Prevention of Pressure Ulcers in Patients within Healthcare Facilities

Prevention of Pressure Ulcers in Patients Within Healthcare Facilities

Section Introduction

So far, the project has established four core areas in preventing pressure in patients within healthcare facilities. These areas include 1) introduction to the clinical issue, 2) A SWOT analysis of the specific health facility to determine how it is positioned to implement quality improvement alternatives, 3) an outline of the prevention plan as part of the quality improvement process, and 4) the resources that the health facility will require to implement and evaluate quality improvement alternative. Each of these sections provides vital information key to the completion of the current section. In the current section, the paper will focus on the potential strategies for implementation evaluation of the prevention of pressure ulcers among patients within the health care facility. Thus, the section is outlined as follows: implications of information from the previous sections (1-3), potential strategies that can be implemented based on this information, and ideal measures for evaluating the implemented quality improvement alternatives.

The implication of Information from Previous Sections

In the first section, the current clinic problem was defined, and the risk factors established. The key risk factors include cognitive impairment and decreased sensation, with age playing a critical role. Areas with bony prominences, such as the sacrum, heels, ischial tuberosities, lateral malleoli, and greater trochanters, are more likely to be affected by pressure ulcers, especially in immobile patients (Ebi, Fetensa Hirko, & Mijena, 2019). Other risk factors include poor nutrition, increased moisture, and existing comorbidities among patients confined in a healthcare facility. Further, the pathophysiology of pressure ulcers was discussed in this section, leading to the conclusion that when there is persistent pressure on a bony prominence, either skin friction or lack of blood supply leads to tissue necrosis. Lastly, the section established that pressure ulcers burden the patient, healthcare facility, and the public health system.

The second section of the project involved a SWOT analysis of the healthcare facility to establish its implementation of recommended quality improvement alternatives. In this section, it was established that the healthcare facility's strengths lie in the presence of early identification of at-risk patients, excellent time management by staff, and knowledgeable staff members. The critical weaknesses identified include increased staff workload, which results in job burnout, high turnover ratio, lack of appropriate equipment, and nurses' attitude. Additionally, the section established that advancement in technology provides an opportunity through which the healthcare facility can improve outcomes in this area. In terms of threats, the financial implication is the biggest challenge for the organizations.

In section 3, the key stakeholders and resources were identified. Apart from the patient, the healthcare facility staff are also core stakeholders, while the resources include human resources (staff), finances, time, and medical supplies. Some of the action plans suggested in this section will play a vital role in developing possible interventions.

Each of the three sections is vital in the construction of the current prevention plan. For instance, by identifying the key stakeholders (section 3), quality improvement is established because it is possible to tell the individuals affected either directly or indirectly. Further, by understanding the extent of available resources, the prevention alternatives will be confined with boundaries since resources in the healthcare facility are limited. Lastly, the strengths, weaknesses, opportunities, and threats will further shape the prevention recommendations. For instance, where lack of training is the critical issue, recommendations must encompass how the nurses can be trained based on limited resources and work-related burnout.

Potential Prevention Strategies for Implementation

Prevention strategies are based on the popular argument that prevention is less costly compared to treatment. The cost burden of pressure ulcers is felt by all stakeholders involved. For instance, the patient accumulates more cost of care because the treatment becomes part of the treatment plan that brought the patient to the hospital in the first place. Such patients may also experience an increased length of stay in the healthcare facility due to the conditions. This leads to the occupation of the necessary resources, including nurses' time and bed space, to serve other patients. In this case, the reliability and efficiency of the healthcare facility become questionable. On a larger scale, pressure ulcers are costly to the public health system as more funds must be channeled to health facilities. All these outcomes can be prevented by implementing a robust prevention plan that involves three core areas: risk assessment, interventions, and assessment of established pressure ulcers wounds.

Risk-Assessment Plan

The risk assessment involves inspection of the skin and identification of risk factors. In his plan, risk factors are classified into two groups: intrinsic and extrinsic. Risk assessment aims to prevent the condition or identify resulting wounds in their early stages. As already established, the critical weaknesses in the current healthcare facilities include nurses' attitudes and lack of training. Based on this, the risk assessment should be included in the training program for nurses to be equipped with the necessary knowledge.

Intrinsic factors include limited mobility, poor nutrition, comorbidities, and aging skin. In other words, intrinsic factors can also be perceived as problems the patient faces without external influences (Guest, Fuller, & Vowden, 2018). Examples of aging factors include loss of skin elasticity, flattening of the rete ridges, reduced cutaneous blood flow, and decreased dermal-epidermal blood flow. Poor nutrition manifests through anorexia, dehydration, poor dentition, and dietary restrictions. In terms of comorbidities, factors include existing conditions like diabetes, peripheral vascular conditions, decreased pain sensation, and congestive heart failure. All these factors play a crucial role, but reduced mobility is the most notorious intrinsic factor. Issues that can lead to reduced mobility include spinal cord injuries, cerebrovascular accidents, and progressive neurological disorders such as Parkinson's disease and Alzheimer's.

On the other hand, extrinsic factors include friction with bedding, pressure from hard surfaces, shear caused by involuntary muscle movement, and moisture. In other words, extrinsic factors are also external forces within the healthcare facility that leads to pressure ulcers among patients. When these factors (both intrinsic and extrinsic) are part of the nurse’s training plan, they help in availing the necessary knowledge required by the nursing staff, which is critical in shaping attitudes, especially where there is excessive workload. Further, the training should also involve the application of assessment scales. An example of such a scale is the Braden Scale (Smith, Snyder, McMahon, Petersen, & Meddings, 2018). The scale highlights the key areas nurses must consider when assessing the risk factors as part of the prevention plan.

The advantage of a robust risk assessment plan is that it guides nurses’ decision-making processes leading to standardized procedures and outcomes. As such, it provides an ideal way through which standardized evaluation can be done (Padula & Black, 2018). The purpose of assessment is to provide vital information that can lead to classification of patients based on the existing level of risk factors. Establishing such information is necessary for prevention because it provides a basis on which preventive decisions and actions can be made or taken based on the available resources. Technology provides some solutions to this end especially when it comes to nurses’ in-work training on issues such as the Braden scale.

Potential Interventions (Plan)

Pressure Reduction Strategies

The purpose of risk assessment is to establish at-risk patients. Such patients must have a signifier such as a symbol on the bedside or within the patient records that indicate their level of risks regarding pressure ulcers. Such classification of a...