Problem Statement
The lack of standardized protocols for the prevention of pressure ulcers (PU) in ICUs and other emergency departments compromises patient safety and induces prolonged hospital stay as well as increased treatment costs. Developing and implementing effective standards would significantly reduce the risk of PU in immobile bedridden patients.
Hypothesis and Variables
The implementation of the PU-preventive protocol, which covers a broad range of nursing behaviors about the identified adverse health condition will provide better results and reduce the occurrence of hospital-acquired PUs when compared to standard emergency department practices during a prolonged hospital stay. Variables tested in the scope of this hypothesis are as follows:
- Dependent variable: Patient outcomes (frequency and severity of pressure ulcers in immobile bedridden patients during a prolonged hospital stay).
- Independent variable: Frequency and correlation of the implementation of preventive healthcare measures.
Research Questions
The literature reviewed in the scope of this paper will seek to answer some of the following questions:
- Does the implementation of the prevention protocol reduce the incidence of PU in hospitalized patients?
- What are the patient and the hospital costs of utilizing the new protocol compared to usual care procedures?
- How effective is the new protocol in treating PUs registered on patient admission in terms of wound recovery?
- What are the major difficulties and barriers to the implementation of the PU prevention protocol in the hospital environment?
Each source will answer one or several of these questions, providing important data for the research.
Review of Literature
Silicone foam dressing is one of the primary methods of preventing pressure ulcers in patients. However, it is not widely implemented as a standard protocol, which relies primarily on repositioning and the use of soft padding under the points of contact. Truong, Grigson, Patel, and Liu (2016) analyzed the available literature on the effectiveness of silicone foam dressings versus standard protocols. According to their findings, silicone foam shows greater effectiveness in preventing ulcers (42.9% vs. 3.6 for standard protocol). Also, the average net cost of the intervention was found to be significantly lower (52.87 dollars vs. 107.91 dollars). This source directly answers some of the research questions about the thesis of this paper. However, its major limitation lies in the duration of the experiment and its small sample size, which makes it difficult to extrapolate the results.
Cano et al. (2015) experimented with changes to the standard protocol and the materials used for preventing the development of pressure ulcers in patients. Namely, all standard supportive surfaces were replaced with Hill-Rom Advanced Microclimate Technology Mattresses. Advanced protocols of supervision and care were strictly followed. As a result, the incidence of PU dropped from 11.7% to 2-4%. This source directly answers the first, second, and third research questions, providing data for financial feasibility and the overall effectiveness of the intervention. One of the potential gaps in this research, however, lies in the lack of comparison between newly introduced and standard protocols. It is possible that high results were achieved because of higher percentages of compliance associated with motivation from participation in an experiment.
The article by Worsley, Clarkson, Bader, and Schoonhoven (2016) investigated some of the barriers and facilitators to participation in pressure ulcer prevention. According to their findings, the greatest barriers to practicing PU prevention were limitations in resources (not enough staff/lack of equipment), lack of professional education, and professional boundaries. This source answers the fourth research question by addressing factors directly and indirectly associated with the implementation of PU prevention protocols. One of the greatest limitations of this study is that it does not provide any guidelines for overcoming the problem.
References
Cano, A., Anglade, D., Stamp, H., Joaquin, F., Lopez, J. A., Lupe, L., … Young, D. L. (2015). Improving outcomes by implementing a pressure ulcer prevention program (PUPP): Going beyond the basics. Healthcare, 3(3), 574–585.
Truong, B., Grigson, E., Patel, M., & Liu, X. (2016). Pressure ulcer prevention in the hospital setting using silicone foam dressings. Cureus, 8(8), e730.
Worsley, P. R., Clarkson, P., Bader, D. L., & Schoonhoven, L. (2016). Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: A mixed methods evaluation. Physiotherapy, 103(3), 304-310.