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Show Proactively Preventing Pressure Problems University of Utah College of Nursing Madeline Beckstead, Student Nurse METHODS FOR IMPROVEMENT INTRODUCTION It is standard procedure for a patient to be rotated every two hours when on bedrest (1). These "Never Events" not only harm the patient population, but financially impact the hospital as they are not reimbursed by Medicare or Medicaid since 2008 (2). Since this extra incentive was put into place the rate of pressure sores actually increased from 21.7/1000 discharges in 2014 to 23/1000 discharges in 2017 (2). This is unacceptable and needs to change. The bariatric population is especially susceptible so it is reasonable to use them as the study population. In bariatric patients on bedrest, how does creating an order for patient rotation and repositioning compared to no standing order for patient rotation affect the development of hospital acquired skin breakdown over a trial period of three months? • Increased risk factors: individual risk assessment by provider upon admission recognizing risk factors such as (5): • poor circulation • reduced vascularity of adipose tissue • Increased weight increases pressure on susceptible areas DISCUSSION Across the world there have been various "bundles" implemented, but statistically only 14% of those are supported by evidence (4). There are evidence based ways to approach bariatric pressure sore prevention. This will ultimately benefit the patient population, the nursing staff, and the hospital as a whole. Limitations & Barriers • Even those these methods for improvement are • Decreased mobility supported by evidence, a clinical trial would • Malnutrition need to take place in order to prove that they • Co-morbidities are effective. • This would a be a wide spread change that would have to start at the unit level and Problem Investigation • Braden Scale supplement: based on individual assessment • A higher Body Mass Index (BMI) comes with creating a personalized order for sore prevention such as: gradually grow to include multiple units. Valuable Lessons Learned increased risk factors for pressure sore • More frequent rotations development making the Braden Scale not • Use of wedge cushions sufficient as the solitary tool for risk assessment • Floating Heels complete picture it is helpful to look at multiple (3). • Protecting areas of existing sores papers referencing the same topic. • Change will not take place if research is not • Technological devices are not as reliable as human judgement, but some are being developed that could potentially serve as accountability trackers (4). • Shifts become busy, and patient repositioning can be over looked especially with bariatric being done and shared. • Accountability tool: an order icon on charting dashboard, like those for medications and labs • As technology improves it may be another accountability tool used in the future References: • Pressure sore prevention is possible but will interprofessional team RESULTS " " Pressure ulcer prevention is complex. Studies and interventions need to include contextual and patient characteristics along with preventative care interventions (2) CONCLUSION require cooperation of the whole patients that require more time and people to effectively accomplish the task. • There is evidence all over, but to gain a While there may be some resistance on part of the staff due to potential increased time demands, through contextual education and patient specifications upon initial assessment, pressure sore prevention interventions will be successful. (1 ) H a n d , M .C ., R o se , M .A ., P o k o rn y , M .E ., C a stle s, R .T ., W a tk in s, F ., K irk p a trick , M .K ., S w a n so n , M ., E n g e lk e , M ., M o o re , R ., W u , Q . & C h e n , K . (2 0 1 3 ). P ilo t te stin g th e a u g m e n te ch b o d y p o sitio n se n so r o f th e m o rb id ly o b e se p a tie n t. A p p lie d N u rsin g R e se a rc h , 2 6 , 9 2 -9 5 . (2 ) B a e rn h o ld t, M ., Y a n , G ., H in to n , I.D ., C ra m e r, E ., & D u n to n , N . (2 0 2 0 ). E ffe ct o f p re v e n tiv e ca re in te rv e n tio n s o n p re ssu re u lce r ra te s in a n a tio n a l sa m p le o f ru ra l a n d u rb a n n u rsin g u n its: Lo n g itu d in a l a sso cia tio n o v e r 4 y e a rs. In te rn a tio n a l Jo u rn a l o f N u rsin g S tu d ie s, 1 0 5 , 1 -8 . (3 ) G risw o ld , L.H ., G riffin , R .L., S w a in , T ., & K e rb y , J.D . (2 0 1 7 ). V a lid ity o f th e B ra d e n S ca le in g ra d in g p re ssu re u lce rs in tra u m a a n d b u rn p a tie n ts. Jo u rn a l o f S u rg ic a l R e se a rc h , 2 1 9 , 1 5 1 -1 5 7 . (4 ) P ick h a m , D ., B e rte , N ., P ih u lic, M ., V a ld e z, A ., M a y e r, B . & D e sa i, M . (2 0 1 8 ). E ffe ct o f w e a ra b le p a tie n t se n so r o n ca re d e liv e ry fo r p re v e n tin g p re ssu re in ju rie s in a cu te ly ill a d u lts: A p ra g m a tic ra n d o m ize d clin ica l tria l (LS-H A P I stu d y ). In te rn a tio n a l Jo u rn a l o f N u rsin g S tu d ie s, 8 0 , 1 2 -1 9 . (5 ) N e ss, S .J., H ick lin g , D .F ., B e ll, J.J. & C o llin s, P .F . (2 0 1 8 ). T h e p re ssu re o f o b e sity : th e re la tio n sh ip b e tw e e n o b e sity , m a l n u tritio n a n d p re ssu re in ju rie s in h o sp ita l in p a tie n ts. C lin ic a l N u tritio n , 3 7 , 1 5 6 9 -1 5 7 4 . • There are tools that can be improved upon, such as the Braden Scale and charting technology, to be able to adjust prevention strategies based on an individual patient basis and help keep nursing staff and other team members accountable. |
