A pressure ulcer is a common disease among patients whose medical conditions limit their ability to change positions. According to Mervis & Phillips (2019) , the illness is also prevalent among patients who stay on beds or chairs for long. Pressure ulcers lead to a high rate of mortality and length of stay in the hospital. In a research study by Anthony, Alosoumi & Safari (2019), the authors reveal that 11% of patients who suffer from long term illness in the hospital have pressure ulcers. The researchers further indicate that in most nursing homes, the pressure ulcer prevalence ranges from 1.2% to 2.1%. Xu, Ma, Yao & Zhao (2019) reveal that the cost of treating pressure ulcers ranges between m $500 to $40,000. The authors further indicate that pressure ulcers also link to a high rate of mortality and also readmission in most hospitals in the world. The implication is that there is a need to have a comprehensive plan to prevent the disease. Research on the intervention strategies to reduce the prevalence of ulcer pressure in healthcare reveal that most prevention techniques focus on treating the symptom. However, the high rate of prevalence of this disease is an indication that such preventive measures are not fully effective. Therefore, this project introduces a systematic and comprehensive quality improvement process that aims to address the management of the ulcers pressure condition. The project takes place at Kendall Regional Medical Center . The aim is to educate the nurses and medical practitioners on the use of heel protectors, improvement of patients' environment, and also the use of government incentives as a way to manage pressure ulcers in a clinical setting.
A Description of the Clinical Issue for the Project
The project aims to present a comprehensive quality improvement process to address the high rate of pressure ulcers incidences in a clinical setting. Pressure ulcers are injuries on the underlying body tissues due to high pressure on the skin. The disease develops gradually and affects any part of the body under stress. The bony parts of the body, such as hips, spine, heels, and elbows, have high chances of developing this condition ( Díaz ‐ Valenzuela, García ‐ Fernández, Carmona Fernández, Valle Cañete, & Pancorbo ‐ Hidalgo, 2019). The warning signs of the diseases are swellings, pus-like draining, tender areas, unusual changes in the skin color, and change in texture (Xu et al., 2019). For people who use wheelchairs, pressure ulcers attack the tailbone or the buttock, back of the arms and legs that rest on the chair, and the shoulder blades of the spine that also relax on the chair (Perez, Cauble & Daniel, 2020). Perez et al. (2020) further state that the condition attacks the backside of the head, shoulder blades, heels, skin behind the knees, hip, tailbone, and ankles for those who stay on the beds for long.
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Constant pressure on a specific part of the body, according to Arai, Yamamoto, Suzuki, Mitsukawa & Ishii (2020), is the primary causative factor of the pressure ulcers. The authors state that constant pressure reduces the amount of blood flowing to a specific tissue, and thus reduce the rate of oxygen flow to that particular part. Oxygen, according to the authors, is critical for tissue growth and health. Lack of it leads to damage to the skin on such a spot. The result could be tissue suffocation and death. Such pressure tends to accumulate on a particular body part for those who experience little mobility (Prakash, Raj, Jacob & Ross, 2019). The intensity of such force, therefore, leads to the development of pressure ulcers.
Friction is another cause of pressure ulcers, mostly where the skin rubs against a chair or a bed sometimes. According to Arai, Yamamoto, Suzuki, Mitsukawa & Ishii (2020), friction can make fragile skin more vulnerable to injury, especially if the skin is also moist. Shear force is another cause of pressure ulcers. Share takes place when opposing effects are in action (Xu et al., 2019). For instance, when the bed’s elevation at the head is high, there is a high chance that the patient can slide down. As the tailbone moves down, the skin over the bone might stay in place. It essentially pulls in the opposite direction, thereby causing share force.
SWOT Analysis of the Quality Improvement Process
The quality improvement process for pressure ulcer condition targets patients’ environment, patients’ management, and the mobilization of resources to support the elimination of the disease in a clinical setting. The project’s strength is the fact that it takes a holistic approach to pressure ulcer management in a clinical setting. For instance, the project examines the patients' physical environment and looks for the best ways the medical staff should set the patients’ environment to reduce the prevalence of the disease in the hospital. It, therefore, suggests a variety of strategies such as t urning regimes, sitting regimes, choices of the mattress, and management of skincare ( Richardson, Peart, Wright, & Mccullagh, 2017). It further suggests the use of different techniques such as heel protectors as a way to manage the disease. The suggestion also includes the continuous patients' assessment to ensure that there is a quick recovery.
The opportunity for this project is the fact that there are many existing projects of similar concerns. The pressure ulcers is a condition that is at the center stage of different research projects. In most of the previous projects, the objectives were to find the best ways to reduce the prevalence of pressure ulcers in the clinical setting. The availability of such projects is an opportunity for the current plan because the team can study their strategies and find areas where such projects were successful and areas that led to their failures. Fine-tuning regions where the previous project was successful and also correcting past mistakes could lead to a high possibility of success for the present project ( Gould, Bohn, Bryant, Paine, Couch, Cowan, Simman, 2019). Another opportunity is the fact that the project gets support from different stakeholders. The project receives wholesome support from Kendall Regional Medical Center. With such a back-up, the study population and the implementation site is available. The project team needs to utilize such support to come up with convincing ways of managing the disease to reduce its severity and prevalence in the population. The last opportunity is the fact that most research studies look at treatment strategies and preventive strategies as separate entities while handling pressure ulcers. It is an opportunity because this project examines the whole problem from treatment to the management of the disease as well as the assessment to aid in quick recovery.
