Pressure ulcers are skin injuries that appear in patients with limited mobility as a result of continuous pressure. The introduction of changes in skin management practices in intensive care units (ICU) is a response to this persisting clinical problem (Sving, Idvall, Högberg, & Gunningberg, 2014). The pressure ulceration acquired in an operating room (OR) is the issue that is responsible for almost 45 percent of all pressure ulcers; therefore, it is a safety/risk concern that leads to negative patient outcomes (Black, Fawcett, & Scott, 2014).
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Change Model Overview
The ACE Star Model of Evidence-Based Practice is a framework that is used to understand the cycles and the essence of knowledge through organizing concepts of care improvement into a holistic picture. This model is used in nursing as it provides a simple and demonstrative explanation of knowledge transformation steps as well and their relations with one another, which makes it an effective tool for organizing and implementing EBP. The ACE Star Model presents knowledge in the form of a sequence moving from one cycle to another and encompassing both old and new concepts to put evidence-based practice processes into operation. The framework is depicted in the form of a 5-point star – each point stands for one stage of knowledge transformation (Tang, Ye, & Hu, 2014).
Define the Scope of the EBP
The practice problem that has to be addressed is extremely high rates of hospital-developed pressure ulcers. The percentage of patients experiencing the condition at the facility currently ranges from 3.3 percent to 53.4 percent. The practice issue is the use of foam dressing for the prevention of perioperative pressure ulcers (Santamaria et al., 2013).
On a broader scale, the problem of pressure ulcers is associated with high treatment costs as the condition is often resistant to interventions. Moreover, pressure ulcers may bring about litigation that negatively affects performance statistics.
The team will consist of:
- registered nurses;
- management team;
- nursing assistance;
- family members.
Determine Responsibility of Team Members
The responsibilities will be divided in the following way:
- registered nurses: providing quality patient care, nurse coaching;
- physicians: evaluating interventions, giving practical recommendations;
- pharmacists: giving consultations on treatment and medications that may be beneficial;
- dietitians: developing a healthy diet for quicker recovery;
- management team: hiring more professionals to deal with the problem, monitoring documentation;
- nursing assistance: helping nurses in daily care;
- family members: providing support to patients and help them with preventive measures.
The research relies on EBP guidelines that allow it to give a clear description of the problem, explain reasons for change, provide thorough root-cause analysis, and precisely outline internal and external factors as well as obstacles that may hinder implementation of the project. The sections are abundantly supported with evidence providing a deep insight into the issue.
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Summarize the Evidence
The majority of twenty-one publications used for the systematic review concur that prophylactic dressings substantially facilitate pressure ulcer prevention. A comparison between the influence of different dressings on the effectiveness of ulcer prevention shows that soft silicone foam dressings are the best in terms of the reduction of pressure damage (Santamaria et al., 2013). Specifically, the material is capable of reducing the incidence of pressure ulcers from 5.9 percent to 0.9 percent (Clark et al., 2014). Thus, the major evidence-based intervention that is going to be used is foam dressings that reduce pressure damage.
Develop Recommendations for Change Based on Evidence
The research allows making the following recommendations:
- apply foam dressings to sacrum and bony prominences areas;
- develop a healthy diet for quicker recovery;
- use foam mattresses to redistribute pressure;
- increase patients’ mobility when possible;
- not to offer gauze dressings;
- offer medications in case the condition is developing.
The implementation plan will include the following steps:
- create an intervention team;
- coach novice nurses to avoid understaffing;
- perform skin inspections of patients;
- apply foam dressing for the prevention of perioperative pressure ulcers;
- identify and implement additional interventions (diet, medications, etc.);
- provide ongoing monitoring of the process;
- perform regular evaluations of the change and document the results.
The major part of the project is supposed to be covered in a 4-month period. Evaluation of the change will take place on a regular basis and the final outcomes will be summarized at the end of the period.
Process, Outcomes Evaluation, and Reporting
The desired outcome is to reduce the occurrence of pressure ulcers through the implementation of foam dressings. They will be measured by assessing the incidence and prevalence of the condition on a monthly basis. The results will be reported to the patients and their families directly. Team members will discuss the results at a closed meeting.
Identify Next Steps
To plan should be applied in clinical environments that feature almost the same list of needs and problems related to pressure ulcers. Moreover, information has to be spread in other hospitals with the help of brochures.
To disseminate the results, it is necessary to organize conferences and release brochures to reach larger audiences.
Pressure ulcers present a persisting clinical problem. To address it, ACE Star Model can be used as a guide to facilitate the change process as it highlights obstacles that may be encountered when applying theories in practice and provides the most effective solutions. The introduction of foam dressings is proposed as a major intervention. The change process will consist of: 1) discovery research; 2) summary of current evidence; 3) translation to guidelines; 4) evaluation of the process and the outcome.
Black, J., Fawcett, D., & Scott, S. (2014). Ten top issues: Preventing pressure ulcers in the surgical patient. Wounds International, 5(4), 14-19.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2013). A randomized controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal, 12(3), 302-308.
Sving, E., Idvall, E., Högberg, H., & Gunningberg, L. (2014). Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. The International Journal of Nursing Studies, 51(5), 717-725.
Tang, L. W., Ye, Z. H., & Hu, B. B. (2014). Application of ACE Star model in evidence-based nursing training. Chinese Journal of Nursing, 8(2), 021-034.