Pressure ulcers usually occur among patients that are critically ill and they have the highest risk for morbidity and mortality. A pressure ulcer can be described as a local injury to the underlying tissue that is as a result of pressure or pressure and a combination with friction. The consequences of pressure ulcers are usually worse compared to their actual appearance since the muscles and the subcutaneous tissue are usually more susceptible to pressure-induced injury. A pressure ulcer can result in a considerable amount of harm that is caused to patients can result in the development of serious infections and pain which hinders a quick recovery. This paper analyzes the clinical issue of pressure ulcers, analyzes the reasons why there is a need to change the status quo, and identifies various quality improvement initiatives.
The Issue of Pressure Ulcers
The issue that has been identified as the clinical problem is that of pressure ulcers. During treatment, patients can develop pressure ulcers that comes about from a local injury to tissues as a result of pressure and friction. Pressure ulcers are a high-risk factor for patients that are critically ill. The problem can result in a considerable amount of harm to patients and hinders a smooth and quick recovery and often leads to several other infections and severe pain among the patients. Patients that have pressure ulcers have also been associated to have a prolonged time of stay, sepsis, and even mortality. However, by taking appropriate measures the issue of pressure ulcers can be solved.
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Rationale for the Change
The prevention of pressure ulcers is very important since there are serious consequences on the patient that include an increased length of stay at the hospital and the patient going through a difficult time as they experience pain and scarring. Such wounds may also cause the patient’s health status to deteriorate significantly when placed under certain conditions. In some instances, the wounds can be life threatening and the treatment can impose a significant financial burden for the family. Pressure ulcers also has an impact on the quality of care since it has an influence on the physical, emotional, psychological, social, spiritual, and the financial dimensions of the patient.
There are associated costs as a result of pressure ulcers that impact healthcare facilities and impact the reputation of the healthcare facilities. The reports on the incidences of pressure ulcers also varies in healthcare institutions from about 3% up to 20% and this suggests that there is a potential opportunity to realize a reduction in harm in different healthcare institutions (Hommel et al., 2017). There could also be a long-term impact on the patient as a result of pressure ulcers and this is usually dependent on the individual characteristics of the patient. Healthcare professionals thus have to recognize the impact that pressure ulcers can have on the patient and follow the right quality improvement plan to improve the conditions of the patient.
Best Initiatives to Improve the Issue
Improving Patient’s Environment
One of the initiatives that can be used to reduce the incidences of pressure ulcers is to improve the environment of the patient. The patient’s physical environment can be improved through different activities that focus on turning regimes, sitting regimes, choices of the mattress, and management of skin care (Richarson et al., 2017). Richarson et al., (2017) undertook these initiatives over a 4-year period and observed the improvement of incidences of pressure ulcers. From the analysis, there was a sustained reduction in pressure ulcers especially in the more severe occurrences of pressure ulcers. The study also observed that the ability to continuously monitor and to measure the impact of the pressure ulcers was an important component of the improvement program. By continuously monitoring the health status of the patients, one can easily identify what physical condition would result in a deterioration of the patient’s health status. However, the study also observed that category III ulcers did not appear to change and this necessitated for another initiative to solve the issue of pressure ulcers.
Heel Protectors
The use of heel protectors can also act to protect an individual from the incidences of pressure ulcers. Hanna-Bull (2016) developed a system of using heel protectors in order to prevent pressure ulcers through a step by step process. The first step involved the development of a criteria for patients that may require the heel protectors. The facility can identify patients that have a high risk of the development of pressure ulcers and then ensure that they use heel protectors. Hanna-Bull (2016) further observed that there is a need for every facility to develop appropriate policies that can be used to assist in heel pressure ulcer prevention. Some of the policies could involve provision of a way that nurses can judge that a heel protector would be required and enabling the staff to apply the heel protector without necessarily having direct orders from the physician. Hanna-Bull (2016) applied such as a treatment approach and observed that the implementation of heel protectors reduced pressure ulcers from 5.8% to 4.2% within a period of one year. The results showed that pressure ulcers can actually be prevented by taking the right steps.
Education of the staff was also identified as an important quality improvement initiative. Hanna-Bull (2016) noted that there is a need to have an ongoing education for the quality initiative team regarding the issue of pressure ulcers, the targeted outcomes expected of patients, and the role that it plays in quality improvement. The education could also involve everyone that interacts with the patient such as nurses, physical therapists, occupational therapists, physicians, surgeons, managers, and the directors. The education could involve specific topics such as the importance of pressure ulcer prevention, the impact it has on the patients, and the quality improvement initiatives that can be applied.
Government Involvement Through Incentives
The government also plays a huge role in ensuring that healthcare facilities provide adequate care through the use of incentives. For instance, the Affordable Care Act ensured that through the Partnership for Patients, healthcare facilities were able to receive approximately $1.1 billion so as to assist them in reducing hospital-acquired infections that were preventable and having readmissions. Through the financial incentive, the number of preventable hospital-acquired infections was found to decrease over a 4-year period (Averill et al., 2017). The government should thus continually show support towards the program so that healthcare facilities can have the motivation to work on reducing pressure ulcers.
Conclusion
The problem of pressure ulcers was identified as a serious health concern for healthcare facilities and that there was a need to undertake quality improvement. Pressure ulcers was found to result in pain and could lead to other complications for the patients. It could also result in death and huge financial implications for the healthcare facility. There were different quality improvement strategies that were noted from literature that varied from improvement in the patient’s environment, the use of heel protectors, education of health care practitioners, and the use of government incentives. These initiatives were observed by different literature and found to result in a reduction in the incidences of pressure ulcers.
References
Averill, R. F., Hughes, J. S., Fuller, R. L., & Goldfield, N. I. (2017). Quality improvement initiatives need rigorous evaluation: the case of pressure ulcers. American Journal of Medical Quality, 32(5), 552-555.
Hanna-Bull, D. (2016). Preventing heel pressure ulcers: sustained quality improvement initiative in a Canadian acute care facility. Journal of Wound Ostomy & Continence Nursing, 43(2), 129-132.
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.
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, 1-7.
