Pressure ulcers (PUs), otherwise known as bedsores, are a common problem for patients, especially older adults, whose movement is limited. This problem brings significant losses to healthcare and inconvenience to patients. The International Pressure Ulcer Prevention Survey found that the prevalence of PUs in hospitals varied from 8 to 14%, and incidence – from 3 to 5% (Jaul et al., 2018, p. 2). At the same time, nurses’ knowledge of pressure injury prevention is often limited and does not correspond to the recommended levels (Dalvand et al., 2018). Given the impact of the problem, action must be taken to solve it. The purpose of the capstone project is to implement a quality improvement education plan using evidence-based- practices for the nursing staff at skilled nursing/rehab facilities to reduce the risks of PUs for geriatric patients with limited mobility over a four-week period.
Besides implementing the plan, there will be several assessment measures that will illustrate whether the project had positive results or did not impact the participants. The implementation is potentially beneficial for the nursing facility due to the existing evidence that such policies lead to a decrease in PU cases, an increase in patient satisfaction, and an overall advancement in the field of patient-centered care. In order for the objectives to be met, it is essential to design an adequate approach, planned outcomes, budget, and a description of results as evidence of the educational measures being successfully applied. Thus, after detailed planning of the PU prevention measures through training of the medical staff, it is critical to document the results and compare previous knowledge and skills with the newly acquired ones. The paper aims to illustrate the critical need for preventative measures for pressure ulcers, the effectiveness of evidence-based educational frameworks for nurses, and the possibility of multilevel risk mitigation.
Statement of the Problem/Opportunity
The comfort and well-being of the patient is essential when providing basic or tailored care to them. The development and/or poor management of existing PUs does the complete opposite. It causes the patient pain, discomfort, and can potentially be detrimental to their health such as the acquirement of an infection, and death. Nurses play a crucial role in the prevention, as they can assess for risk factors of PUs and take action to implement timely care. However, often, this problem is not given the attention needed to alleviate or prevent PUs, due to nurses’ lacking knowledge. These reasons justify the relevance of the project and its importance.
Pressure ulcer (PU) treatment is among the features of patient therapy in which nursing practice interoperates with healthcare providers. It is the third most expensive ailment, after cancer and cardiovascular disorders (Nussbaum et al., 2018). Since October of 2008, hospitals have not received any Medicare reimbursement for ulcer-specific treatment of patients who develop Stage III or IV PUs following inpatient hospitalization (Fehlberg et al., 2017). As a result of policy changes adopted by the Centers for Medicare and Medicaid Services (CMS), facilities now must assess all patients diagnosed with skin problems to identify the likelihood of developing PUs.
Despite contemporary strategies for PU therapy, nurse knowledge and clinical expertise in this area of study are out of date, and negative stereotypes about prevention efforts are on the ascent. Du et al. (2021), for example, commissioned a survey by comparing traditional didactic approaches that offered information about PUs to a therapeutic scenario simulation-based strategy for developing the competence to identify the risk of PUs. According to the findings of the study, nursing students in the therapeutic scenario simulation cohort did much better in identifying and estimating the threat of developing PUs. In another study on hospital-acquired PUs prevention conducted by Gaspar et al. (2021), the majority of nurses possessed insufficient knowledge and competency to utilize the Braden scale. In this sense, PU prevention is complicated and needs a systematic approach with robust EB information.
Pressure ulcers are critical issues within the medical field that are challenging due to the fact that they are frequent and dangerous on multiple levels. Researchers point out that more than 2,5 million Americans develop bedsores every year, resulting in more than 60,000 deaths (Englebright et al., 2018). The urgency for prevention measures is highlighted by the relatively high mortality rate and the even higher number of individuals dealing with tissue damage each year. Moreover, it is essential to point out that pressure ulcers affect vulnerable demographics. Thus, older adults, immobile people, individuals who use wheelchairs, and palliative patients are more likely to experience such skin injuries due to the circumstances in which they occur. Such a tendency creates an even more critical urgency for new preventative measures to be implemented in medical settings. The project is especially relevant to environments specializing in gerontological care.
A critical factor that suggests that the background of the lack of PU prevention measures is present consists of the current state of the hospitals and nursing facilities. Research conducted recently has shown that multiple cases of pressure injuries are acquired in hospitals. Specifically, more than 0,2 percent of all patients have experienced pressure injuries correlating with their stay in hospitals (Dreyfus et al., 2017). Based on the fact that the researchers did not analyze a particular demographic but instead examined the complete picture, it is evidence that the frequency of hospital-acquired tissue damage is a critical health issue. These numbers illustrate the lack of preventative measures, knowledge, and skills to create a safer environment.
Another significant factor that supports that preventative measures are critical is the differences in outcomes. Researchers have analyzed the circumstances in which PUs are prevented vs. treated by the medical staff. The findings reveal that treatment is almost three times more expensive than prevention. Furthermore, it increases the hospital stay by over 25 days and may lead to infections and other health issues (Wung Buh et al., 2021). Moreover, the authors concluded that the US spends about $15 billion yearly on PU-related injuries. Thus, evidence shows that preventing bedsores is less expensive, dangerous, and time-consuming compared to ignoring the issue and dealing with the consequences. Creating an environment in which healthcare providers apply several techniques aimed towards the mitigation of risk factors correlating with PU occurrence can lead to major improvements. These improvements are linked to the economic factor, patient satisfaction, and the overall health of the general population.
