Introduction to the Quality Improvement Initiative
Elderly patients in the nursing home have an increased risk of developing problems with pressure and skin breakdowns. It is especially problematic for immobile patients who require constant supervision from medical personnel (Mervis & Phillips, 2019). The problem is that older people have thinner skin, which is typical for their age, and it is easy to injure it without possibly healing it (Mervis & Phillips, 2019).
Among the causes of different kinds of sores and skin damage are dietary issues, including not drinking and eating enough, incontinence, thinking, and memory issues (Mervis & Phillips, 2019). Pressure sores, in turn, appear when the patient does not change their position during an extended period, including sitting or lying (Mervis & Phillips, 2019). Therefore, the quality improvement initiative aims to find ways to decrease the high risk of pressure and skin breakdowns in the nursing home setting to improve the state of older patients.
Target Population
The target population or audience is older adults who stay in nursing homes for a comparatively long time. This category of people includes both those patients whose problems with locomotive functions are temporary and those who are immobile (Mervis & Phillips, 2019). Fractures of the skin and pressure sores hurt a lot and may require a while to recover (Mervis & Phillips, 2019). They may also result in more severe issues like infections or irreversible destruction of muscle or bone tissue (Mervis & Phillips, 2019).
An injury may result in a prolonged stay at the hospital (Mervis & Phillips, 2019). When the patient departs the medical facility, it may also make it harder for them to care for themselves and maintain their autonomy (Mervis & Phillips, 2019). Therefore, implementing the plan for quality improvement is a valuable opportunity for older patients in the nursing home with a high risk of skin injuries.
Benefits of the Quality Improvement Initiative
The benefits of the quality improvement initiative include creating better conditions for the nursing home residents and caring for their physical and emotional state, affected by the pain from skin breakdowns and pressure. It can be defined as implementing a patient-centered approach to medical care because these health issues significantly affect the patient’s state (Gupta & Addison, 2020). Older adult patients in nursing homes have a high risk of developing multiple health problems simultaneously (Gupta & Addison, 2020).
For instance, patients who have survived a stroke have spastic fingers that cause injuries on the palm (Gupta & Addison, 2020). Typically, it is impossible to treat these injuries using the standard approach, which leads to the inability of the patient to support proper hygiene and chronic pain (Gupta & Addison, 2020). This example shows that skin problems among older adult patients can have various causes, and it is vital to determine the reasons to minimize the harmful effects. In all cases, patients receive better assistance when the quality improvement initiative is implemented in practice.
Interprofessional Collaboration Required for Implementation
Interprofessional collaboration is needed to implement the discussed project in clinical practice. In particular, there is a need to develop a complex approach to the issue to eliminate the situations when older patients with high risks of skin pressure and breakdowns are neglected. A practical method of evaluating the risks of skin injury development is a visual assessment of the patient’s skin (Kim et al., 2018). The patient can assess their state visually without the help of the nurse or the physician, even though it does not mean that the nurse can neglect this responsibility (Kim et al., 2018).
In addition, the nurse checks the subepidermal moisture value every week (Kim et al., 2018). This investigation requires professional qualification, which means that the regular attention of the healthcare personnel to the patient’s skin state is essential (Kim et al., 2018). Therefore, physicians and nurses should pay equal attention to this issue when communicating with patients or checking their state. Patients should also be informed about the potential risks associated with their skin and report any changes during daily visits with the nurse or the physician.
Cost and Budget Justification
The budget for the initiative implementation includes the expenses for the products necessary for maintaining skin integrity and avoiding sores and pressure ulcers. Medical personnel must ensure the patient’s skin is dry and clean (Andayani et al., 2020). At the same time, it is vital to avoid substances that can lead to extreme drying of the patient’s skin, including alcohol cleansers and aggressive soaps (Andayani et al., 2020). In addition, the nurse should provide the patient with a moisturizer that has a water-based formula.
There is a need to increase the patient’s awareness about the state of the skin, which requires time for consultation. Patients should drink water and eat balanced food regularly, which requires attention from healthcare professionals. It is vital to introduce regular repositioning of immobile patients and pressure mattresses to decrease the risks of skin injuries (Andayani et al., 2020). Therefore, the expenses of introducing the improvement initiative include the cost of the balanced diet, the moisturizer, the soft cleansing lotion, and the time required to explain the problem to the patient.
Evaluation Criteria for the Quality Improvement Initiative
It is possible to evaluate the results of the quality improvement initiative using data regarding the number of skin pressure and breakdowns among the nursing home’s patients and nurses’ self-reports. The combination of the opinions of the healthcare personnel, patients, and the statistics concerning skin injuries allows for elaborating the objective vision of the situation.
The critical aspect is connected with the need to check the reports of the visual analysis made by patients by nurses. It helps to ensure that the risks of developing skin issues are minimal. Even though a patient’s self-report can be an excellent supporting means of diagnosing skin injuries at the early stage, it is not the major one. The analysis of this data is necessary for evaluating the practice and showing its medical justification.
Conclusion
The quality improvement initiative focused on decreasing the high risk of skin breakdowns and pressure in the nursing home setting is justified from the medical point of view. It is an effective way to improve the health state of older patients because skin issues affect the physical and psychological well-being of nursing home residents. Pressures and skin injuries cause pain and inconvenience that do not allow older adults to live without chronic discomfort.
In addition, the fact that they have skin sores often affects their emotional state because many older adults react to such signs of illness negatively. It can cause apathy and a depressed state, especially when skin pressure and breakdowns are combined with prolonged pain. It states that implementing the improvement initiative is a vital component of the patient-centered approach to nursing.
References
Andayani, R. P., Nurhaeni, N., & Wanda, D. (2020). Assessing effectiveness of regular repositioning in preventing pressure ulcers in children. Pediatric Reports, 12(1), 8696. Web.
Gupta, A. D., & Addison, S. (2020). Healing hand ulcers caused by focal spasticity. International Wound Journal, 17(3), 774–780. Web.
Kim, C. G., Park, S., Ko, J. W., & Jo, S. (2018). The relationship of subepidermal moisture and early stage pressure injury by visual skin assessment. Journal of Tissue Viability, 27(3), 130–134. Web.
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. Web.