Risk Factors for Pressure Ulcers

Introduction

Pressure ulcers are a result of constantly applied pressure on a certain region of skin continuously, which creates localized erosion, tear, and necrosis of the tissue. Pressure ulcers can be categorized as a major and significant burden in both the national and global healthcare field since their implications are costly on a multitude of levels. For example, it is stated that “In the USA, approximately 1–3 million people develop pressure ulcers each year, and more than 2.5 million patients in the United States acute care services suffer from pressure ulcers, and 60,000 each year die from the complications of such ulcers” (Saghaleini et al., 2018).

Another study is indicative of the fact that “preventing pressure ulcers is one of the most challenging goals existing for today’s health care provider. Currently used tools that assess the risk of pressure ulcer development rarely evaluate the accuracy of predictability, especially in older adults” (Park et al., 2016). In other words, the problem of pressure ulcers is challenging to prevent and treat, which is why any form of effective detection and monitoring measure can be highly useful in a clinical setting.

The implementation of educational approaches, such as an evidence-based checklist, and care process modifications, such as separate rooms, can be highly effective for the geriatric group against the development of pressure ulcers (Simon et al., 2016).

Purpose

The purpose of this project is to use an evidence-based checklist to teach pressure ulcer preventative measures to the healthcare team. The key is to determine whether the integration of the evidence-based checklist in staff training will be effective at reducing the occurrence rate of pressure ulcers among the geriatric population. The proposed methodological framework is substantiated by the fact that evidence-based approaches are already showing a great deal of improvement in areas such as skin care, nutrition, and risk assessment of nursing care (Sayilan, 2019).

Great Significant Risks for Patients

In other words, there is strong evidence to consider evidence-based checklists as effective educational measures which can be directly applied to the problem of pressure ulcers. Therefore, it is critical to focus on novel and evidence-based practices to combat the issues and minimize their effects.

Literature Review

This literature review will focus on analyzing and summarizing the available data regarding pressure injuries released in recent times. The literature review was conducted using electronic sources of information and the internet. Relevant medical journals were consulted to gather the data used. Google Scholar was the primary search engine to find the featured articles, in addition to PubMed. Keywords were used to find the particular works that will be discussed, including such terms as – pressure injury, pressure injury training, pressure injury nursing, and others. All available information was additionally sorted based on language and the year of publication. The literature review was organized and prepared for nurses and other healthcare professionals working with an interest in skincare and pressure wounds.

The most important results and ideas found:

1. Among notable findings, it was shown that patients of color, specifically black and Hispanic people, were affected by pressure-related injury more often than their counterparts. Additionally, researchers note that the occurrence of pressure-related trauma further exacerbates other negative processes, including system failure, breaches in skin integrity, infection, and disease (Ahn et al., 2016)
2. The authors have found that a number of people in critical care are presented with a higher risk of developing pressure ulcers. In particular, the elderly, those with altered mobility, poor perfusion, or receiving a vasopressor infusion come under risk (Alderden et al., 2017). This information is particularly necessary when working with older patients and prioritizing care, as well as predicting possible future risks for the patients.
3. The insights gathered from nurses reinforce the position of pressure trauma as an important part of the entire patient care process. The task of ensuring patient wellness and safety involves protection against pressure injury and management of its occurrence in patients.
4. Immobility, septic shock, vasopressor use, head-of-bed elevation greater than 30° sedation, and mechanical ventilation for more than 72 hours were all noted as significant risks for developing pressure-related injuries for patients (Cox et al., 2018).
5. More than 90% of all participant nurses had inadequate knowledge of ulcer prevention, putting patients’ well-being at risk (Ebi, 2019). The lack of education and training received by medical professionals was also noted (Ebi, 2019). The results of this study highlight the need for better pressure injury education, awareness, and knowledge among medical care professionals.
6. The prevention and monitoring of different types of pressure injuries are crucial for the work of a nurse and the continued maintenance of patient health. The review is helpful in informing nurses about the potential dangers of medical equipment in relation to ulcers.
7. Using a measurement called subepidermal moisture (SEM), the authors compare its effectiveness to the standard method of using clinical skin and tissue assessment (STA) for this purpose (Okonkwo et al., 2020). While the limitations of the study are acknowledged, the authors note that the new approach has a lot of potentials to be used complementarily with STA to allow for faster and more accurate monitoring of pressure injury.
8. For the elderly population, the prevention of medical operation-related pressure injuries is even more important due to the population’s fragility. It is crucial for medical professionals to recognize and remedy this trend with proper prevention measures and care.
9. Nurses need to cooperate in developing the best evidence-based practices and approaches for tackling this issue on an intrinsic level.
10. Research has shown that there are a number of risk factors associated with a pressure injury. Age, mobility status, the severity of a patient’s condition, and their head’s elevation, among other things, can all be considered threats to their wellness.