Significance of the Project
One of the common problems amongst the geriatric, bed-bound, immobile, unalert, and patients with limited mobility are the development of PUs. They occur when some areas of the skin do not receive an adequate amount of blood flow due to constant pressure, and as a result, the tissue is damaged (Mitchell, 2018). Pressure ulcers occurs significantly often in skilled nursing/rehab facilities due to lack of knowledge, training, and continuing education. As well as poor communication between staff in different departments within the facility, such as nursing staff, physicians, physical therapy, unlicensed assistant personnel, and the dietary department. There should be a constant dialogue and communication between these departments to provide the best care to the patient and exude knowledge and implementation of interdisciplinary care. Nursing staff and healthcare workers should be educated on the prevention of PUs. Many times, simple indicators of the initial development are overlooked due to lack of knowledge, such as recognizing non-blanching of skin, assessing bony prominence areas, malnutrition, dehydration, and predisposed diseases. Educating the nursing staff and unlicensed assistant personnel on PU prevention will decrease number of pressure ulcer development, increase patient’s well-being, staff teamwork, and reduce the patient’s length of stay in return reducing the cost for the facility. At the same time, according to Wung Buh et al. (2021), PUs prevention is 2.5 times cheaper than treatment. Additional complications associated with PUs include tissue infection, bone infections, cancer, and sepsis (Mayo Clinic, 2020). Thus, PUs significantly impairs the quality of life of older adults and are detrimental to their health.
Since the effects of PUs are hazardous, their avoidance is an integral part of caring for the geriatrics and patients with the inability to move and care for themselves. Key preventative measures include careful patient monitoring, timely response to complaints, assistance in movement, and changing pose (Institute for Quality and Efficiency in Health Care, 2018). Other measures that help to avoid PUs include a balanced diet, skincare, and special mattresses and support surfaces (Institute for Quality and Efficiency in Health Care, 2018). Such knowledge of these preventative measures can play a critical role in prevention and proper patient care. Knowledge and understanding are essential for both relatives-caregivers and nurses working with patients. Knowledgeable and trained license staff can educate families on the prevention during stay and upon discharge to continue the continuity of care.
Although nurses play a crucial role in caring for patients, a significant workload does not allow all aspects to be considered all the time, and some of them are overlooked. The prevention of sores is one of the problems that does not receive enough attention. Sure, many times discovering erythema areas while the skin is intact prior to the development of skin breakdown is overlooked not deliberately, but rather due to lack of knowledge and improper patient care. In geriatric patients and patients with preexisting conditions, PUs is the gateway to them acquire life threatening infections and debilitating diseases. According to Dalvand et al. (2018), nurses’ knowledge of the issue is insufficient. The paper provides a broad review of the research that has examined nurses’ knowledge. As a result, it was revealed that all three study groups – nurses, student nurses, and assistant nurses – had a level of expertise below the recommended level by the Pressure Ulcer Knowledge Assessment Tool (PUKAT) (Dalvand et al., 2018). Updating nurses’ knowledge and testing them can significantly reduce the prevalence of the PUs problem.
Thus, the most significant issues in which this project focuses are educating the staff on the prevention and management of PUs and improving nurses’ knowledge about them. Updating knowledge can affect the practice and policy of providing care to the senior population, bedbound, immobile, limited mobility, and unalert patients in skilled nursing/rehab facilities. Risk assessment and threat management should be a mandatory part of care. There should also be mandatory ongoing training refreshers for staff implement every 6 months or annually to help with retainment of knowledge, prevention, and management of PUs. The project may also affect patient-staff relationships and engagement in the knowledge obtained. Patients, especially the older generation, and those who are unable to care for themselves need attention and respect from nurses.
The primary benefit that educating and improving knowledge should bring is reducing the prevalence of sores. Moreover, a decrease in this problem will favorably affect patients’ quality of life and health, lowering risks. Positive changes will allow focusing on other serious issues that need to be solved in the future. Favorable results will also empower other professionals to use their knowledge gained to improve practice. Continuing education and development are an essential part of nursing practice to address such problems as PUs.
Pressure ulcers (PUs) commonly known as bedsores, refer to the pressure injuries that affect the patient’s skin and the tissues. PUs are localized areas of tissue damage that results from compression of soft tissue between a hard surface and a bony prominence (coccyx, ankle, shoulder blades, or hip). PUs can affect anyone, but they frequently affect geriatric patients, malnourished patients, and those patients that have limited mobility and/or immobile. As per Gefen (2021), the growth of pressure ulcers is a serious issue that can lead to. interruption with someone’s recovery since it might be complicated by infection for a long while. Gefen (2021) argues that healthcare staff should make sure that patient’s comfort is maintained by relieving the pressure and avoiding subjection of skin to shear forces. Proper staff education, training, reinforcement of skills and knowledge as well as interdisciplinary care can combat this growing concern. This paper presents a literature review on healthcare staff education on pressure ulcer prevention and management. The project is geared towards educating staff on pressure ulcer prevention and management amongst geriatrics patients, malnourished patients, and those who are immobile or have limited mobility at skilled nursing facility or rehab.
