Question

Case Eliminating Pressure Ulcers at Lakeview Frustrated with ongoing complaints from family members, Reba Sanders the administrator of 100-bed Lakeview Skilled Care and Rehabilitation Facili replaced the director of nursing (DON) after she had been on the job for less the 2 years. At the exit conference with Reba, the DON had remarked, "I don't thin pressure ulcers have been a problem in this facility the way it is made out to be by some families. Some patients develop the ulcers at the hospital before they con here; we try our best to take care of them, and I have explained to the families what we are doing. I think firing me is unfair, but it is your decision." Before the new DON, James Osterwal, was hired for the job, Reba had mentioned to him that looking into the pressure ulcer problem would be his first priority. Reba arranged for James to attend meetings of the local chapter of a national quality improvement organization for nursing homes. Based on some of the informa- tion presented at the meetings, James quickly settled on making pressure ulcer elimination as his primary goal. James was quite familiar with the PDSA quality improvement cycle. He discussed it with the charge nurses, decided how data would be collected, and started a campaign asking all nursing staff to adopt the motto: "We will eliminate pressure ulcers at Lakeview." The associates liked the motto because it gave them a specific goal to work toward. At James' request, Reba approved hiring an RN nurse coordinator to float between the three shifts. The charge nurses asked their nursing assistants to report to them right away all cases of skin breakdown. James trained the nurses in best practice protocols to treat pressure ulcers. After 4 months, data showed little to no improvement in the prevalence (total number of cases) of pressure ulcers at Lakeview. Both Reba and James could not understand why. Questions 1. Based on what you have learned in this chapter, evaluate the quality improv program as it pertains to pressure ulcers at Lakeview. Provide a specific of weaknesses in the overall approach. 2. Use the PDSA cycle to address the issue of pressure ulcers. Be spe example, how should data be collected? How would you go about identity causes of the problem? What interventions would you implement should the various personnel and the administrator have? S. Be specific. For ut identifying root implement? What roles

Answer 1

Pessure ulcer / Decubitus ulcer refers to an impairment in skin integrity secondary to prolonged bed ridden, malnourishment, constant pressure on the bony prominences, lack of knowledge among the nurses.

1)Quality improvement program evaluated based on the following measures:

Assessing nurses knowledge about normal skin anatomy and physiology and the concepts of decubitus ulcer etiology,risk factors and effective nursing care to prevent it. Comprehensive skin assessment aid nurses to identify the presence of bed sores and the ability to distinguish between a normal skin disorders and bed sores. Recognize essential parameters to assess skin damage based on skin intactness, level of moisture, temperature changes int he affected skin,elasticity of the skin. Frequent comprehensive skin assessment is done among patients in critical care unit. Documentation of skin assessment helps in continuity of care by nurses changing each shift. Assess all skin creases and bony prominence as risk of pressure ulcer is more in that area. During physical examination check in occipital area, during auscultation check back,sacrum and coccyx. Special focus id given to the areas in which patient has lack of sensation.

Once pressure ulcer is determined nurses must initiate the protocol to cure skin ulcer like: Washing hands before rendering skin care, inquire underlying pressure sources like tubings : oxygen, urinary catheter, intravenous tubes, cardiac monitors cables. If any constant pressure seen the source should be removed and make patient comfortable.

Empower nurses to understand correct etiology wounds, skin assessments, proper communication between nurses during each shift changes. Proper skin care, positioning like assisting patient to turn or reposition every second hourly to reduce pressure over the bony prominences. Application of bed filled with water or pneumatic devices helps in equal distribution of pressure over the areas. Nutritional component is met first by assessing nutritional status of the patient, calorie calculation,amount of protein intake, serum albumin level. Based on the findings nutritional plan can done to prevent emaciation that end up with pressure ulcer and impaired wound healing. Antibiotic protocol to be monitored to reduce bacterial colonization int he skin ulcer. Antibiotics to be given in proper time in order to prevent antibiotic resistance. Swab can be taken from the ulcer to identify the type of infection.

2) PDSA cycle enhances a scientific assessment of the skin assessment or identifying the route cause of the problem and act accordingly to implement measures.

- Comprehensive skin assessment aid nurses to identify the presence of bed sores and the ability to distinguish between a normal skin disorders and bed sores.

-Recognize essential parameters to assess skin damage based on skin intactness, level of moisture, temperature changes int he affected skin,elasticity of the skin.

-Frequent comprehensive skin assessment is done among patients in critical care unit.Proper skin care, positioning like assisting patient to turn or reposition every second hourly to reduce pressure over the bony prominences.

-Application of bed filled with water or pneumatic devices helps in equal distribution of pressure over the areas.

-Nutritional component is met first by assessing nutritional status of the patient, calorie calculation,amount of protein intake, serum albumin level. Based on the findings nutritional plan can done to prevent emaciation that end up with pressure ulcer and impaired wound healing. Antibiotic protocol to be monitored to reduce bacterial colonization int he skin ulcer.

The data can be collected using standardized Risk assessment to evaluate the knowledge of nurses regarding pressure ulcer and early identification, nursing care.