Nursing Research Journal

Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced

Data should be collected on pressure ulcers, this is easily provided by conducting audits and creating a Skin Champion position, as is the case in my hospital, that is filled by a nurse that creates educational documents, conducts audits on the use of Braden scale and following up with Wound Care staff. Changes in healthcare, as in any business, usually starts when there is a direct impact on financial reimbursement, and the formation of new pressure ulcers on inpatient care places the cost on the facility and not Medicare or Medicaid (Medscape, 2015). The audits should provide management with enough data to track ulcer formation, this will drive education, change in nursing attitude towards use of restraints, improve patient satisfaction and improve reimbursements to the facility.

Assessment of a patient is key in preventing a pressure ulcer from occurring as well as keeping a pressure ulcer from getting progressively worse. A history of the debilitated patient can often determine the cause and risks. Some risk factors include bed rest/immobility, incontinence, diabetes mellitus, inadequate nutrition/hydration, and altered mental status. (Ignatavicius, 2013) Nurses must meticulously assess a patient history to determine the severity of developing an ulcer. The Braden Scale is a widely used tool for predicting a patient’s risk for developing a pressure ulcer. It uses 6 categories that include sensory perception, moisture, activity, mobility, nutrition, and friction and shear and rates the risk of 1-4 for each category. A patient with a score of <11 is at severe risk, 12-14 puts a patient at moderate risk, and a score >14 is at low risk. (Ignatavicius, 2013) When physically assessing a patient, the nurse must inspect the entire

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

Due to the burden and impact of pressure ulcer development on both the individual and the health service, it is accepted practice that risk assessment should be undertaken on

The aim of this article was to assess the validity of the Waterlow Scale instrument using a longitudinal cohort of internal medical patients. To identify risk factors contributing to the injury of pressure ulcers (information outlined in the abstract overview of the study) (BJN, 2010).

Identify a range of interventions that can reduce the risk of skin breakdown and pressure sores.

(IHI, 2011). The implementation of preventative interventions and assessment of patients at risk for pressure ulcers can decrease in occurrence of pressure ulcers. Implementation of protecting bony prominences, repositioning frequently, redistributing pressure surfaces, bladder and bowel management, and skin assessment are some interventions. Therefore, IDT education and effective communication are essential for the process to be successful. The team will use a check list on purposeful hourly rounding with the intention to keep patient safe, comfortable. The IDT will implement the Plan-Do-Study-Act (PDSA) model as a guide to assess changes for best results ng (Nelson et al. 2011, p. 276). The IDT will identify the patients at risk and will intervene with a patient-centered-care, skin assessment (Plan), the team will then implement the changes, and interventions, using the redistributing pressure surfaces (DO), as a follow up, the team will evaluate collected data from check list and shift reports (Study), and implement what was learned from using redistributing pressure surfaces

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

According to the Agency for Healthcare Research and Quality (AHRQ), 2.5 million patients are affected by pressure ulcers and incur costs anywhere from $9.1 billion to $11.6 billion per year in the United States (AHRQ, 2014). As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for cases in which the pressure ulcer was acquired after admission (CMS, 2008). Because of this high cost, the number of patients affected each year, and insurances no longer reimbursing hospital acquired pressure ulcers (HAPU), an accurate skin assessment upon admission is critical to reduce costs, ease pain in patients, and lower incidences of pressure ulcers. This paper will address what leadership and management skills and functions are required of a wound care nurse who identifies a problem with the accuracy of skin assessments on newly admitted patients.

A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).

I have significantly developed my skill in wound care assessment and dressing, in developing this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer assessment it provides a basis for deciding the effectiveness of the current treatment.

A full assessment of the wound should be carried out prior to selection of dressings. Any allergies should also be noted. The wound should be traced, photographed and measured providing data for comparison throughout the treatment. Consent should be gained prior to photographing the wound and the patient should not be identifiable from the photograph (Benbow 2004). All information should be documented in patients’ records, using the wound assessment tool. The pressure sore was identified as grade two

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

“Pressure ulcers are key clinical indicators of the standard and effectiveness of care (Elliott, Fox & McKinley, 2008).” L.M. was at high risk for pressure ulcers for multiple factors such as immobility, poor nutrition, age, and health. Therefore, I used the Braden Scale as a quality indicator in order to assess the risk of pressure ulcers and also to