Methods of Searching
This literature review was conducted using electronic resources, specifically the peer-reviewed works found in Google Scholar among other reliable channels. Qualitative research using evidence-based as well as quality improvement articles and journals were used to obtain a substantial amount of reliable support for this paper. The sources used are published journals with digital object identification. Furthermore, online books and websites that have a notation to major healthcare bodies such as American Nursing Association (ANA) among others have been used. There is a total of eleven sources that have been utilized to bring the relevant content about the management of pressure ulcers to the targeted group. Thus, the content presented in the paper derives significance from the resources used.
Review of the Literature
Healthcare staff should be educated on preventing and managing pressure ulcers in the specified group of patients. If they have vast knowledge in the etiology, physiology, and physiological changes of pressure ulcers it will help them maintain patient safety and quality care. Educating staff on PUs prevention and management will supply them with the knowledge, training, and the education they need in the management of patient’s skin integrity while implementing proper bedside care. Obtained and retained knowledge, can be one way of helping to take care of the patients living with such conditions and managing pressure ulcers. PUs is not only painful, but they can be detrimental to one’s health and quality of life. PUs is the gateway to infection and items such as, wheelchairs, mattresses, clothing can be a fomite with carrying infection combine these two can be a death sentence for a patient. Beal and Smith (2016), evaluate the importance of keeping nurses and doctors trained on how to prevent pressure sores. According to the authors, the effect of educating healthcare professionals on PUs prevention may lead to better patient care for people living with such conditions particularly, bedbound individuals (Beal & Smith, 2016). The evidence that Beal and Smith are attempting to convey is that healthcare staff trained to handle pressure ulcers may be more efficient in prevention and management than those without such knowledge.
Nutrition is a key factor in the prevention of PUs such as a diet filled with complex carbs, protein, and fruits and veggies to help build a strong immune system and maintain body requirements. According to Burch and Kopke (2017), poor nutritional status may lead to the lower tolerance of skin and fundamental body tissues when it comes to pressure. Thus, the resistance and shearing force enables a high chance of acquired PUs amongst geriatric patients and patients suffering from malnutrition. Burch and Kopke’s study show that if a nutritional supplement is given to geriatric patients in hospitals or other care facilities, there is a notable difference in the growth of PUs. Thus, nutrition is an important factor when managing PUs amongst fragile patients.
Skilled nursing/rehab facility personnel require knowledge on the essence of dietary elements in preventing PUs. The staff knowledge should be assessed throughout employment, and not just upon hiring. According to Penman et al. (2020), dietary intake contributes significantly to the management of pressure ulcers for people with limited mobility or older individuals. The reason is that body requires proteins, vitamins, and minerals such as iron and zinc to support the healing process. For example, nursing staff can promote proper dietary intakes by giving patient’s supplemental drinks and/or nutritious snacks between meals to prevent or manage pressure ulcers. Therefore, educating and training nursing staff and increasing their knowledge on nutrition and its impact on pressure ulcers prevention is vital in promoting quality health and care to the patients.
Preventing PUs, educating the staff on assessments, signs and symptoms, and treatment such as the impact of dressings and topical agents for geriatrics who may or may not have a history of PUs is of high importance. Staff working in healthcare facilities must be trained on how topical agents contribute to preventing pressure ulcers so that they can give proper care to patients with limited mobility, such as individuals in wheelchairs. If the patients are alert and orientated, they can advise and educate them as well as families and caregivers on PUs prevention and management. Lack of knowledge leads to preventable mistakes. According to Burch and McCallum (2016), topical agents such as fatty acids and olive oils may provide protection against pressure ulcers in patients. About 96% of patients subjected to topical agent intervention measures would show positive results (Burch & McCallum, 2016). Trials reports show that ulcer incidents were lower with fatty acid-containing treatment compared with control compounds of tristearin.
By reviewing multiple sources, the review finds that standard traditional helps to prevents pressure ulcers. For instance, the silicone procedure is more efficient in lowering the growth of PUs. According to Burch and Tort (2016), there is efficacy and value in the combatting pressure sores by the utilization of silicone foam coverings. Silicone foam dressings such as Mepilex that have silver act as antibiotic agent leads to less skin abrasion hence, stabilizing the skin for the individuals who may have pressure-related conditions (Burch & Tort, 2019). Care facilities ought to train nurses and doctors on how to apply such agents as one way of regulating and managing this medical condition in the older group and any other specific target.
There are many ways of preventing pressure ulcers amongst the geriatrics and mobility restricted patients. Citing literature by Kalyani & Mohanasundari (2016), patient safety involves preventing pressure ulcers, a subject that doctors and nurses must know. The study shows that regularly repositioning bedbound and limited mobility patients is important and vital to their prevention. The reason is that it allows circulation of blood to be efficient in the body (Kalyani & Mohanasundari, 2016). Additionally, a nurses should assess the patient’s skin daily to ascertain risks where pressure ulcers may be evident to acquire on the body.
In cases where geriatric and/or bedbound patients have been diagnosed with pressure ulcers, the staff working in skilled nursing/rehab facilities are advised to have knowledge of actions to take to treat such conditions. Citing to Townsend (2018), adults have been mostly affected by this healthcare issue. The author argues that applying dressings to speed the recovery is important. The use of specially designed mattresses to pump the flow of air to patients is considerable in this case (Townsend, 2018). Additionally, cleaning wounds and removing damaged tissues is an important step and slowing or stopping further deterioration.
