A pressure injury or ulcer is a localized skin injury or an underlying tissue injury from unrelieved pressure. “Critically ill patients in the intensive care unit (ICU) are at an increased risk” primarily due to interventions done at the ICU, the critical illness itself, or the pre-existing comorbid conditions. Moreover, pressure ulcers are common for bedridden patients for long periods, sedated, or ventilated in the ICU. Patients who acquire pressure ulcers experience psychosocial distress, increased morbidity, and pain linked to social isolation and independence loss. “In the article Pressure Ulcers in the Intensive Care Unit: An Analysis of Skin Barrier Risk Factors” , He et al. identified that “failure to provide appropriate preventive care” might heighten the “risk of litigation” (2016). Pressure injury-associated risks include immobility, low cardiac output state, decreased nutrition, impaired consciousness level, and vasopressor use. However, pressure ulcers are considered preventable conditions. Thus, it is an indication of the quality of care in any healthcare organization ( Al-Dorzi, 2019) . Incontinence cannot cause pressure injuries, although it makes patients in the ICU more vulnerable to the development of the condition due to skin damage by corrosive effects of urine.
Pressure ulcers are a definite and fundamental challenge in the medical healthcare system. The condition is gradually on the rise despite the utilization of know-how and new medical equipment ( Gill, 2015) . Mostly the weak, vulnerable, and the elderly in society are most affected by the condition. The complications are expensive to treat due to the high medical cost and causes patients misery and pain.
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Research has shown that if nursing staff are knowledgeable and educated on the prevention of pressure ulcers, improvement and change can be achieved in the nursing practice. The prevention of pressure ulcers is a vital nursing care aspect whereby most nurses are oblivious of its importance and effects in maintaining quality care in the ICU. Thus, pressure ulcer management and treatment require an overabundance of knowledge and skills to care for and manage the complication.
Why is this a leadership issue? This is a nursing leadership issue because an efficient leader can recognize it as a challenge and take it upon themselves to explore the problem and find suitable solutions. Pressure ulcers are prevalent in the ICU, and researchers have estimated that approximately 13% of ICU patients develop the complication while been treated. “The prevention and treatment of pressure ulcers” involve consuming large quantities of resources, including nursing time and equipment. Moreover, risk factors to patients due to poor quality of care in the ICU increases the rate of morbidity, healthcare costs, impaired consciousness level for the patients.
Therefore, seeing how that is a challenge, the application of necessary nursing interventions will highly assist in decreasing the problems because nurses will have performed a routine risk assessment for ICU patients; thus, risks will be identified early. The leadership style would be thought leadership, whereby the leader utilizes an idea to convince others to consider new ways and ideas to minimize the risks of pressure ulcers among patients in the ICU. Strong leadership is necessary to persuade other nurses to adopt nursing interventions such as performing routine risk assessments on all ICU patients.
Literature Review
Pressure ulcers are a common occurrence and pose a significant health challenge to the recovery of patients in the ICU. The complications are associated with increased healthcare costs and can be prevented. Interventions and measures to prevent pressure ulcers are crucial in nursing care. Pressure ulcers make the conditions of a patient worse by hindering recovery. ICU patients might constantly be receiving prolonged mechanical ventilation and intravenous infusion, lethargic and bedridden for long periods, in addition to not being able to turn themselves and being turned over incorrectly by caregivers. Organ failure, hemodynamic activity, sensory perception changes, and the receiving vasopressin treatment result in increased pressure ulcers. Moreover, the ICU is where most life-threatening and severe illnesses and injured patients are taken care of and provided constant surveillance; hence are at an increased risk of contracting pressure ulcers ( Zaratkiewicz et al., 2010) . Therefore, the ICU staff and doctors should be well trained to take care of patients in the medical unit.
The prevention of pressure ulcers is a vital index in the measure of nursing care quality. Most prevention strategies require the coordination of medical staff. As nurses play a crucial role in taking care of patients in the ICU, nursing care is vital in preventing pressure ulcers acquired in the hospital. Research has shown that careful implementation and planning of nursing measures can minimize pressure ulcer occurrence ( Yongli, & Chengcheng, 2018) . Nurses should also understand the hazards and study the nursing and prevention of pressure ulcers for a breakthrough.
Interventions include skin interventions whereby early skin compromise detection resulting from excess moisture and pressure is crucial based on skin assessment and close monitoring. Nurses should perform daily skin assessments and biweekly evaluations of patients to help detect pressure ulcers; thus, medical staff can take necessary precautions. Secondly, essential interventions should be taken to relieve compression on tissues of the skin. It can be achieved through frequent replacement of posture whereby nurses reposition and turn over patients to prevent pressure ulcers ( Armour-Burton et al., 2013) . Additionally, a decompression device such as an air fluidized bed significantly decreased pressure ulcers. A third intervention is the application of protective measures to lessen the formulation of pressure ulcers. The protective measures are applied on the heels, sacral part of the bone, and the bone joint. Dressings are used as a protective measure to prevent pressure ulcers. Another preventive measure is nutritional support, whereby the intravenous infusion of albumin can help in the reduction of pressure incidence in ICU patients and reduce the severity of pressure ulcers.
