thelly, A. S., & Mathew, J. M. (2023). Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer. Indian Journal of Palliative Care, 29(1), 75-81. https://doi.org/10.25259/IJPC_99_2022

Awoke, N., Tekalign, T., Arba, A., & Lenjebo, T. L. (2022). Original research: Pressure injury prevention practice and associated factors among nurses at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia: A cross-sectional study. BMJ Open, 12(3). https://doi.org/10.1136/bmjopen-2020-047687

Better Health Channel. (2021). Older people in hospital - Skin care and preventing pressure sores. https://www.betterhealth.vic.gov.au/health/servicesandsupport/skin-care-and-preventing-pressure-sores-in-hospital

Black, J. M., Brindle, C. T., & Honaker, J. S. (2016). Differential diagnosis of suspected deep tissue injury. International Wound Journal, 13(4), 531-539. https://doi.org/10.1111/iwj.12471

Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., Onate, K., Denis, L., & Pomey, P. (2018). Engaging patients to improve quality of care: A systematic review. Implementation Science : IS, 13. https://doi.org/10.1186/s13012-018-0784-z

Brennan, S., McKenzie, J. E., Whitty, P., Buchan, H., Green, S., Bosch, M., Fiander, M., Strobel, N. A., Donoghue, E., Page, M. J., & Yost, J. (2017). Continuous quality improvement: Effects on professional practice and healthcare outcomes in primary care. The Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.CD003319.pub3

Darlenski, R., Mihaylova, V., & Handjieva-Darlenska, T. (2022). The Link Between Obesity and the Skin. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.855573

Ebi, W.E., Hirko, G.F. & Mijena, D.A. (2019). Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: A cross-sectional study design. BMC Nurs 18, 20. https://doi.org/10.1186/s12912-019-0346-y

Furtado, K., Lopes, T., Afonso, A., Infante, P., Voorham, J., & Lopes, M. (2022). Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey. Journal of Clinical Medicine, 11(3). https://doi.org/10.3390/jcm11030583

Galletta, M., Piazza, M. F., Meloni, S. L., Chessa, E., Piras, I., & Arnetz, J. E. (2022). Patient Involvement in Shared Decision-Making: Do Patients Rate Physicians and Nurses Differently? International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192114229

Gary Ong, B. K., Balakrishnan, T., & Kang, M. L. (2021). Implementation of a Quality Improvement Roadmap in the Department of Internal Medicine of an Academic Medical Centre in Singapore. Cureus, 13(5). https://doi.org/10.7759/cureus.14877

Gaspar, S., Guedes, F. B., Vitoriano Budri, A. M., & Ferreira, C. (2022). Hospital-acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 36(4), 978-987. https://doi.org/10.1111/scs.12995

Gaspar, S., Peralta, M., Marques, A., & Budri, A. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. https://doi.org/10.1111/iwj.13147

Gefen, A., Creehan, S., & Black, J. (2020). Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review. International Wound Journal, 17(5), 1405-1423. https://doi.org/10.1111/iwj.13408

Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults. The Cochrane Database of Systematic Reviews, 2020(6). https://doi.org/10.1002/14651858.CD009958.pub3

Greenwood, C. E., Nelson, E. A., Nixon, J., & McGinnis, E. (2017). Pressure‐relieving devices for preventing heel pressure ulcers. The Cochrane Database of Systematic Reviews, 2017(5). https://doi.org/10.1002/14651858.CD011013.pub2

Gunowa, N. O., Hutchinson, M., Brooke, J., & Jackson, D. (2018). Pressure injuries in people with darker skin tones: A literature review. Journal of Clinical Nursing, 27(17-18), 3266-3275. https://doi.org/10.1111/jocn.14062

Higuchi, D., Takahashi, Y., & Tomita, Y. (2023). Effects of Slide Sheet Use and Bed Position on Muscle Activities in the Low Back and Extremities: A Pilot Experimental Simulation Study. Workplace Health & Safety, 21650799231155626. https://doi.org/https://doi.org/10.1177/21650799231155626

Hommel, A., & Santy-Tomlinson, J. (2018). Pressure Injury Prevention and Wound Management. In Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient [Internet]. Springer Open. https://www.ncbi.nlm.nih.gov/books/NBK543831/