Implementing quality improvement education to healthcare facility staff using evidence-based practices (EBP) is important to increase their knowledge on how to prevent pressure ulcers. According to Sayin (2019), most preventive interventions support the idea that pressure ulcers can be prevented. For instance, advanced static mattresses and overlays are linked to a lower risk for pressure ulcers when compared to normal mattresses. Other pieces of evidence that need to be informed to the staff include nutritional supplementation, cleanser, dressings, and lotions (Sayin, 2019). When healthcare staff have such skills, they will advise and guide patients, hence marking an epitome of a long journey when it comes to preventing pressure ulcers in society.
Knowledge on the how to deal with pressure ulcers can be retained by nursing staff when quality improvement education plans are practiced. The reason is that when nurses are aware of the solution of the condition, they lead to patient’s knowledge and participation in preventing pressure ulcers. Schoeps et al. (2016), insinuate that the combined efforts between the healthcare staff and patients lead to the successful management of pressure ulcers. 45% of patients who are given such information will willingly assist in following the laid metrics about controlling the condition. Thus, keeping healthcare staff aware of prevention techniques is important combating pressure ulcers.
Training staff in hospitals and skilled nursing facilities leads to relevance in getting prevention measures on pressure ulcers done efficiently. As per Zdzioch (2017), there is a raft of guidelines on how pressure ulcers can be prevented. That means healthcare facility staff can obtain knowledge about that from this article. For example, Zdzioch argues that patients that have high possibility of developing PUs, such as the older age population need to be repositioned frequently, every two hours to be exact. The repositioning techniques include a 30° slanted side-lying position, which should be done alternatively on all sides. Thus, if nursing staff get all these tips, are great prevention measures against pressure ulcers.
The project has reviewed scholarly sources about how to deal with bedsore for geriatrics and limited mobility individuals. From the sources used in previous sections of the paper, the literature helps one to understand that there are common interventions that can be useful to combat bedsores. First, nutrition has been mentioned regularly, and thus, diet would be a key aspect to consider while treating or fighting growth of pressure ulcers (Townsend, 2018). 10% of persons hospitalized have this medical issue where 40% of the number have malnutrition issues that lead to the bedsores (Schoeps et al., 2016). The role of diet is clear as macro and micronutrients are needed by each organ to enable proper functioning of all body parts.
The other notable idea on how to fight pressure ulcers is foam dressing with specific agents. From the literature review, this project concur that hydrocolloid, silicone, and film foams are useful in managing this condition in geriatrics and those with challenges of freely moving with their feet (Zdzioch, 2017). Furthermore, some therapeutic interventions would be key in preventing these conditions such as static foam mattresses and cushions that help pump constant flow of fresh air. In most serious cases, surgery is undertaken to remove the damaged tissues and closing of the wound is done to prevent further deterioration of the body tissues (Burch & McCallum, 2016). More than 38% of patients with body challenges have experienced this health problem and thus, prevention is important to ensure the comfort of the patients (Penman et al., 2020). For patients with movement challenges such as those with wheelchairs, it is important to keep on changing their position to help in blood circulation.
Outcomes, Approach, and Budget
Pressure ulcers (PUs) prevention should be a priority in skilled nursing/rehab facilities especially amongst those who are immobile and unaware of their risk factors. Patients such as the geriatric, bed bound, immobile, unalert, and those with limited mobility. This PUs prevention education plan will consist of evidence-based knowledge, strategies, and training to educate the staff on the prevention and management of PUs which, in return will help sustain and/or improve the patient’s quality of life. Older adults tend to have multiple comorbidities, particularly chronic diseases, due to their compromised immune systems. PUs is among the ailments that limit their well-being and require collaborative care among the nursing staff and healthcare departments to offer effective and personalized care. This is an ongoing issue amongst the specified population and will continue to migrate and escalate in patients until proper knowledge is gained and retained. The US government incurs $11 billion every year to eradicate the disease due to the high prevalence of at least 2.5 million annual pressure ulcer incidents (Boyko et al., 2018). Many interventions can effectively prevent PUs and reduce their occurrence, such as proper assessment, treatment, repositioning, a healthy diet, nutritional supplementation, vitamins, and proper skincare. This project will supply the staff with evidence-based knowledge to implement a quality improvement pressure ulcer prevention education plan. It will help decrease the acquirement and increase the prevention and management of PUs amongst the geriatric patients, bed bound, immobile, unalert, and patients with limited mobility at skilled nursing/rehab facilities.
The pressure ulcer prevention education plan focuses on equipping nursing staff, unlicensed assistive personnel (UAP), and supporting healthcare staff with the knowledge to assess, detect, and collaborate to improve the well-being of geriatric, bed-bound, and limited mobility patients. Nurses’ expertise is the primary determinant of prevention and management since they perform the initial assessment upon admission, educate the patient, family, and staff. Also, interpret risk factors to rely to the physician to offer proper patient care. This project focuses on the following outcomes to improve the patient’s care and establish the pressure ulcer prevention plan.
- Nursing staff and UAPs will demonstrate effective knowledge of evidence-based practice on PUs prevention and management by the end of week four as evidenced by a 75 % retainment on the post-test assessment.
