Summary
Pressure ulcers are common problems for many patients and result in high costs related to usages of resources and negative impacts on the quality of life of the patient. Studies have demonstrated that hydrocolloid dressings result in effective management of pressure ulcers because they enhance healing, pain and exudate management and assist in autolytic debridement, particularly in advanced stages of pressure ulcers. An effective implementation of hydrocolloid dressings as indicated by evidence-based practices could result in favourable outcomes for patients and cost benefits to health care facilities.
Background and Literature Review
Pressure ulcers are a significant indicator of health care problem because they lead to severe patient pain and suffering, increase the length of hospital stay, mobility challenges, as well as costs of health care provisions (Bluestein & Javaheri, 2008; Bluestein & Javaheri, 2008; Fletcher, Moore, Anderson, & Matsuzaki, 2011; Günes, 2008). A study by Jaul on pressure ulcers showed that it was a an ever-increasing challenge in the entire area of the health care sector, including private homes, clinics, hospitals, and other long-term care homes (Jaul, 2010). The duration of the condition in patients varied, but others remained with pressure ulcers throughout their lifetime. Moreover, a number of patients who had pressure ulcers of “grade 3 and 4 developed chronic wounds while some cases led to deaths due to ulcer-related complications (sepsis or osteomyelitis)” (Jaul, 2010, p. 311). Apart from deaths, pressure ulcers also lead to a geriatric condition with multifactorial pathological complications.
Hydrocolloid can be used to treat pressure ulcers and they are commonly used, particularly in grade 2 and 3 pressure ulcers. They are highly effective and affordable relative to gauze dressings (Heyneman, Beele, Vanderwee, & Defloor, 2008). Some studies have indicated that hydrocolloid usages in wound dressing are highly effective and facilitate healing than gauze dressings (Heyneman et al., 2008). Hydrocollid dressing has “high absorption capacity, the time needed for dressing changes is low, the pain is managed when dressing changes and the side-effects are significantly” (Heyneman et al., 2008, p. 1164). Fletcher et al. (2011) noted that the use hydrocolloid dressings was effective in “moist wound healing, manage exudate, aid autolytic debridement and assist with pain management” (p. 4) relative to other modes of interventions. In addition, hydrocolloid dressings were effective in protecting tissues from exposure and constant damages, friction and edge rolling. Therefore, it is necessary to develop an effective implementation plan for hydrocolloid dressing.
Aims of the Implementation
It is expected that the implementation plan will provide an effective plan for enhancing the use of evidence-based pressure ulcer dressings by using hydrocolloid. In addition, it will provide evidence-based recommendation for management of pressure ulcers for improved patient outcomes. This would lead to cost-benefit for the patient and hospital. It is also expected that the implementation will be used to improve pain management and quality of patient care.
Nurses will data and analyse data for evaluation purposes. The outcomes will be compared with the benchmark indicators or against previous practices and procedures in hydrocolloid usages to evaluate the effectiveness of the implementation plan.
Identification of Stakeholders, Champions and Targets
Managing pressure ulcers involves various health care workers and therefore it is a multidisciplinary approach. These health care providers include nurses, physicians, physicians’ assistants, dieticians, and the patient. The implementation plan, therefore, should be useful for all health care workers who are involved in managing pressure ulcers in patients. Irrespective of health care workers’ responsibilities in the process, the main stakeholders in this case are the patients and thus, the strategy of this implementation plan is patient-centred. Health care workers who will implement the hydrocolloid dressing must understand its mechanism and the patient wound. Health care workers, such as nurse leaders and managers, advanced practice nurses, physicians and their assistants, nurses and other nursing care practitioners remain the champion and target groups for the hydrocolloid dressing implementation plan.
All key stakeholders have specific roles when providing care for patients who require hydrocolloid dressing to manage their pressure ulcer wound and pain. For instance, the system consideration for wound care involves evaluation of high-risk patients and pressure ulcers, a diagnosis of spreading acute infection, optimisation of the host response as a management strategy, biological dressing, and surgery among other intervention strategies.
Identification of Barriers
The decision to change health care practices depends on the nurses and physicians recommendations, which health care facility management must approve. Health care workers, particularly nurse leaders and managers have the responsibility to facilitate the implementation of hydrocolloid dressings for pressure ulcers. However, as various studies have shown, such leaders and managers could be the main source of barriers to effective implementation of any plans, specifically the implementation of evidence-based outcomes in health care facilities (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012).
Such studies point out that resistant to change could be a deeply rooted hospital culture perpetuated by nurse leaders and managers whose training did not cover evidence-based practices (Wallis, 2012).
From the guideline of best practices in managing pressure ulcers, it is clear that wound management is an elaborate process that requires adequate resources, skills, knowledge and experience. A lack of adequate training and skills in using hydrocolloid dressings to address pressure ulcers could hamper the implementation of the plan. Health care workers who lack such skills and experiences may affect the effective implementation of the plan. Moreover, resources and adequate time required to address pressure ulcers could be limited.
While there are impediments to effective implementation of the hydrocolloid implementation plan, it is necessary for health care facilities and nurses to address such barriers for effective implementation and subsequent cost-benefits and improved patient outcomes.
Significance of the Project
As indicated earlier, pressure ulcers have detrimental outcomes on quality of health of patients in addition to medical costs. Given such impacts, it is imperative for health care providers to understand the best practices in wound management. In addition, health care workers must also understand how such practices can be effectively implemented in their respective settings for overall best outcomes for health care facilities and patients.
Pressure ulcers have intense pain. This implementation plan will ensure that health care workers understand pain assessment and management strategies. In addition, they would be able to identify and manage wounds by using hydrocolloid dressings appropriately.