Hommel, A., Gunningberg, L., Idvall, E., & Bååth, C. (2017). Successful factors to prevent pressure ulcers–an interview study. Journal of Clinical Nursing, 26(1-2), 182-189. https://doi.org/10.1111/jocn.13465

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18. https://doi.org/10.1186/s12877-018-0997-7

Karine Goh, C. C., Cheong, R. Q., Ong, Z. L., Betty Khong, P. C., & Chan, Y. (2021). Effectiveness of skin cleanser and protectant regimen on incontinence‐associated dermatitis outcomes in acute care patients: A cluster randomised trial. International Wound Journal, 18(6), 862-873. https://doi.org/10.1111/iwj.13588

Kennedy, B. M., Rehman, M., Johnson, W. D., Magee, M. B., Leonard, R., & Katzmarzyk, P. T. (2017). Healthcare Providers versus Patients’ Understanding of Health Beliefs and Values. Patient Experience Journal, 4(3), 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751953/

Kim, J. M., Lee, H., Ha, T., & Na, S. (2018). Perioperative factors associated with pressure ulcer development after major surgery. Korean Journal of Anesthesiology, 71(1), 48-56. https://doi.org/10.4097/kjae.2018.71.1.48

Kim, J. Y., Lee, Y. J., & Continence Nurses, W. O. (2019). Medical device‐related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses. International Wound Journal, 16(Suppl 1), 51-61. https://doi.org/10.1111/iwj.13023

Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Registered nurses’ approach to pressure injury prevention: A descriptive qualitative study. Journal of Advanced Nursing, 78(8), 2575-2585. https://doi.org/10.1111/jan.15218

Mäki-Turja-Rostedt, S., Stolt, M., Leino-Kilpi, H., & Haavisto, E. (2019). Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review. Journal of Clinical Nursing, 28(13-14), 2420-2442. https://doi.org/10.1111/jocn.14767

Maryniak, K., & Garrett, R. (2022). Best Practices to Prevent Nursing Errors. In: Preventing Errors and Pitfalls in Nursing with Infectious Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-86728-7_6

McInnes, E., & Leung, V. (2018). Support surfaces for treating pressure ulcers. The Cochrane Database of Systematic Reviews, 2018(10). https://doi.org/10.1002/14651858.CD009490.pub2

McQuillan, R. F., Silver, S. A., Harel, Z., Weizman, A., Thomas, A., Bell, C., Chertow, G. M., Chan, C. T., & Nesrallah, G. (2016). How to Measure and Interpret Quality Improvement Data. Clinical Journal of the American Society of Nephrology : CJASN, 11(5), 908-914. https://doi.org/10.2215/CJN.11511015

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins. http://editaisdesenv.prppg.ufrpe.br.pdf

Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881-890. https://doi.org/10.1016/j.jaad.2018.12.069

Mitchell, A. (2018). Adult pressure area care: preventing pressure ulcers. British Journal of Nursing, 27(18), 1050-1052. https://doi.org/10.12968/bjon.2018.27.18.1050

Mondragon, N., & Zito, P. M. (2020). Pressure injury. https://europepmc.org/article/nbk/nbk557868

Moore, Z. E., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. The Cochrane Database of Systematic Reviews, 2019(1). https://doi.org/10.1002/14651858.CD006471.pub4

Moore, Z. E., & Patton, D. (2021). Patient and lay carer education for preventing pressure ulceration in at‐risk populations. The Cochrane Database of Systematic Reviews, 2021(2). https://doi.org/10.1002/14651858.CD012006.pub2

Moore, Z. E., Bradbury, I., & McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. The Cochrane Database of Systematic Reviews, 2018(5). https://doi.org/10.1002/14651858.CD011620.pub2

Mortazavi, H., Safi, Y., Baharvand, M., & Rahmani, S. (2016). Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree. International Journal of Dentistry, 2016. https://doi.org/10.1155/2016/7278925

NHS England. (2022). Plan, Do, Study, Act (PDSA) cycles and the model for improvement. https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf

NHS Inform. (2023). Pressure ulcers. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/pressure-ulcers.