- 75% of the nursing staff and healthcare workers will demonstrate knowledge of an interdisciplinary approach to coordinate care for the patient as evidenced by the end of week four as evidenced by accurately listing three requirements of the interdisciplinary approach.
- 100% of the nursing staff and UAPs will demonstrate knowledge on how to accurately reposition a patient using proper body mechanics by the end of week three as evidenced by verbal teach-back methodology.
- 80% of the nursing staff will demonstrate how to correctly identify three key elements of patient and family education regarding an effective approach to manage existing PUs and decrease the acquirement of new PUs by week three.
- 80% of the nursing staff will be able to accurately identify all the steps for PU assessment. To assess the retainment, there will be a question on the post test that requires them to put the steps in accurate order. If 80% get the answer correct, the outcome would be met.
The PUs prevention education plan will aim toward increasing the staff’s knowledge of initial and ongoing assessments, basic care, and to promote the patient’s quality of health. Which will decrease the occurrence of acquired pressure ulcers as well as the exacerbation of existing PUs in patients at long-term healthcare facilities. This project will focus on a specified population such as geriatric, immobile, limited mobility, malnourished, and other patients with predisposed conditions that puts them at a greater risk for developing pressure ulcers. It will supply the staff with the knowledge and education needed to prevent and manage PUs. During a four-week duration, the staff will be given evidence-based knowledge to implement a quality improvement education plan. The PUs prevention education plan will consist of a pre-test and post-test using Piper’s Pressure Ulcer Knowledge Test formulated by the Agency for Healthcare Research and Quality (AHRQ, 2017) to assess knowledge and retainment. As well as a PUs prevention educational in-service, and a live demonstration on repositioning. Which will help promote proper patient care, recognize risks factors, and apply gained intervention. The key factor in this project is to promote the patient’s quality of care by educating staff on PUs prevention and management. PUs is the gateway to more debilitating health issues such as infection, necrosis, gangrene, sepsis, and potentially death. The first step to demolishing this preventable harm is education, knowledge, implementation, and continuity of care.
The PUs educational plan will commence with researching qualitative evidence-based research. Using both electronic and quality improvement literature in forms of peer-reviewed articles and journals to provide reliable research for this project. Despite the availability of evidence-based guidelines, nurses’ knowledge of pressure injury prevention has been shown to be variable. This is a significant factor in patients acquiring pressure injuries during hospital and care facility admissions as well as in the home care setting (Hommel, 2018). The information will be presented to the staff in written form as well as visually to help facilitate the staff’s attention and retainment of the knowledge. The in-service will offer accurate information and educate them on the etiology, physiology, and physiological changes pressure ulcer has on patients.
To assess the effectiveness of this project it will begin with a pre-test to assess the staffs baseline knowledge on pressure ulcer prevention and management. Followed by an in-service led by the charge nurse which will include videos, a power points presentation, and reading material. Once the in-service presentation is complete there will be time allotted for staff to ask questions for clarity and to ensure they accurately understood the information given. The physical therapist will give a live demonstration of repositioning a patient using proper body mechanics. Finally, the PUs prevention plan will be evaluated by assessing the staff retainment with a post-test. An improvement in the staff’s test scores and/or a 75% retainment of knowledge amongst the staff as evidenced by a comparison of the pre-test and post-test scores will provide the results if knowledge was gained and the effectiveness of the project.
Staff will be knowledgeable on the sign and symptoms, risk factors, management, treatment, basic care, repositioning, and nutrition while outlining the strategy to eradicate PUs in skilled nursing/rehab facilities. Ebi et al. (2019) mention that the lack of staff and limited training services as the main barriers to offering adequate care to patients. Consequently, this project intends to increase nursing staff knowledge of the treatment and prevention approach. The treatment plan focuses education on pressure relief and infection control to improve the well-being of the specified patients. Pressure relief entails regularly repositioning patients, introducing special beds, and refitting prosthetics, while infection control involves initial disease evaluation and treatment using antiseptics to improve geriatric care (Boyko et al., 2018). Nurses’ knowledge will initiate this project by supplying them with the knowledge, training, and education they need to manage patients” skin integrity while implementing proper bedside care. The knowledge the staff will gain from this PUs prevention education plan will lead to the patient’s quality of care being obtain by applying accurate interventions.
Although physicians and nurses play a major role in treating and preventing PUs. Meaning the nurses are required to assess regularly and relay any abnormal findings or risks factors to the physician to order any required treatment for the patient. Lack of communication is a hindrance and aides in the acquirement of PUs. The use of interdisciplinary care and knowledge is needed to combat pressure ulcers. Such as the UAPs, physical therapists, and dieticians are all important entities in the PUs prevention process and management. Patients can also participate in their management and prevention. This project will educate and give the nursing staff the knowledge needed to educate their patients and families on self-treatment and interventions. They can be informed about the contribution one’s lifestyle has on their susceptibility to acquiring PUs, such as poor nutrition, and share ideas on prevention (Mutair et al., 2020). Therefore, the education prevention plan will urge nurses to interact with patients suggest lifestyle changes to improve their well-being and quality of health. It will also allow patients to be proactive in their care and treatment if applicable.
