Reaching Zero
Abstract
The goal of this project is zero hospital acquired pressure injuries. The project is centered on decreasing hospital acquired pressuring. The policy on what a nurse is expected to do is outline in accordance with different issues, such as how to prevent any skin breakdown and which patient to monitor the most. A Wound Committee was also created as a monthly source where the number of hospital acquired pressure injuries and any trends are outlined. A Chest List was created called the Braden Chest list to help assist the charge nurses during their time with the patient. Every nurse must run a report that a computer system gives them with points scaling from 18 or less. After every shift the patient is turned in accordance to the turning clock, heels off bed and skin intact. In addition, a Mandatory Intense analysis of any hospital acquired pressure injury was implemented.
Pressure ulcers are a growing problem in hospitals and can affect the most vulnerable people causing the patients a great amount of unease, distress and economic expense because of the treatment costs. According to Gill, in 2013 there was a total rate of 12 patients who had suffered from hospital acquired pressure ulcers and out of these 12, 6 injuries happened in the intensive care unit (Gill, 2017). Even though there are an increased amount of technological services and advancements, still the prevalence and cost of hospital acquired pressure ulcer is continuing to be costly. However, research has shown that pressure ulcers are highly avoidable when the nursing staff are knowledgeable on pressure ulcer prevention (Gill, 2017). Due to the fact that pressure ulcer prevention is something that occurs on a recurring basis in hospitals, nurses don’t always see how important keeping up standards of care is and how not keeping this up can lead to dire consequences for the vulnerable patients.
Project Rationale
The need for helping nurses decrease the amount of injuries related to hospital acquired pressure was noted when I saw a great increase in these types of injuries. What was noticed was how many of the supposed pressure injuries were not correctly staged, missed on admission or caused due to not turning. The main people who will be benefitted by this project is by far the patients. The nurses will also benefit because they will have the ample knowledge in caring for patients at risk of getting hospital acquired pressure injuries and can rest assured that they did everything in their power to prevent a preventable injury, which is what a hospital acquired pressure injury is.
According to Etafa et al (2018), nurses are in the primary role of avoiding these kinds of injuries for patients and need to understand their importance as an individual in this matter. Etafa states “pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organizations throughout the world, and a key factor in pressure ulcer prevention and management is individual nurse decision making” (Etafa, 2018). Even though nurses are solely responsible for preventing pressure injuries, when the rest of the team is also knowledgeable in prevention of pressure injuries, everyone wins. This is why the implementation of the Braden Check List will serve the nurses and staff well. Not only will the check list give them a set of standards to look for when turning a patient, but also will help remind them of how to properly do this : heels off bed and skin intact. The hospital setting can get very stressful but maintaining the proper form when performing simple tasks as turning a patient is of the utmost importance in providing the highest level of care for patients.
Personal/Professional Expectations
Every year patients are suffering from a preventable injury and I want to aid in decreasing this from happening. When a patient comes into the hospital to receive treatment, there is no reason why the patient should feel extra suffering and it’s the nurses job to take the time to become knowledgeable in proper care for patients. I hope to be able to help the patients and be able to prove that prevention is the key to avoiding the prevalence of pressure injuries. I want to prove that pressure injuries are preventable and that if the health care team works together in a multidisciplinary approach, this goal can be accomplished. By educating, documenting and accountability tactics there can be positive change in reducing the amounts of patients suffering from hospital acquired pressure injuries. Through use of mandatory intense analysis of hospital acquired pressure injuries, nurses and staff can be held accountable for what they are doing in regards to this matter. The intense analysis will be a meeting where all staff that care for a single patient including management, PT, Nutrition and administrative team meet to go through an investigation of the chart and find any opportunities or areas that may need to be improved upon to avoid incident from happening to another patient. From these intense analysis meetings, there can be an implementation of unit Process improvements or education tasks to further help nurses and staff become more knowledgeable in best practices for certain special patient cases.
Literature Review
Much of the literature researching hospital acquired pressure injuries maintain the stance that these injuries are highly preventable when the right education and tools for accountability are use within the hospital. This is not to place all the blame on the nurses for not doing a proper job but more on keeping up with the new technologies present in the hospital. According to Gill (2017), “pressure ulcers are complex wounds requiring an overabundance of skills and knowledge to manage and care for [and while] there are many policies and guidelines on pressure ulcer prevention and management, regrettably, studies have shown that many qualified staff nurses don’t adhere to these guidelines or evidence based practices [which is what] leads to insufficient pressure ulcer prevention practice.” The National Pressure Ulcer Advisory Panel created a 2014 prevention and treatment of pressure ulcers clinical practice guideline to help aid nurses and staff in knowing what to look for these cases. This guideline was created using evidence-based recommendations for preventing and treating pressure ulcers and included “575 explicit recommendations and/or research summaries for the following pressure ulcer topics: etiology, prevalence and incidence, risk assessment, skin and tissue assessment, preventive skin care, among many others” (2014). Thus, there are a great amount of research based best practices for nurses to adhere to but if they don’t upkeep with the new methods relating to new technology and new research, then the patients will suffer.
Procedure
I have been working on this project for 6 months now.
- I have created a policy that took 1 month and then another month to go through the critical care committee, Medical executive committee and then governing board.
- I created a class which took me 2 weeks. I presented it to CNO got her approval and teach the class every 2 weeks. I have also started to teach in the critical care course, ED course and new employees.
- I created the wound committee which took me a month, I will have this committee monthly starting next month and there will discuss the number of hospital acquired pressure injuries, trends, finding and locations.
- I will be tracking the hospital acquired pressure injuries for next 2 years to see not only a decrease but to be sustained.
- I created the Braden checklist which took me 1 week and received approval by Nursing directors. It was decided to do every shift by the Charge nurse in every unit. The directors do spot checks and are responsible that it gets done.
- I created an intense analysis format that is very similar to a root cause analysis with all the data collected and a fish chart to be able to identify where our opportunities were.
Evaluation
Therefore, including the Braden Check list will facilitate in reminding nurses of what they need to remember in dealing with these situations. At the end of the day, these injuries are preventable. The Health Research and Educational Trust (2017) believes that tracking the progress will lead towards improving the amount of injuries. The Health Research and Educational Trust states that “collecting these monthly data points at your hospital {outcome measures) will guide your quality improvement efforts as part of the Plan-Do-Study- Act Process (PDSA)” (2017). This is exactly what I would be doing with the Wound Committee which would be conducted on a monthly basis and track how many injuries and trends happened and ways to improve in the next month.
Etafa et al (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention.
BMC Nurs (17) 14.
Gill (2017). Reducing hospital acquired pressure ulcers in ICU.
Health Research and Educational Trust (2017).
The National Pressure Ulcer Advisory Panel (2014). Prevention and Treatment of
Pressure Ulcers Clinical Practice Guideline.