Method of Knowledge Transfer: Planned Staging of Implementation Activities
One must acknowledge that introducing evidence-based practices in a health care facility is likely to meet resistance. The best approach to eliminate such threats to any implementation plan is to get the support of all stakeholders through a wide consultation. Training and education on the importance of hydrocolloid dressing plan should be a priority in such situations. Education and training could facilitate behaviour change among nurses and lessen resistance.
Wound management requires a multidisciplinary team. Consequently, it is necessary for all stakeholders to understand their roles throughout the process with the aim of facilitating collaborative pressure ulcer management (Ross, King, & Firth, 2005).
Nurses could work in groups to improve learning of new skills and sharing of information and best practices in hydrocolloid dressing techniques.
Proposed Evaluation
Hydrocolloid dressings are evidence-based practices that enhance quality of care among patients. It is, therefore, necessary to gather relevant data for evaluating its outcomes. In this regard, nurses who implement the plan shall collect and analyse data before and after the project implementation in order to evaluate the effectiveness of the hydrocolloid plan.
Ethical or Resource Implications
While many studies (Fletcher et al,. 2011; Bluestein & Javaheri, 2008; Heyneman et al., 2008) have highlighted the effectiveness of hydrocolloid dressings in managing pressure ulcers, there are others issues that require consideration.
Other studies, however, have pointed out that further studies are required to ascertain the effectiveness of hydrocolloid dressings in managing pressure ulcers (Heyneman et al., 2008). In addition, other researchers have established that currently there is “no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing or a topical cream containing plant extracts” (Dumville, Deshpande, O’Meara., & Speak, 2013). In this regard, decision-makers in wound management must evaluate various interventions using other criteria such as costs and select the best one.
There are also contraindications associated with the use of evidence-based practices in wound management. Autolytic debridement could present challenges in large pressure ulcers, individuals with low immunity, infections and other undermining situations. Health care providers, therefore, must use such strategies with caution when addressing pressure ulcers. In addition, they have to account for bleeding disorders and effective therapy for pain management when implementing the plan. Such patient-based conditions require caution when implementing the plan and could result in further clinical implications and legal issues if poorly managed.
Patients should receive the best care and they have legal rights to request for such services. Wound management requires effective management of all other related challenges. It is, therefore, important for health care workers to rely on a consistent approach for implementing the plan based on the needs of specific patients. The implementation plan should account for all the required resources for effective implementation. This would ensure that the plan provides evidence-based practices and implementation procedures as indicated.
Budget.
Justification
Pressure ulcers have placed greatest burdens on patients and health care workers and studies have shown some of the best outcomes for managing such conditions. There are, however, few implementation guidelines for such best practices. Evidence-based practices have emphasised the relevance of implementing the outcomes to enhance the quality of care and cost-benefits for the health care facility and the patient. The plan would reduce risks associated with poor wound dressings in patients.
There is significant focus on the use of evidence-based outcomes to facilitate the provision of effective care to patients. Consequently, health care stakeholders have focused on the use of methods that can reduce pressure ulcers and effective management of the resultant wounds. The costs associated with other modes of interventions could be costly while hydrocolloid dressings are cost-effective.
The complexity associated with wound management and several other interventions available implies that health care workers must rely on evidence to make effective decisions for their patients (Keogh et al., 2013).
This implementation plan shows that researchers have evaluated various dressing types for wound management and provided their outcomes. Evidence suggests that many wound care management approaches are available, however, they still require further studies to ascertain their effectiveness. Therefore, there is a clear need for effective implementation plan to support and promote the best outcomes. This would ensure that health care workers make the best decisions for patient care and follow the right procedures required in managing pressure ulcers.
Time line.
Conclusion
Studies have recognised the burden of pressure ulcers on patients and health care providers. While it could be difficult to eliminate pressure ulcers, effective management of wounds could be highly important. Research has shown that hydrocolloid dressings are effective relative to other forms of interventions. Hence, it is necessary for health care workers to have a standard implementation guideline for specific interventions. In this regard, an implementation plan could be highly effective in guiding the best practices, identifying challenges and proposing solutions through data collected for evaluations and improving the plan.
References
Bluestein, D., & Javaheri, A. (2008). Pressure Ulcers: Prevention, Evaluation, and Management. American Family Physician, 78(10), 1186-1194.
Dumville, J., Deshpande, S., O’Meara, S., & Speak, K. (2013). Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database System Review, 8, CD009099. Web.
Fletcher, J., Moore, Z., Anderson, I., & Matsuzaki, K. (2011). Pressure ulcers and hydrocolloids Made Easy. Wounds International 2(4), 1-4.
Günes, Ü. Y. (2008). A Descriptive Study of Pressure Ulcer Pain. Ostomy Wound Manage, 54(2), 56-61.
Heyneman, A., Beele, H., Vanderwee, K., & Defloor, T. (2008). A systematic review of the use of hydrocolloids in the treatment of pressure ulcers. Journal of Clinical Nursing, 17(9), 1164-73. Web.
Jaul, E. (2010). Assessment and management of pressure ulcers in the elderly: current strategies. Drugs & Aging, 27(4), 311-25. Web.
Keogh, S., Nelson, A., Webster, J., Jolly, J., Ullman, A., & Chaboyer, W. (2013). Hydrocolloid dressings for treating pressure ulcers. Web.
Melnyk, B., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators. Journal of Nursing Administration, 42(9), 410–417. Web.
Ross, A., King, N., & Firth, J. (2005). Interprofessional Relationships and Collaborative Working: Encouraging Reflective Practice. OJIN: The Online Journal of Issues in Nursing, 10(1), 3. Web.
Wallis, L. (2012). Barriers to Implementing Evidence-Based Practice Remain High for U.S. Nurses. American Journal of Nursing, 112(12), 15. Web.