Outcomes

The project suggests the evaluation and measurement of the following five outcomes of the training program for nursing staff:

• Healthcare Staff will demonstrate retention knowledge of pressure ulcer prevention methods as evidenced by an 80% passing rate on the posttest.
• The in-service will show effectiveness in training healthcare staff, as evident by the 80% compliance noted in the self-assessment questionnaire at the end of week six.
• The proposed budget requirement will remain at the predicted cost, as evident by the actual cost total of $505 by the end of week six.
• Healthcare staff will demonstrate effective training on the usage of the evidence-based checklist by using the show-me method by the end of week five.
• Healthcare staff will demonstrate knowledge of the proper patient and family teaching of pressure injury prevention, as evident by the verbal teach-back method.

Approach

To address the first objective, it is essential to measure the relationship between the implementation of the pressure ulcer risk assessment tool in a skilled nursing home and the incidence of bedsore development. In particular, the frequency and incidence rates of bedsores in the nursing home must be evaluated before and after the checklist use, but due to time-constraints, this project will only be evaluated by measuring the retention of knowledge through the usage of a post-test. Furthermore, nurses will be interviewed about their opinions on the tool’s effectiveness, impact on the quality of care, and key issues.

To achieve the second outcome, it is necessary to evaluate the effectiveness of the proposed in-service training on the checklist implementation. In this regard, self-assessment questionaries’ can be used to assess the compliance of the knowledge acquired with the learning objectives. Specific Key performance indicators (KPIs) can be determined to measure the employees’ performance. Furthermore, the perception of the nursing staff must be considered, along with the difficulties associated with educational outcomes. Such an approach will allow for identifying ways to the improvement of the training program and address gaps that prevent effective risk assessment tool implementation.

To measure the third desired outcome, the proposed budget requirements will be assessed and maintained throughout the project. Only the listed budget items will be used during the implementation of this project. It is essential to compare the predicted cost of the project with the actual expenditures. Since there are several stages involved in the training program, the expenses associated with each of them should be measured. Along with the effectiveness assessment, this measure will indicate how relevant the project is to implement in the clinical setting.

The fourth outcome will evaluate whether the designed training program ensures that the staff utilizes the evidence-based checklist correctly. The evaluation will include a show-me method, where the healthcare team member will demonstrate the specific instruction within the checklist. The training provided will aim to ensure the staff’s competency with the tool. Nevertheless, a follow-up evaluation will be done through a post-test to measure whether the employees have retained the information provided and implemented the risk-assessment tool correctly. Such an approach will ensure the consistency of the evidence-based checklist used in the nursing home. The complexity of the bedsore problem in limited-mobility patients implies numerous factors affecting patient outcomes. The use of the pressure ulcer prevention checklist aims to minimize these negative impacts, and thus proper training is essential.

Finally, it is important for patients and families to be involved in their care as much as possible. They should be aware of all the steps that need to be taken to prevent pressure injuries. And it becomes critical to ensure that nursing staff can effectively provide knowledge to patients and their families on pressure ulcer prevention. The evaluation will include a verbal teach-back method, where the healthcare team member will verbalize the teaching learned throughout the implementation of the project. This will not only help determine their understanding but will help to establish the major issues that come with providing training to others (Shi et al., 2018).

Budget

The proposed budget requirements and allocation are presented in Table 1. As can be seen, the project involves the use of pre- and post-test to assess retention knowledge of pressure injury prevention in senior patients. The total cost of the training and tools required for its implementation accounts for $505. The in-service training was estimated using the minimum rate of $30 dollars per hour and them multiplied by the 45 min in service times.

The total expense was reached by taking this sum and multiplying it by the number of employees being trained. The Printing and writing material will be provided by the facility, but an estimated amount has also been added to the project budget. The project budget is on the slide.

Strategies

Several measures are included in the plan of action to mitigate pressure ulcers in the nursing home setting. First, an assessment tool will be put in place to examine the current knowledge healthcare providers have regarding pressure ulcer prevention. Moreover, in-service training for staff members will contribute to practical and in-detail information that healthcare staff will be able to apply to patient care. Another important step is to include an evidence-based checklist that will help the staff practice all the necessary practices for mitigating and preventing pressure injuries. Finally, all the implementations will be assessed in terms of the actual knowledge the staff has because of the previous training on prevention methods and the usage of the evidence-based checklist. Similarly, there will be an examination of how the staff discusses care with patients and family members for the prevention of pressure injuries at home.

Furthermore, since the action plan involves the inclusion of patients and family members, the strategies will lead to the minimization of pressure injuries even after the patient leaves the nursing home.

