Methodology
This DNP project will be a retrospective chart review on the prevalence of pressure ulcers in elderly in home settings receiving services from a community-based health care provider located in New Jersey with a total patient population of over 3000 in eight counties. Prevalence will be defined as the total number of patients who currently have pressure ulcers or have been treated for pressure ulcers and the risk associated with the development of pressure ulcer for the past 12 months. A retrospective chart review has been chosen for this project because it is often used to evaluate associations between models of care and the clinical outcomes of interest (Hess, 2004). It is also an inexpensive way to research accessible data for any condition where there is latency in available data and most importantly to generate hypothesis for future studies (Gearing, Mian, Barber & Ickowicz, 2006). Setting: The reviewer will extract 100 convenience sample charts from the electronic database of the participating primary practice to determine the prevalence of pressure ulcer. The practice is a community-based primary health care provider that services the elderly in their homes. The majorities of these elderly are cognitively impaired, have mobility problems, and can no longer leave their homes and are in need of medical care. The geographical locations of the patients are Passaic, Essex, Bergen, Union, Middlesex, Morris, Monmouth, and Ocean counties in New Jersey.
The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.
A common health concern seen in the elderly, especially those within institutions, are pressure ulcers. A pressure ulcer is defined as a localized injury to the skin or underlying tissue that occurs when something keeps rubbing or pressing against the skin. Pressure on the skin causes a decrease of blood flow to that area and as a result, an ulcer may form because of the skin dying due to the lack of blood in that region. They generally occur over bony prominences such as, the buttock, elbow, hip, heel, back of the head and ankles. An ulcer has a greater chance of forming if the person uses a wheelchair or stays in bed for a long period of
Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.
Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of
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).
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 during a hospital admission are preventable. Assessment and early intervention can stop skin breakdown before it begins. Many factors regarding Mr. J’s condition placed him at a high risk regarding nursing indicators. Mild dementia, recent fall and a fractured hip all require a high level of nursing care and indicates preventative practice. Upon assessment, precautions should be in place to deter further complications. The elderly are more
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
While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).
Research Review: What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors by C. Gorecki et. al.
What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors (Gorecki, Nixon, Madill, Firth and Brown, 2012)
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.
Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the
Pressure ulcer is an adverse outcome in the clinical care setting that also linked to poor quality of nursing care. Though pressure should never happen in a professional care setting, it is still prevalent throughout the world’s medical settings. This article looks at many other previous studies from 1992 to present to compare and find the underlying issues that may contribute to pressure ulcer. A closer look at the nurse’s knowledge versus actual decision will be observe, because it is the key factor in pressure ulcer prevention.