However, the limited scope of the project, as well as the growing number of the incidences of pressure ulcers, present both weaknesses and threats to this project. The plan limits its scope to Kendall Regional Medical Center. The implication is the project relies on the data from this institution and defines most of its operation in this institution. It means that it does not depict a variety concerning the differences that may exist from one institution to next. A threat is that as the project strives to define the best way to manage pressure ulcer conditions, the incidence of this disease is growing by the day. According to Al-Hashemi, Thomson, Alqurashi, Jan, Farran & Al-Sabban (2019), the authors reveal that the prevalence of the pressure ulcers may double in the next few years. According to these authors, the incidence of this disease increases every two years. With such a rate, the prevalence of the condition could be worse in the next few years. The implication is that the project is under pressure to define whether a comprehensive quality improvement process it suggests will be the right means to manage incidences of this disease in a clinical setting.
An outline of the action plan for the project
The project aims to establish a quality improvement plan to manage the incidence of pressure ulcers in a clinical setting. The initiatives that together form the comprehensive quality improvement process are the management of patients’ environment, education of the need and importance of heel protectors for pressure ulcer patient and also awareness on the best ways to use government incentives to reduce the cost of the pressure ulcer management for patients and the hospital as a whole. There will be five stages of the action plan to determine the need to introduce quality improvement and set up the best way to manage and implement the proposed quality improvement process. These steps will include assessment, research, clinical question formulation, reporting, and training.
The first step will be to conduct the need assessment at Kendall Regional Medical Center. The aim is to determine the medical staff’s level of knowledge on the pressure ulcers and the means of treatment and prevention of the disease within Kendall Regional Medical Center. The next step is to research the incidences of the ulcer pressure, the strategies of treatments and prevention that the hospital outline in its policies, and whether they meet the standard and are workable. The assessment will have different categories of issues to examine to make it easy to conduct the study. The first category will be the knowledge about pressure ulcer prevention among the nurses handling of patients. The focus is to examine whether their strategies of treating patients could enhance or reduce pressure ulcers. These include the skin assessment records, the positioning of the patients on the bed, the ulcer assessment rates, nutritional evaluation, and evaluation of the positioning on the chair. At this point also, the focus is to understand how the bedside nurses set up the heel protectors for the patients
The next category will be the assessment of different treatment and management policies within the hospital to manage the disease. These will include the examination of the choice of mattress, the culture of pressure ulcer assessment, and other risk factors in the hospital that could lead to mobility impairments, thus increasing the incidence of pressure ulcers for the patients. The third action will be to assess the cost and means of pressure ulcer treatment in the hospital. The fourth step is to come up with a clinical question depicting the shortages and areas in the hospital that needs improvement. The next action plan is to draft a report from the finding assessment and come up with a lesson template that summarizes the findings and make a recommendation on areas where to train the staffs. The education format is both online format and face-to-face- meeting with nurses for demonstration. The next action is to team up with the quality management committee in the hospital to set a stage for training the nurses. Training will involve the PowerPoint was presentation using HealthStream, an online format, for all bedside nurses to complete within the agreed-upon 14-day time period.
Assessment of clinical issue that is the focus of the quality improvement project
The focus of the quality improvement project is to come up with a solution to reduce the incidence of pressure ulcers in a clinic setting. The aim is to establish a quality improvement plan to manage the prevalence of pressure ulcers in a clinical environment. While assessing pressure ulcers as a disease, the focus is on its prevalence, techniques of presence, and knowledge about the disease among the nurses. According to Anthony, Alosoumi & Safari (2019), the ulcer pressure prevalence is high at 1.2% to 2.1% in most clinical settings. In a research study by Ling, Raman, Tan, Hao & Saw (2019), the authors reveal that inadequate knowledge and training among nurses could be the reason that explains the high rate of pressure ulcers in most clinical environments. In a research study by Anthony, Alosoumi & Safari (2019), the authors' recommendation is training for bedside nurses to understand the position of the patients. The authors further recommend that there is a need to emphasize the treatment of pressure ulcers disease patients through heel protector techniques.
The physical environment of patients is also critical in managing pressure ulcers (Mizokami, Takahashi & Isogai, 2019). Pressure ulcers are prevalent among patients whose mobility is limited. In this sense, the aim is to examine whether bedside nurses and the hospital staff as a team develop the mindset and have in place strategies to minimize the chance of patients developing pressure ulcers. In this regard, regard, the number of skin assessment tests, the body position for the patients, and also the knowledge on the better use of heel protectors are critical strategies to manage the disease. These strategies help change the physical environment for the patient to avoid any skin tissue suffocation that leads to the pressure ulcers. Therefore, the quality improvement team aims to educate nurses and also create an awareness in the hospital on the best ways to manage patients to reduce the rate of pressure ulcers, especially for those patients from an acute disease that pins them on beds or chairs for long.
