Although modern medicine has reached a lot in preventing severe illnesses, some of them are still difficult to cure. An example is pressure ulcer, a damage which appears as a result of a prolonged pressure on tissues. Every patient is exposed to the injury, as the ulcers emerge in case of individuals’ inability to move. The project proposes modern proactive measures to be implemented during the patients’ hospital stay to prevent appearance of the pressure ulcers.
The Spirit of Inquiry Ignited
Pressure ulcer is a treatable medical illness. Being an underestimated disease, PU can emerge spontaneously and cause considerable troubles for a recipient. The vulnerable to the disease individuals are those who have specific medical conditions that limit their mobility and ability to switch positions. Those individuals who spend most of the time in bed are also exposed. The PU can develop quickly and unexpectedly, and, while some injuries can heal over time, some traumas do not heal over time at all. Thus, the importance of appropriate care to prevent the disease is undeniable.
The PICOT Question Formulated
The PICOT question is the following: among the patients identified as those with high risk for pressure ulcer progression (P), does the implementation of a pressure ulcer protocol initiated in the emergency department (I) compared to usual treatment of patients with predisposition for pressure ulcer (C), reduce the incidence of acquired during a hospitalization pressure ulcers (O) within a 3-day period of hospital admission (T)?
Search Strategy Conducted
CINAHL, PubMed, Cochrane Database of Systematic Reviews, the National Guideline Clearinghouse, and TRIP Database were used to search the scholarly articles related to the issue of pressure ulcers. The utilized keywords were the following: Pressure ulcer, pressure ulcer protocol, hospital-acquired pressure ulcer, emergency department. The discovered studies examined the emergence of pressure ulcers and the effective measures for the prevention of the disease. The search process allowed discovering several level I evidence studies.
Critical Appraisal of the Evidence Performed
The project evaluates several researches on the matter of emergence of pressure ulcers during a hospital admission. A study conducted by Behrendt, Ghaznavi, Mahan, Craft, & Siddiqui estimated the 422 patients’ skin and overall condition (2014). The research allows comparing the continuous bedside pressure mapping (CBPM) implementation with the ordinary pressure ulcer protocols. The level I evidence of the study showed that nurses can use CBPM devices to enhance the effectiveness of patient repositioning interventions.
A pragmatic randomized controlled trial by Gunningberg, Sedin, Andersson, & Pingel, observed and controlled 190 patients’ condition in a Swedish hospital (2017). The stress of the ulcer prevention exploration was on the patients’ continuous observance by the nurses. The eligible patients of over 50 years old were observed using the digital pressure mapping system. This level I evidence failed to demonstrate drastic positive change in pressure ulcer prevention, but the authors assure the material contains useful information, can be used as a manual by nurses, and should be further investigated.
Another study, “Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediators”, involved 67 patients divided into several groups (Krishnan et al., 2016). Those individuals with pressure ulcers and plasma samples, with pressure ulcers and urine samples, were matched accordingly with the patients suffering from spinal cord injury but with no pressure ulcers. The study explored hospitalization-related causes of the disease using secondary analysis of the data. Being a level I study, this research proposes that the altering levels of inflammatory mediators can precede the pressure ulcers of the SCI patients.
The other research by Shi, Dumville, & Cullum included 42 studies of patients with high risk of pressure ulcer (2018). The focus of the level I evidence study is on skin examination of the patients. The outcomes imply that the connection between erythema condition and appearance of pressure ulcers lacks evidence.
The last study included in the project examined condition of patients aged 50 or older (Swafford, Culpepper, & Dunn, 2016). The level I evidence included sufficient design, methodology, and support during the research. A result of the study is a strong evidence of combined interventions significantly reducing the incidence of pressure ulcers in patients.
Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice
Evaluation Plan
The purpose of this project based on the evidence is to decrease percentage of pressure ulcer emergence among the patients that are at a high-risk group. In order to achieve the goal, hospital staff should implement several changes in the patient care. The clinical question proposed according to the plan is the following: are precise observation, CBPM usage, and regular repositioning can decrease risk of pressure ulcer emergence compared to standard protocols? Estimated time for the intervention to act is 3 days, as evidence shows that pressure ulcers during short-term treatments typically develop within the three-day period of hospitalization. The stakeholders involved in the program implementation are the patients at risk and the nurses, but the hospitals might also need aid from the investors for CBPM devices.
Methods
The theoretical framework of the project includes complex system theory which aims to decrease the risk of PU from various approaches. The design of the project should be experiment-based, as the theory implies the results can be received solely after proper examination of the patients. The main independent variables that should be included are age, gender, length of stay, pressure on ulcer-susceptible points, nurse workload, and nursing skills to examine the emergence of PU. The data received from patients will be strictly ciphered according to a hospital confidentiality policy.
The selected 100 patients will include individuals from 18 to 65 years who are at risk of PU. The hospital capabilities and nurse staff will aid in the procedure. After admission, the patients will be observed and given proper care with CBPM devices, skin observations and other intensive protocols. The data will be measured at the end of the 3 days trial to define positive changes in the patients’ condition and the risk of PU. The used instruments for the assessment will be the nurses’ detailed reports.
Outcome of Practice Change Evaluated
The main evaluated data of the project will be the incidence of pressure ulcers among the patients involved in the trial. The results will be formed according to the nurses’ reports and observations. The major aspects of the project will be compared to the initial data. The planned result will be achieved when the percentage of patients diagnosed with PU after the 3-day hospital stay remain 0% with a minimum deviation.
Project Dissemination
The results of the evidence-based project will be disseminated to the hospital nurses and staff. Senior nurses along with those who were direct participants during the experiment will receive reports and discuss the results during several meetings. Each conference will cover different method of alternative PU protocol so that the participants can decide on the most appropriate measures. The results of the study will be publicly available to promote the findings of PU elimination.
Conclusion
In conclusion, the project aims to eliminate the risk of pressure ulcer emergence among the hospital patients. The research revealed several studies which encourage using proactive alternative methods of preventing PU. The complex systems theory and the experiment-based design were formed to create the study framework. The expectation of the experiment is elimination of PU risk and prevention of emergence of the disease after 3 days of hospital stay.
References
Behrendt, R, Ghaznavi, A. M., Mahan, M., Craft, S., & Siddiqui, A. (2014). Continuous bedside pressure mapping and rates of hospital- associated pressure ulcers in a medical intensive care unit. American Journal of Critical Care, 23(2), 127-133.
Gunningberg, L., Sedin, I. M., Andersson, S., & Pingel, R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. International Journal of Nursing Studies, 72, 53-59.
Krishnan, S., Karg, P.E., Boninger, M.L., Vodovotz, Y., Constantine, G., Sowa, G.A., & Brienza, D.M. (2016). Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediators. Archives of Physical Medicine and Rehabilitation, 97(10), 1656-1662.
Shi, C., Dumville, J. C., & Cullum, N. (2018). Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. International Journal of Nursing Studies, 87, 14-25.
Swafford, K., Culpepper, R., & Dunn, C. (2016). Use of a comprehensive program to reduce the incidence of hospital-acquired pressure ulcers in an intensive care unit. American Journal of Critical Care, 25(2), 152-155.