The ability to gauge the likely benefits of the available preventive strategies and compare their cost–effectiveness is essential to making evidence-based decisions about the selection and implementation of preferred methods (Ocampo et al., 2017). As seen in the budget table below the cost of this project is cost-effective and requires a sum of $901.75 for the education, implementation, and evaluation process. The budget table will include a detailed breakdown of the cost, description, and its sources. The knowledge assessment and educational portion which consist of a pre-test, post-test, and presentation will cost $100 for the supplies needed. The in-service and live demonstration will come from the facility’s payroll department, and staff will be paid their regular hourly wage as well as any overtime incurred for their attendance or facilitation.
|Budget Item||Description||Amount Needed||Proposed Sources|
|Education||Video and Power point (Pressure ulcer prevention, nutrition, management)||$0||Facility’s library|
|Training||In-Service (education on pressure ulcer prevention and Q&A) and PT demonstration (Proper repositioning and body mechanics)||Hourly rate X training length 3.5 hours = cost |
RN (2)-83×3.5= 290.50×2=$581
Estimated cost-$ 801.75
|Education||Pre-Test (baseline assessment)||$50||Outsource supplies (facility budget)|
|Education||Post-test (staff retainment)||$50||Outsource supplies (facility budget)|
|Payroll||Cost/hour for staff to attend training||Hourly rate X training length = cost||Department Budget|
Strategies and Results
The Pressure Ulcer Prevention Education Plan aims to address incompetency issues among nursing staff and Unlicensed Assistive personnel (UAPs), that is mainly contributed by lack of proper knowledge. Prevention and management of pressure ulcers (PUs) amongst patients in skilled nursing/rehab facilities have been on the downward trend, evidenced by the increase in pressure ulcers in various stages amongst patients. To improve the prevention and management of pressure ulcers, the education plan focused on educating nurses on how to improve the well-being of geriatric patients, bed-bound, and patients with limited mobility (Lamppu et al., 2019). During the four weeks of educating the nurses, and UAPs on pressure ulcers prevention and management, they were given a pre-test and post-test to evaluate the effectiveness and efficiency of the pressure ulcers prevention education plan. The purpose of this paper is to discuss the effectiveness of evidence-based practices in increasing the knowledge of nursing staff during the implementation of a quality improvement education plan on pressure ulcers prevention amongst patients.
The plan of action for the project is to increase the knowledge retainment of nursing staff on pressure ulcers prevention by using evidence-based practices. The education and implementation of the nurses and UAPs will go for four weeks. They will be educated on the prevention and management of pressure ulcers on the specified population of patients. The targeted population includes malnourished, immobile, geriatric, limited mobility, and other vulnerable patients that can easily develop pressure ulcers. During the four weeks of implementation, nurses will be supplied with learning materials, knowledge, and education required to help prevent and manage PUs. Nurses and UAPs are assessed using Piper’s pressure ulcers knowledge test before and after the implementation phrase to assess their baseline knowledge and retainment.
Advantages of the Pressure Ulcer Prevention Education Plan
A clear advantage of the Pressure Ulcer Prevention Plan is that it protects patients from harm associated with pressure ulcers. According to Lavallée et al. (2018), increasing knowledge of an interdisciplinary approach amongst nurses reduces patients’ susceptibility to pressure ulcers by up to 45%. Once patients are infected with pressure ulcers, it takes a long time to heal. This makes the treatment of pressure ulcers patients costly. It cost the hospital approximately $40,000 to treat each occurrence of pressure ulcers (Rutenberg et al., 2019). Moreover, the occurrence of pressure ulcers increases a patient’s hospital stay by twelve to twenty days. Therefore, it is crucial to prevent pressure ulcers to avoid cost implications on patients and their families.
Limitations of The Pressure Ulcer Prevention Education Plan
The plan had several limitations on quality enhancement in healthcare delivery. One of the limitations is the duration of the project it was restricted to four weeks. The short duration can produce a biased result, either a false-positive or an over-estimated magnitude of association in the result (Berete et al., 2021). Another limitation associated with the research is the size of the population studied. The study was conducted in a single skilled/rehab facility with a nurse population of less than one hundred. The smaller the sample size studied, the higher the margin of error.
Ethical issues Related to the plan
In a study that involves an individual’s health information, the main ethical issue is always the respondent’s privacy. In this study, both nurses’ privacy, UAPs, and the patients were adequately observed. Nurses and UAPs were asked to conceal patients’ information and avoid using patients’ names when responding to pre-test and post-test (Dale & Helton, 2018). As well as, during the question-and-answer discussion portion of the education plan staff are asked to avoid using patients’ information to protect their privacy. To affect this, nurses and UAPs signed consent and privacy non-disclosure form. Similarly, nurses’ and UAPs’ privacy were also observed, and all were asked to avoid their identity when submitting their tests. To observe the privacy of nurses and UAPs, nurses were asked to submit their responses for the tests through a sealed box. Following these guidelines, the pressure ulcers prevention plan complied with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rules that regulate protected healthcare information disclosure.
