Preventing Pressure Ulcers in Postoperative Patients
this is a nursing research evidence-based practice project paper. THIS IS A NURSING PROJECT. SINGLE SPACE. 6 PAGES FOR THE PROJECT, 2 PAGES FOR THE LISTED INFO Directions: 1. You developed EVIDENCE-BASED NURSING PRACICE PROJECT (EBP).
What are the best practices to prevent pressure ulcers in postoperative patients?
This project aims at implementing evidence-based prevention strategies for pressure ulcers in postoperative patients.
There are many risk factors associated with pressure ulcers such as lack of movement, poor nutritional intake, hypothermia, and dry skin. Postoperative patients are at increased risk of developing pressure ulcers because they often have long period of immobility and poor nutritional intake. As a result, they experience pain and discomfort and poor quality of life as a result of pressure ulcers. Pressure ulcers are preventable using strategies such as repositioning of patients to prevent accumulation of pressure, use of mattress overlays to reduce pressure on the skin, proper nutritional intake, and skin care to prevent drying.
A detailed literature search was conducted on Medline, PubMed and the Cochrane Library to identify studies that focus on prevention strategies of pressure ulcers in postoperative patient. Four articles were selected including a guideline document published by the Royal College of Nursing in the UK. The IOWA model was used to manage the change in practice in the hospital. In the project, nurses will be required to conduct risk assessments for pressure ulcers in postoperative patients every 2 -- 3 hours and provide the appropriate care. A detailed algorithm will be provided as a quick reference guide for the project.
Preventing pressure ulcers in postoperative patients
Pressure ulcers are a major burden of sickness in postoperative patients. They experience reduced quality of life as a result of this. Pressure ulcers also cost the health system greatly. In the UK, it is estimated that between £600,000 and £3,000,000 is spent each year in prevention and treatment of pressure ulcers in a 600-bed hospital. Therefore, the cost of each patient ranges from £10,000 - £40,000 (Royal College of Nursing, 2001). Pressure ulcers are localized damage to the skin and tissue as a result of pressure, friction and sheer. They can be prevented through simple quality of care improvement strategies and ensuring the staff are well trained to handle them.
Among adults hospitalized surgical patients, pressure ulcers cause pain, discomfort, reduced productivity, and poor health outcomes. They also lead to social isolation, helplessness and loss of hope which adversely affect the patients' quality of life. Patients with pressure ulcers are often prone to sepsis and infections depending on the extent of damage. In the U.S., the International Pressure Ulcer Prevalence Survey found a 5% prevalence of hospital-acquired pressure ulcers and the prevalence in patients receiving critical care ranged from 8% to 10%. In Intensive Care Unit patients, the prevalence stands at 3.3% (VanGilder, Amlung, Harrison, & Meyer, 2009). An understanding of the risk factors associated with pressure ulcers and the causes will help evaluate preventive measures.
A systematic review of prevention strategies for pressure ulcers grouped interventions into three groups (Reddy, Gill, & Rochon, 2006). The first is the interventions that target impaired mobility. They found that in acute care, strategies such as support surfaces to reduce pressure such as overlays e.g. gel, air, foam, etc. placed on mattresses can be effective in reducing pressure ulcers. Repositioning of patients was also important through turning them every two hours. This strategy was also found to be effective in preventing pressure ulcers in postoperative patients. Though the authors only identified two studies, they found some evidence of effectiveness of patient repositioning (Reddy et al., 2006).
The second group of interventions was those targeting impaired nutrition. They found little evidence to support the relationship between prevention of pressure ulcers and nutritional intake. Only one study of 672 patients provided evidence that nutritional supplementation was advantageous. The last group of strategies was the interventions targeting impaired skin health. The authors found three trials including 439 patients in acute care and found topical agents to be effective in preventing pressure ulcers (Reddy et al., 2006).
The trials included in the systematic review, however, provided little evidence of the effectiveness of strategies to prevent pressure ulcers because the authors were not able to conduct a meta-analysis of the trials they identified. However, the authors recommend mattress overlays and skin care to prevent pressure ulcers. They also recommend nutritional supplements, though there is limited evidence, because there are other benefits of adequate nutrition (Reddy et al., 2006).