NICE. (2022). Helping to prevent pressure ulcers. https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/helping-to-prevent-pressure-ulcers

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20, 1-8. https://doi.org/10.1186/s12913-020-4999-8

Nixon, J., Smith, I. L., Brown, S., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., & Hulme, C. (2019). Pressure relieving support surfaces for pressure ulcer prevention (PRESSURE 2): clinical and health economic results of a randomised controlled trial. EClinicalMedicine, 14, 42-52. https://doi.org/10.1016/j.eclinm.2019.07.018

NMC. (2018). Nursing and Midwifery Council Fitness to Practise Committee. https://www.nmc.org.uk/globalassets/sitedocuments/ftpoutcomes/2018/august-2018/reasons-parker-ftpcsor-52067-20180806.pdf

Purnamawati, S., Indrastuti, N., Danarti, R., & Saefudin, T. (2017). The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review. Clinical Medicine & Research, 15(3-4), 75-87. https://doi.org/10.3121/cmr.2017.1363

Reed, J. E., & Card, A. J. (2016). The problem with Plan-Do-Study-Act cycles. BMJ Quality & Safety, 25(3), 147-152. https://doi.org/10.1136/bmjqs-2015-005076

Richardson, A., Peart, J., Wright, S. E., & McCullagh, I. J. (2017). Reducing the incidence of pressure ulcers in critical care units: a 4-year quality improvement. International Journal for Quality in Health Care, 29(3), 433-439. https://doi.org/10.1093/intqhc/mzx040

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System. Nursing Research, 67(1), 16. https://doi.org/10.1097/NNR.0000000000000258

Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., & Ostadi, Z. (2018). Pressure Ulcer and Nutrition. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 22(4), 283-289. https://doi.org/10.4103/ijccm.IJCCM_277_17

Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Jammali-Blasi, A., & McInnes, E. (2021). Alternating pressure (active) air surfaces for preventing pressure ulcers. The Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.CD013620.pub2

Silver, S. A., Harel, Z., McQuillan, R., Weizman, A. V., Thomas, A., Chertow, G. M., Nesrallah, G., Bell, C. M., & Chan, C. T. (2016). How to Begin a Quality Improvement Project. Clinical Journal of the American Society of Nephrology : CJASN, 11(5), 893-900. https://doi.org/10.2215/CJN.11491015

Taylor, C. (2017). Importance of nutrition in preventing and treating pressure ulcers. Nursing Older People, 29(6). https://doi.org/10.7748/nop.2017.e910

The Health Foundation. (2021). Quality improvement made simple. https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf

UNC School of Medicine. (2023). Stakeholder Analysis. https://www.med.unc.edu/ihqi/resources/stakeholder-analysis/

Westby, M. J., Dumville, J. C., Soares, M. O., Stubbs, N., & Norman, G. (2017). Dressings and topical agents for treating pressure ulcers. The Cochrane Database of Systematic Reviews, 2017(6). https://doi.org/10.1002/14651858.CD011947.pub2

Wood, J., Brown, B., Bartley, A., Cavaco, A.M.B.C., Roberts, A.P., Santon, K. & Cook, S., (2019). Reducing pressure ulcers across multiple care settings using a collaborative approach. BMJ Open Quality, 8(3), p.e000409. http://dx.doi.org/10.1136/bmjoq-2018-000409

Worsley, C., Webb, S., & Vaux, E. (2016). Training healthcare professionals in quality improvement. Future Hospital Journal, 3(3), 207-210. https://doi.org/10.7861/futurehosp.3-3-207

Wu, J., Wang, B., Zhu, L., & Jia, X. (2022). Nurses' knowledge on pressure ulcer prevention: An updated systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.964680

Young, C. (2021). Using the'aSSKINg'model in pressure ulcer prevention and care planning. Nurs Stand, 36(2), 61-6. https://doi.org/10.7748/ns.2021.e11674

Zaidi, S. R. H., & Sharma, S. (2020). Pressure Ulcer. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553107/

You Might Also Like

Qualitative Research in Nursing and Healthcare Assignment Sample
Nursing Case Study Assignment Help
Get Top-notch Nursing Assignment Writing Help