Stakeholders and Decision-Makers
The stakeholders will find people who will feel the impact of the quality improvement plane either directly or indirectly. In this sense, any person who will have an opportunity to participate will be stakeholders. For instance, the patients will be stakeholders in this project because the outcome of the project will directly affect them. The staff, for example, the nurses, will also be part of the stakeholders because the study will involve them directly. The project focuses on the means of improving the nurses’ skills on how to handle pressure ulcer patients. It means that the outcome will benefit the nurses as it will sharpen their skills on the best ways to manage patients suffering from this condition. Also, the host hospital Kendall Regional Medical Center will be part of the stakeholders. Moreover, the quality improvement quality, the directors of nurses, and also the hospital administrators will also be part of the stakeholders during the project life cycle. The role of the stakeholders will be to ensure that the project achieves all the objectives and goals.
The decision-makers will be the team that will be responsible for formulating the plan to assess, train, and implement the whole project. It will be the decision-makers that will also come up with the follow-up plan and even make recommendations based on the outcome of the project. The quality improvement committee will be the chief decision-maker for the project. Also, the Pressure Ulcer Prevention Committee and the change management team at Kendall Regional Medical Center will be at the center of decision making. The Chief Nursing Officer, the head of nursing departments, Education Nurse, and the Director of Quality Control will all have a role in the decision making process during the project life cycle. The purpose of a decision-making team will be to ensure that there are specific strategies to achieve the objective of the project.
TheResources Budget, Personnel and Time for the Project
The Budget Plan
The cost is a critical factor for this project. The aim is to use the best alternative that is cost-effective but guarantees quality results at the end of the project. In this case, the plan will not consume too much amount of money because it entails education as a form of training with a limited scope. Together, the project will take about 98 hours for all the target nurses. The average nurse salary at the facility is $25.00 an hour for a cost of $2,450. For the training, there were four positions, each costing about $20.00, and this totals to $80.00. Items such as sealed boxes for displaying the photos of pressure ulcers were critical, and the cost for each piece was $10.00. Four of such boxes were enough for the project at the expense of $40.00. Also, four more reams of paper for the education program was used, and the total cost was $35.99. The printing ink’s price was $100.00. Four folders were needed to keep the educational materials at the nursing stations, and each was $5.50 for a total value of $22.00. The last part of the budget was the cost of the clinical guideline at $50.00 and the cost of the large folder for displays at $10. The total cost was, therefore, $2,787.99 for the entire project.
The Project’s Team
The project will include many people from different disciplines. The first will be the directors of nursing departments in all the departments that will be affected by the project. Part of the team will also include members of the quality and change management team. These are people who will help with facilitating the quality change management process. The pressure ulcer specialist and nurses will also be part of the group as well as the physician, clinician, and even pharmacists. The physical therapy, quality, and dietician are all essential individuals who will form the team for the project. Finally, the Education Nurse and the Director of Quality Control and the Chief Nursing Officer will also be essential people for the project. The role of each of these individuals will contribute to getting the best results from the project.
Time Allocation for the Project
The project phases will include the following: assessment, research, clinical question formulation, reporting, and training. It implies that the project will not take a long time before the conclusion. The evaluation will consume the bulk of time, but a single week will be enough to gather data, assess them and write a report about the pressure ulcer state and also define whether there is a need to implement new changes in the hospital. The next will be training and awareness creation, which will entail demonstration, online tests, and also engagement with nurses. A period of one week will be enough for such a training approach. Entirely, the project can take about two weeks to come to an end.
The Implementation and Evaluation
The implementation plan for the project was a series of steps towards achieving the project objectives. The first step was the establishment of the nursing knowledge concerning the pressure ulcer condition. A written test to determine the level of nursing knowledge is an implementation tactic. The next step is educations for the nurses. The implementation tactic was an online platform interaction, where there were questions and answer sessions. Also, there was a demonstration to enhance skills. There were meeting sessions to discuss the importance of different strategies, such as the use of heel protectors as well as various illustrations for the same process. Each department is also to take and keep a notebook for the project that details the recommendation and provide an answer to technical questions that the nurses may have during their work on similar issues. The evaluation process is to test the nurse’s knowledge, post-education, with the same test as the pre-education. In this sense, the aim is to understand whether there is a change in awareness among nurses.
References
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Arai, K., Yamamoto, K. H., Suzuki, T., Mitsukawa, N., & Ishii, I. (2020). Risk Factors Affecting Pressure Ulcer Healing: Impact of Prescription Medications. Wound Repair and Regeneration .doi/abs/10.1111/wrr.12791
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Xu, X., Ma, Y., Yao, Z., & Zhao, Y. (2019). Prevalence and Risk Factors for Pressure Ulcers in Patients with Enterocutaneous Fistula: A Retrospective Single-Center Study in China. Medical Science Monitor , 25 , (2591–2598). doi: 10.12659/msm.913261