A ) Starting the Project
Actions Taken: The project's scope is not broad since it includes the patient care technicians, nurses, dietary staff, and physicians. The stakeholders for the project include physicians and nurses who mostly operate in the ICU. The primary resources are the Centre “for Medicare and Medicaid Services (CMS)”. The Harborview Medical Centre (HMC) is committed to the provision of excellence of nursing care in addition to pressure ulcers and optimal care of the skin. The HMC organization includes a system that monitors the occurrence of pressure ulcers.
A monthly multidisciplinary intensive research was conducted on hospitalized pressure ulcers. Then there was an application of an algorithm used in the determination of whether hospitalized pressure ulcers could be prevented, developed, and implemented.
Problems Encountered, the Analysis and Solutions: There were a few challenges faced with the implementation of the “Prevention of Hospital Acquired Pressure” Ulcer in the ICU. One of the main challenges was finding out how the information would be communicated to the nurses and physicians who served in the intensive care unit. Moreover, the intensive review process, incidence tracking, and evaluation involved many people and utilized a lot of resources. Additionally, having the needed number of Certified Wound Care Nurses (CWCNs) to aid and monitor the project proved to be a major hindrance. However, the Patient Care Services department is dealing with the problem by “increasing the number of CWCNs”. Another challenge is not having enough nurses to turn the patients or monitor them regularly ( Richardson et al., 2017) . For the implementation of the project, there would need to have available care nurses who would watch and check on the patients regularly.
Organizing and Preparing
Actions Taken: The staff registered nurses completed “skin assessments for their patients” after every shift, and the evaluation was charted “in the EMR. The charting process includes” questions in a “simple check box” asking questions such as whether the patient had a pressure ulcer. The chart documentation was used in the generation of a daily reporting the network servers of the institution ( Richardson et al., 2017) . If the charts showed the occurrence of pressure ulcers in a patient, the patient was included in the daily report sent each morning to the CWCNs.
Carrying out the Work
Actions Taken: The project is carried out by Certified Care Wound Nurses (CWCNs) at Harborview Medical Center. The participants were patient safety, nursing, administration, clinical education, medicine, quality improvement, CWCNs, clinical data systems, occupational therapy, respiratory therapy, and dietary ( Richardson et al., 2017) . The case presentation and evaluation by the review team were done, and recommendations for the practice made in guidance with clinical data.
Closing the Project
Actions Taken: The results of this project Aretha the “Prevention of Hospital Acquired Pressure” Ulcer in the ICU, are being implemented by Harborview medical center and are being utilized successfully by staff members in the facility. The evaluation includes monthly documentation of hospitalized pressure ulcers of patients in the ICU ( Richardson et al., 2017) . A comparison is made to compare the rates at which the condition is occurring in patients.
Reflection of the Leadership Project
The projected results of this project include decreased rate of the occurrence of hospitalized pressure ulcers, medical staff who are more focused on patient care. The “Prevention of Hospital Acquired Pressure” Ulcer in the ICU will be utilized in the Harborview Medical Center.
References
Al-Dorzi, H. M. (2019). Prevention of pressure injury in the intensive care unit. Saudi Critical Care Journal , 3 (1), 24.
Armour-Burton, T., Fields, W., Outlaw, L., & Deleon, E. (2013). The Healthy Skin Project: changing nursing practice to prevent and treat hospital-acquired pressure ulcers. Critical Care Nurse , 33 (3), 32-39.
Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Open Quality , 4 (1).
He, M., Tang, A., Ge, X., & Zheng, J. (2016). Pressure ulcers in the intensive care unit: an analysis of skin barrier risk factors. Advances in skin & wound care , 29 (11), 493-498.
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.
Rivera, J., Donohoe, E., Deady-Rooney, M., Douglas, M., & Samaniego, N. (2020). Implementing a Pressure Injury Prevention Bundle to Decrease Hospital-Acquired Pressure Injuries in an Adult Critical Care Unit: An Evidence-Based, Pilot Initiative. Wound Management & Prevention , 66 (10), 20-28.
Yongli, L., & Chengcheng, W. (2018). How pressure ulcers can be prevented in intensive care unit (ICU) patients: A descriptive literature review.
Zaratkiewicz, S., Whitney, J. D., Lowe, J. R., Taylor, S., O'Donnell, F., & Minton‐Foltz, P. (2010). Development and implementation of a hospital‐acquired pressure ulcer incidence tracking system and algorithm. Journal for Healthcare Quality , 32 (6), 44-51.
