Hospital-Acquired Pressure Ulcer Prevention

Introduction

Hospital-acquired pressure ulcers (HAPU) have been recognized as a preventable issue affecting patients who remain immobile for a prolonged period of time. The incidence of the condition is almost 9% higher in surgical patients compared to other groups (Aloweni et al., 2019). The prevalence of HAPU in this cohort is often associated with the type of surgery, the length of hospital stay, as well as patients’ age, gender, and mental health (Han et al., 2018). It has also been acknowledged that the existing prevention strategies and protocols require improvement and further research due to their limited effectiveness (Gaspar et al., 2019). The purpose of the study is to examine the effects of a comprehensive intervention targeting patients with limited mobility. The present project aims the development of a cost-effective HAPU prevention intervention. The PICOT question guiding the proposed study is formulated as follows:

In emergency department patients (P), does the HAPU prevention intervention (I) as compared to usual care (C) reduce the incidence of HAPU (O) on the third day of patient stay (T)?

Pilot Project Details

Brief Description of the Proposed Intervention

As mentioned above, the purpose of this research is to examine the outcomes of an intervention aimed at reducing the incidence of HAPU in patients with traumas admitted to the emergency department. The patients will receive a set of clinical services, including full-body skin assessment, support surfaces for high-risk patients, and repositioning. These are common prevention methods that have been evaluated in diverse studies. At that, the use of several components is critical as Gaspar et al. (2019) found that single interventions are less effective than the ones encompassing multiple procedures. Hence, the current project is based on the employment of a combination of procedures that have shown the highest effectiveness so far. The implementation will not require significant funds as all the activities do not need specific skills, and minimal equipment is needed.

All patients admitted to the emergency department will be included in the research and divided into the control (usual care) and intervention group randomly. The excluding criteria will be patients’ age and prior trauma history. The preexisting mobility status of older patients and those having injury or conditions leading to immobility can influence the results. The participants will be informed about the peculiarities of the project and sign the consent form. Therefore, the intervention will follow the high ethical standards of the research involving human subjects.

Change Model

In order to implement the intervention successfully, it is necessary to utilize Lewin’s change model. The framework implies the division of the process of change into three major phases: unfreezing, changing, and refreezing (Hidayat et al., 2020). Prior to the start of the intervention per se, it is critical to initiate the discussion of the incidence of HAPU, risk factors, causes, and prevention. Nurses should be encouraged to share their views on the existing protocols and their effectiveness. Prior to the start of the intervention, nurses will discuss HAPU prevalence and prevention during their regular meetings. When the stage of unfreezing is completed, the staff will be informed about the specifics of the proposed intervention.

The phase of implementation will start with the training of the staff participating in the study, accumulating the necessary resources, recruiting participants, and providing the care based on the group status. The intervention will last for a month, and all admitted patients (excluding the ones mentioned above) will take part unless they refuse to participate. The development of HAPU symptoms will be measured three days after admission. The incidence of HAPU in two groups will be assessed one month after the start of the project. Surveys completed by the nurses participating in the project will be collected and analyzed. The evaluation of the intervention and the dissemination of findings will be conducted. The data will be disseminated as a report available from the hospital’s information system.

If the project leads to positive outcomes, the corresponding protocol will be developed and introduced as the benchmark in the hospital. The medical personnel will be provided with results and receive training if necessary. If the intervention displays no effect on the incidence of HAPU, the staff will be informed about that, and the existing protocols will remain the guidelines to follow until new recommendations are developed.

Stakeholders

One group of the stakeholders of the intervention under consideration will be the nursing personnel of the emergency unit. These practitioners will be trained to provide the care based on the new guidelines (a set of full-body skin assessment, repositioning, and support surfaces for high-risk patients). They will also share their views on the implementation of the project during regular meetings, which will be instrumental in improving the quality of provided care. The written consent form will include all the central details regarding the intervention and its expected outcomes, as well as potential benefits for patients during their hospital stay.