The recommendation for mattress overlays is also provided in the Jackson et al. (2011) study. The study used air fluidized therapy beds for their customers because they found them to be effective in lowering pressure between the bed and the patient thus effective at preventing pressure ulcers. The authors found that the incidence of hospital-acquired pressure ulcers reduced from 40% to 15%. The authors also evaluated the cost-effectiveness of the air fluidized therapy beds in relation to the cost of treating pressure ulcers. They found that had the patients developed pressure ulcers, the cost of treatment would have been over $155,000 and this compared to $18,000 for renting the beds. Their evaluation supports the use of air fluidized therapy beds for prevention of pressure ulcers (Jackson et al., 2011).
In another study that evaluated the effect of immobility on pressure ulcer development, the researchers found that patients who were undergoing surgery or in the postoperative period had a higher risk of developing pressure ulcers. This is because they often have long periods of immobility, poor food intake, and other risk factors such as friction as a result of movement, and lack of physical activity. Though the study did not evaluate any preventive measures for pressure ulcers, the authors recommend repositioning of patients to stimulate mobility and thus prevent pressure ulcers
(Lindgren, Unosson, Fredrikson, & Ek, 2004)
Quigley and Curley (1996) suggest the use of risk assessment evaluations to identify patients at risk of developing pressure ulcers to identify patients at risk and respond in the early stages of the ulcers. The authors suggest the use of the Braden Scale or Braden Q, which uses seven subscales, mobility, activity, sensory perception, moisture, friction, nutrition, and tissue perfusion and oxygenation to respond to early signs. The authors provide a detailed algorithm of skin care that provides strategies for preventing pressure sensors based on the risk factors. The specific strategies are mattress overlays, optimizing nutritional intake, turning the patient, and using air fluidized therapy beds.
The Royal College of Nursing in the UK has developed a guideline with a clinical algorithm for care of patients to prevent pressure ulcers. The Royal College of Nursing recommends regular skin inspections of patients with risk factors for pressure ulcers. Depending on the risk factors for the patient and the findings of the skin inspection, they recommend redistributing pressure through repositioning or using mattress overlays, nutritional advice for patients and monitoring progress towards quality improvement (Royal College of Nursing, 2001).
Statement of purpose
Only few studies have focused on the effectiveness of methods to prevent pressure ulcers in postoperative patients. The burden associated with pressure ulcers is high and it is reasonable for these preventive measures to be evaluated to determine their effectiveness in improving patient outcomes and quality of life. The health care system will also benefit from reduced costs associated with treatment of pressure ulcers. This project aims at reducing the incidence and prevalence of pressure ulcers in postoperative patients and, therefore, passes the cost savings associated with these preventive measures to them.
The chosen participants are postoperative patients. Postoperative patients are commonly those receiving acute care and are immobilized during most of their postoperative period. Therefore, they have a high chance of developing pressure ulcers.
Materials and procedures
From the literature, the best strategies for preventing pressure ulcers are using pressure overlays, optimizing nutritional intake, repositioning, and skin care. The skin care algorithm suggested by / / / will be adopted to assess patients' risks of developing pressure ulcers and respond appropriately. The algorithm is essential in making sure patients get the appropriate care based on their associated risk factors while making sure nursing staff can provide the best quality of care without overworking them.
Population and sample
In order to implement the project, a sample of postoperative patients at risk of developing pressure ulcers will be selected. The chosen patients will be used to pilot the preventive strategy for the hospital. Convenience sampling will be used since the implementation is at small scale at first.
Nurses will use the skin care algorithm suggested by / / / to evaluate patient risks of developing pressure ulcers. They will be required to conduct this assessment every 2 -- 3 hours. They will then respond with the appropriate care, mattress overlays, repositioning, nutritional intake, and skin care depending on the assessment.
In order to pilot the change in practice to prevent pressure ulcers, it…