The objective of the pressure ulcers prevention education plan was to educate nurses and UAPs on how to manage and prevent pressure ulcers on the geriatric, immobile, bed-bound, and limited mobility patients. Nurses and UAPs were educated on how to prevent and manage pressure ulcers in a skilled/rehab facility. To evaluate the project’s overall outcome, nurses and UAPs were given a pre-test and pro-test using Piper’s Pressure Ulcers Knowledge Test. The pre-test and pro-test data were compared to check the effectiveness of the project outcome at the end of the four weeks of duration. Before the project’s commencement, the target outcome of the retainment rate was set at 75% after week four post-test assessment. The retainment of interdisciplinary approach knowledge was also placed at 75%. At the end of week four, 100% of the nursing staff were expected to demonstrate mastering of knowledge on the repositioning of the patient. Another targeted milestone is that 80% of the nursing staff were expected to identify all the pressure ulcer assessment steps accurately.
The outcome from the test results showed significant improvement in the tested areas. At the beginning of the project, the Piper’s Pressure Ulcers pre-test indicates that only 60% of the nursing staff demonstrated effective knowledge in evidence-based practice on pressure ulcers prevention. At the end of the fourth week, 92% was recorded on the post-test outcome. On the interdisciplinary approach, 74% was recorded on the pre-test and 96% on the post-test (Gaspar et al., 2019). When it comes to knowledge on the repositioning of patients, 55% was recorded on pre-test and 95% on post-test. In mastering the steps for pressure ulcers assessment, only 40% of the nursing staff were able to outline all the steps, and after four weeks, 90% were able to identify all the assessment steps.
The result of the project at the end of the fourth week shows a significant improvement in the critical elements of preventing and managing pressure ulcers condition in the patient. All the targeted milestones set at the beginning of the project were attained apart from patient repositioning, which only attained 95% instead of 100% as the targeted outcome. This is attributed to a few UAPs who failed to demonstrate an understanding of patient repositioning to prevent and manage pressure ulcers (Moore et al., 2019). The improvement in knowledge retainment among nursing staff is reflected in the pressure ulcers incidences in the healthcare facility. The pressure ulcer cases reduced from 4.2% before education to 3.2% after education.
In the prevention of pressure ulcers, there is a need for a collaborative base between the facility’s nursing staff, UAP, dietary department, and physical therapy staff, as well as patients. Educating and training staff to handle pressure ulcer’s related cases will give the personnel experience to advise patients about how a healthy diet, lifestyle, and general monitoring of the skin is vital to the preventing the development of PUs. Sure, preexisting conditions, age, and mobility issues play a major role in the prevention, but treating it internally is important as well. Additionally, it is significant to have dressing foams with various agents such as silicone for the specified groups. Dressing foam enables regular binding of the body tissues, hence strengthening the body of a patient, which is a key milestone towards preventing pressure ulcers (Burch & Tort, 2019). Since pressure ulcers can lead to infection, compromise skin integrity, and lengthen the patient’s facility stay. There should be policies put into place to aim towards PUs prevention and management. Assessments upon admission, to assess for risk factors associated with developing pressure ulcers are of upmost priority.
Education that focuses on identifying, staging, and treatment must be implemented according to scope of practice to ensure quality, proper care and management of skin integrity and the patient’s overall health and well-being. Lastly, it is important to have therapeutic interventions such as training the alert and orientated patients to change their positions more so training UAP and nursing staff on how to reposition the bedbound and limited mobility patients. For the geriatrics, having advanced static comfortable lying zones will help pump the air in the body hence preventing the risk of pressure ulcers. Educating nurses on controlling possible development of this condition reduces chances in older patients, limited mobility, and bedbound patients to improve their quality of life. Upon research it is prevalent that majority of the reasons for an increase in skilled nursing/rehab facility acquired pressure ulcers were due to lack of knowledge, on-going education and training, a lack of communication between healthcare departments, and assessment. Identifying and assessing the involving staff knowledge is the first step to implementing the education needed for prevention and management. Pressure ulcers are the gateway to infection, which aides in a domino effect in the decline in a patient’s health, it is not only debilitating, but detrimental to the patient’s health. If a PUs is not treated in time and an infection develops the patient can become sceptic and die.
In essence, educating and training nurses by creating a conducive and productive environment can promote good quality of care amongst the geriatric, immobile, and limited mobility patients by treating and preventing pressure ulcers. Additionally, the PUs prevention education plan will involve creating a collaborative nursing team to share knowledge and integrate coordinated patient care to promote quality of care. However, researchers suggest collaboration is essential to preventing the ailments since nurses can undertake designated roles to coordinate care throughout the nursing facility. Reportedly, educating nurses on collaborative action reduces pressure ulcer occurrence by 70% (Berlowitz et al., n.d.). Skilled nursing/rehab facilities can achieve this result by formulating a prevention plan against pressure ulcers. Nursing staff, UAPs, and supporting staff need ongoing training, refreshers on PUs prevention such as those implemented in this project. The refresher should be conducted every 6 months or annually to help the staff with retainment of knowledge in PUs prevention and management.
Beal, M., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence-based practice. Worldviews On Evidence-Based Nursing, 13(2), 112-117. Web.
Berete, F., Heyden, J. V. D., Demarest, S., Charafeddine, R., Tafforeau, J., Oyen, H. V., & Renard, F. (2021). Validity of self-reported mammography uptake in the Belgian health interview survey: Selection and reporting bias. European Journal of Public Health, 31(1), 214-220. Web.