Patients will constitute another group of stakeholders who will take part in the study and provide written consent forms. If necessary, patients’ caregivers will provide the consent and sign the corresponding form. The administration of the facility will also be involved in the project as management allocates funds that are needed to obtain the necessary resources. The administration will also be involved in the process of the development of new guidelines if the project shows positive results.

Two Strategies Promoting Engagement

The primary strategy to ensure stakeholders’ engagement in the project is the provision of detailed information regarding the study. Healthcare professionals and patients, as well as their caregivers, will be motivated to participate in the research if they clearly understand the potential outcomes and positive effects of the study on their health and nursing practice. Another strategy promoting stakeholders’ engagement is effective leadership. The nurse responsible for the implementation of the project will be a transformational leader supporting peers.

Practice Guideline

The proposed study is based on the major provisions of the Clinical Practice Guideline (CPG) 2019. The description of various methods related to the assessment and prevention of HAPU are given in the CPG 2019 report (“Prevention and Treatment of Pressure Ulcers/Injuries,” 2019). The guidelines are chosen as they include the most common practices that have proved to be effective in reaching positive patient outcomes. The nurses will follow the recommended practices to provide both usual care and intervention-related services (such as the combination of support surfaces management, repositioning, and full-body-skin assessment).

Organizational Resources

In order to implement the present project successfully, certain resources are needed. The administration will allocate funds to acquire support surface units. The nursing staff will need additional training to provide the corresponding services, so two training sessions will be conducted for the personnel involved in the project. The medical staff providing care to the intervention group will need to understand the peculiarities of the intervention-related clinical procedures.

The nurse responsible for the implementation of the project will provide the training, or external trainers can be invited (if sufficient funds are available). This professional will also monitor the course of the project and ensure that all the stages of change are managed properly. Finally, the implementation of the intervention is associated with an increased period of interaction between the patient and the healthcare professional, so additional monetary benefits for the nurses taking part in the intervention.

Outcome Measurement

In order to measure the outcomes of the proposed intervention, it is possible to conduct mixed-method research. Clearly, the rate of the HAPU patients will be estimated and compared to the one of the control group. One month is a sufficient period to evaluate the exact effects of the intervention on patients’ health. At that, it can be beneficial to obtain qualitative data to gain insights into the attitudes of the personnel and their compliance with the given protocols. The nurses will complete surveys regarding the intervention, its complexity, possible strengths and weaknesses, and perceived outcomes. This data will be instrumental in identifying nurses’ compliance with the guidelines and their preparedness for (and commitment to) the utilization of the project in their daily practice.

Conclusion

To sum up, the proposed intervention aims at reducing the incidence of HAPU in the emergency department. The intervention will last for a month and will be conducted in terms of Lewin’s change model and with the use of the Clinical Practice Guideline 2019. The nursing personnel involved in the project will receive the necessary training. Since the study implementation requires a certain investment, the provision of the resources will be negotiated with the administration.

After the implementation of the intervention, the outcomes will be measured, and the effectiveness of the initiative will be evaluated. If the intervention leads to better patient outcomes compared to usual care, the corresponding protocols will be designed and accepted as the benchmark. If the procedures offered within the scope of the project display limited influence, another combination of procedures recommended by the existing guidelines and latest studies can be developed and examined as a new quality improvement incentive.

References

Aloweni, F., Ang, S. Y., Fook‐Chong, S., Agus, N., Yong, P., Goh, M. M., Tucker-Kellogg, L., & Soh, R. C. (2019). A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. International Wound Journal, 16(1), 164-175. Web.

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. G. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. Web.

Han, S. H., Kim, Y. S., Hwang, J., Lee, J., & Song, M. (2018). Predictors of hospital-acquired pressure ulcers among older adult inpatients. Journal of Clinical Nursing, 27(19-20), 3780-3786. Web.

Hidayat, A. T., Hariyati, T. S., Muhaeriwati, T. (2020). Applicability of Lewin’s change management model for optimization management function in nursing delegation between head nurse and team leader: A mini project in Jakarta military hospital. International Journal of Nursing and Health Services, 3(4), 471-478. Web.

Prevention and treatment of pressure ulcers/injuries: Quick reference guide 2019. (2019). Agency for Healthcare Research and Quality. Web.