Pressure Ulcer Prevention Repositioning
Introduction
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et al., 2014).
Pressure ulcers are considered an adverse event in health care and guidelines are set to help health care professionals prevent this from occurring. Penalties have been placed as an incentive to help prevent hospital-acquired pressure ulcers (Cantrell, 2013). The most common method used to reduce the risk of pressure ulcers are two hourly repositioning (REF). However, there is insufficient evidence regarding the frequency of repositioning and research regarding the purpose of turning is very limited. The following review will discuss the research found for the frequency of repositioning patients and supportive surfaces used to reduce the risk of the development of pressure ulcers.
Methodology
In gathering articles for this review, numerous methods were used to narrow journal articles that were relevant to nursing. A search was conducted on EBSCO HOST for key terms such as ________. This was narrowed down to articles which were between 2009 and 2014, plus articles which had full text...
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...tioning component” and not used in isolation (Moore, Z., Haynes, J., & Callaghan, R. (2014); Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013).
Conclusion
Pressure ulcers remain a major health problem for patients in all health care setting but may gaps still remain in the understanding and prevention. Studies indicate that comprehensive prevention techniques such as repositioning and pressure relieving aids have slightly reduced incident rates but areas of high skin-bed interface pressures still remain in jeopardy. By preventing pressure ulcers, it would reduce health cost and patient comfort will be increased. Additional research is needed to determine the most appropriate preventative responses, thus, more research should be conducted in regards to the frequency of turning plus the use of pressure releasing equipment. (change and improve outcomes)
The Braden risk assessment tool was deemed to be appropriate due to the patient’s comorbidity’s of peripheral vascular disease and lymphoedema with the addition of an arterio-venous leg ulcer of the right leg. This scale is universally accepted as a tool to help identify those most at risk with a goal of allowing health care providers to use their experience and judgement to consistently reduce the risk or to ensure preventive care is appropriately prescribed (Guy, 2012). Pressure ulcers are a risk factor for those who suffer from
The length of the stay of patients diagnosed with pressure ulcers noticeably increased by about five times. The risk of death is increased about 4.5 times compared to the patients without this condition. This is the main reason this issue is being studied. ICU patients require constant monitoring and invasive procedures performed by the multidisciplinary team. Patients admitted to the ICU are considered critical and hemodynamic unstable. These patients may be sedated, provided with mechanical ventilation, and placed on bed rest for long periods of time. The most difficult challenge regarding pressure ulcers is to maintain skin intact. To ensure optimal pressure ulcer treatment and prevention is used, a multidisciplinary approach, in which nurses play a vital role. Risk assessments, hands-on care, daily skin care, and providing an environment, which will help patients attain optimal health are among these responsibilities. Due to the patients’ inability to turn themselves, critically ill patients have to be repositioned by caregivers frequently. It has to be done by professionals who know about the complications and risk factors because improper repositioning may cause shearing and friction, which will lead to pressure
A study in Hong Kong also evaluates the use of double-gloving during surgery (Guo, 2012). This study fouses more on nurses instead of surgeons. They also focus more on glove perforation as opposed to sensitivity and dexterity. Guo states that “the purpose of our study was to assess the effectiveness of double-gloving in protecting perioperative nurses from having contact with patients’ blood and body fluids during surgery by comparing the frequency of glove perforation between single-gloving and double-gloving groups” (Guo, 2012).
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Patient falls were reduced by 24%-80% when hourly rounding occurred (Mitchell et al., 2014). Most falls occur in the hospital setting are caused when a patient is trying to get to the bathroom or bedside commode and ambulating on their own (Tucker, Bieber, Attlesey-Pries, Olson, & Dierkhising, 2012). With hourly rounding the nurse can help address elimination needs for the patient and help assist the patient to the bedside commode or the bathroom. Pressure ulcers were reduced by 56%. Hourly rounding can help address the issue of turning patients every two hours to reduce the risk of developing a presence of a pressure ulcer (Ford, 2014).
Potter, P. & Perry, A. (2014). Fundamentals of Canadian nursing. 5th. Ed. Toronto: Elsevier 383
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
To sustained the PSI a clear recognition from senior healthcare staffs such as continence nurse advisers, the nurse specialist and community nurse and support by training, coping and adopting strategy to change is needed (NHS ΙΙΙ 2008). The role of the nurse involves investigating patient, communicating with the other healthcare team members such as community nurses to help ensuring the use of the cover for the catheter stand is an essential element of care, rather than being dismissed or patient isolating them self due to stigma (RCN 2013).
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
Maintenance of an appropriate healing environment is also essential throughout the management of diabetic foot ulcers. The choice of dressing is dependent on many factors including presence of infection, amount of exudate and the required frequency of wound bed inspection.
According to Ruth Craven, Constance Hirnle, and Sharon Jensen in Fundamentals of Nursing Human Health and Function a restraint is used to stop a patient from being able to move freely, whether it be physically or assisted with medication. Types of restraints include physical, chemical, nonviolent/self-destructive, violent/self-destructive, and seclusion. Ultimately restraints are used in situations to help keep both the patient and the staff caring for that patient safe. The purpose of this paper is to recognize and explore ways to improve the use of bed restraints and further educate nurses on proper use to enhance patient safety. This is relevant in today’s healthcare setting, because there is still a need to keep patients safe and provide them with quality care, which may include the use of restraints.