While there are multiple advantages to the plan of action, there are certain limitations that need to be addressed. First, it is crucial to address the cost of the implementation. Moreover, due to the relatively dynamic nursing home environment, staff members may meet the new plan with rigidity and inflexibility. It is also essential to mention that medical professionals may find the in-service training time-consuming or tedious, which could lead to a lack of cooperation on the new preventative measures.

Risks

Risks and ethical issues can also occur, which is why it is vital to address them early on. The knowledge of prevention of pressure injuries may differ from person to person, which can make implementation hard. In terms of ethical problems, the implementation involves giving recommendations to family members and patients themselves, which can be viewed as intrusive. Therefore, such factors must be approached professionally and objectively.

Results

The results show a positive change in the domain of measures applied to maintain tissue integrity and mitigate risks for patients developing skin conditions from being bed/wheelchair bound. The expected outcomes have been assessed and achieved, which is highlighted through the scoring on the tests given to staff members, questioners, and show-me methods. The compared data showed the knowledge before and after the training examined through practical activities and the tests given to staff members. The results show that pre-test scores illustrated a 60% passing rate among 80% of the participants. The post-test measures show a 90% passing rate among 80% of participants. The percentage of improvement is 20%, which is an excellent number based on the initial aim to increase the number to 80%.

Another expected outcome was the successful show-me procedures where participants put their knowledge into practice. The results show that most of the participants were successful during this examination and showed an understanding of all the pressure ulcer prevention measures (90%). The primary goal was achieving 80% compliance, which means that the objective was met more efficiently than expected. Moreover, the questionnaires illustrated a satisfactory result in terms of training satisfaction and improvement in current knowledge. 85% compliance noted in the self-assessment questionnaire was evident in 100 % of participants by the end of the training, which is higher than the initially planned 80%.

The next improvement resulting from the implementation was the communication with the patient and family members regarding preventative measures. The verbal teach-back method showed 100% compliance with the checklist, a number more satisfactory than the planned 80%. Every participant was efficient in providing individuals with the necessary tools to perform preventative actions toward the mitigation of risks correlating with pressure ulcers. The overall results are satisfactory, which illustrates that the plan of action was effectively implemented. The strategies were practically applied by most healthcare providers who participated in the training and will continue to use the new risk prevention methods.

Risk prevention in nursing homes and hospitals is the primary concern of medical professionals.). The action plan aimed to minimize such conditions includes a checklist of preventative measures, including in-service training, evaluation through tests, and communication with patients and family members regarding preventative measures. The outcomes show that healthcare providers have more knowledge and skills to deal with bedsores compared to initial results. Considering the improvements, it is to be expected that a decrease in pressure ulcers will be noted in the future of skilled nursing homes.

References

Ahn, H., Cowan, L., Garvan, C., Lyon, D., & Stechmiller, J. (2016). Risk factors for pressure ulcers including suspected deep tissue injury in nursing home facility residents. Advances in Skin & Wound Care, 29(4), 178–190.

Alderden, J., Rondinelli, J., Pepper, G., Cummins, M., & Whitney, J. A. (2017). Risk factors for pressure injuries among critical care patients: A systematic review. International Journal of Nursing Studies, 71(1), 97–114.

Barakat-Johnson, M., Lai, M., Wand, T., & White, K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95–102.

Cox, J., Roche, S., & Murphy, V. (2018). Pressure injury risk factors in critical care patients: A descriptive analysis. Advances in Skin & Wound Care, 31(7), 328–334.

Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC Nursing.

ECU Libraries. (2021). Evidence-Based Practice for Nursing: Evaluating the Evidence. Research Guides.

Kayser, S., VanGilder, C., Ayello, E., & Lachenbruch, C. (2018). Prevalence and Analysis of Medical Device-Related Pressure Injuries: Results from the International Pressure Ulcer Prevalence Survey. Advances In Skin & Wound Care, 31(6), 276-285.

Okonkwo, H., Bryant, R., Milne, J., Molyneaux, D., Sanders, J., Cunningham, G., Brangman, S., Eardley, W., Chan, G. K., Mayer, B., Waldo, M., & Ju, B. (2020). A blinded clinical study using a subepidermal moisture biocapacitance measurement device for early detection of pressure injuries. Wound Repair and Regeneration, 28(3), 364–374.

Spruce, L. (2017). Back to Basics: Preventing Perioperative Pressure Injuries. AORN Journal, 105(1), 92-99.

Teo, C. S., Claire, C. A., Lopez, V., & Shorey, S. (2018). Pressure injury prevention and management practices among nurses: A realist case study. International Wound Journal, 16(1), 153–163.