Berlowitz, D., Beford, V.A., Lucas, C., Parker, V., Niederhauser, A., Silver, J., Logan, C., Ayello, E. (n.d.). Preventing pressure ulcers in hospitals. Agency for Healthcare Research and Quality. Web.
Boyko, T.V., Longaker, M.T., & Yang, G.P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57–67. Web.
Burch, J., & Köpke, S. (2017). Do nutritional interventions help prevent the development of pressure ulcers? Cochrane Clinical Answers, 5(4), 34-37. Web.
Burch, J., & McCallum, I. (2016). What are the effects of topical agents used to prevent pressure ulcers? Cochrane Clinical Answers, 6(7), 90-94. Web.
Burch, J., & Tort, S. (2019). Can silicone dressings help prevent pressure ulcers? Cochrane Clinical Answers, 2(5), 31. Web.
Dale, M. C., & Helton, M. R. (2018). Nursing Home Care 20. Chronic Illness Care: Principles and Practice, 245.
Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: A systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clinical, Cosmetic and Investigational Dermatology, 11, 613–620. Web.
Dreyfus, J., Gayle, J., Trueman, P., Delhougne, G., & Siddiqui, A. (2017). Assessment of risk factors associated with hospital-acquired pressure injuries and impact on health care utilization and cost outcomes in US hospitals. American Journal of Medical Quality, 33(4), 348–358. Web.
Du, Y. L., Ma, C. H., Liao, Y. F., Wang, L., Zhang, Y., & Niu, G. (2021). Is clinical scenario simulation teaching effective in cultivating the competency of nursing students to recognize and assess the risk of pressure ulcers? Risk Management and Healthcare Policy, 14(1), 2887-2896. Web.
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, 18(20). Web.
Englebright, J., Westcott, R., McManus, K., Kleja, K., Helm, C., Korwek, K. M., & Perlin, J. B. (2018). A comprehensive program to reduce rates of hospital-acquired pressure ulcers in a system of Community Hospitals. Journal of Patient Safety, 14(1), 54–59. Web.
Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., Mion, L., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. Web.
Gaspar, S., Botelho Guedes, F., Vitoriano Budri, A. M., Ferreira, C., & Gaspar de Matos, M. (2021). Hospital‐acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 1(1), 1-10. Web.
Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. Web.
Gefen, A. (2021). The etiology of medical device-related pressure ulcers and how to prevent them. British Journal of Nursing, 30(15), S24-S30. Web.
Hommel, A. (2018). Pressure injury prevention and wound management. Web.
Institute for Quality and Efficiency in Health Care. (2018). Preventing pressure ulcers. Informed Health. Web.
Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1), 1-11. Web.
Kalyani, V., & Mohanasundari, S. (2016). A patient safety: Preventing pressure ulcers. Indian Journal of Surgical Nursing, 5(3), 97-105. Web.
Lamppu, P. J., Laurila, J., Finne-Soveri, H., Laakkonen, M. L., Kautiainen, H., & Pitkälä, K. H. (2019). Training nursing home staff to improve residents’ end-of-life care: Design and baseline findings from a randomized controlled trial. European Geriatric Medicine, 10(4), 649-657. Web.
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79-89. Web.
Mayo Clinic. (2020). Bedsores (pressure ulcers). Mayo Clinic Website. Web.
Mitchell, A. (2018). Adult pressure area care: Preventing pressure ulcers. British Journal of Nursing, 27(18), 1050-1052. Web.
Moore, Z., Avsar, P., Conaty, L., Moore, D. H., Patton, D., & O’Connor, T. (2019). The prevalence of pressure ulcers in Europe, the European data tell us: A systematic review. Journal of Wound Care, 28(11), 710-719. Web.
Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, D. (2018). An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value in Health, 21(1), 27-32. Web.
Ocampo, W., Cheung, A., Baylis, B., Clayden, N., Conly, J., Ghali, W.,… Hogan, D. (2017). Economic evaluations of strategies to prevent hospital-acquired pressure injuries. Web.
Watkins, W. (2020). 50 studies every ophthalmologist should know. Oxford University Press USA – OSO.
Rutenberg, T. F., Assaly, A., Vitenberg, M., Shemesh, S., Burg, A., Haviv, B., & Velkes, S. (2019). The outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population. Injury, 50(7), 1347-1352. Web.
Sayin, A. (2019). Evidence-based practices for the prevention of pressure ulcers. Journal Of Health Services and Education, 3(1), 7-10. Web.
Schoeps, L., Tallberg, A., & Gunningberg, L. (2016). Patients’ knowledge of and participation in preventing pressure ulcers- an intervention study. International Wound Journal, 14(2), 344-348. Web.
Section 7. tools and resources (continued). AHRQ. (2017). Web.
Teo, C.S.M., Claire, C.A., Lopez, V., & Shorey, S. (2018). Pressure injury prevention and management practices among nurses: A realist case study. International Would Journal, 16(1), 153 – 163. Web.
Townsend, K. (2018). Fundamental concepts and skills for the patient care technician. Elsevier Health Sciences Publishers.
Wung Buh, A., Mahmoud, H., Chen, W., McInnes, M., & Fergusson, D. A. (2021). Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalized elderly patients: a systematic review protocol. BMJ Open, 11(3), e043042. Web.
Zdzioch, M. (2017). Pressure ulcer prevention. Nursing Standard, 31(21), 64-65. Web.