Preventing Pressure Ulcers in Long Term Care Facilitaties

Evidenced-Based Recommendation: Pressure Ulcer Prevention

Problem:

The professional practice problem is the high incidence of pressure ulcers in elderly patients residing in long-term care facilities. Preventing pressure ulcers in long-term care facilities is crucial to maintaining the health and well-being of residents. Indeed, pressure ulcers can result in severe pain, infection, and decreased quality of life, making proactive care and regular monitoring essential to avoid these preventable injuries. Moreover, pressure ulcers are an indicator of patient neglect, placing long-term care facilities at risk of costly litigation. Consequently, pressure ulcer prevention is an increasingly important concern given the sustained increase of the elderly population in the United States, an increase that is projected to continue through mid-century.

Unfortunately, current practice frequently lacks structured monitoring systems and preventive interventions that can facilitate the prevention of pressure ulcers. Besides being an indicator of patient care, the risks of not addressing this problem include increased patient suffering, higher healthcare costs, and a diminished quality of life for elderly residents. In this regard, studies such as those conducted by Elli et al. (2022) and Haavisto et al. (2022) highlight the need for improved risk assessment and preventive measures. In other words – and to paraphrase an adage -- an ounce of evidence-based pressure ulcer prevention is worth a metric ton of conjecture and good intentions. In sum, it is critically important for long-term care providers to have an evidence-based framework that can help them prevent these otherwise-preventable injuries.

Research Findings:

The research reviewed to develop this evidence-based recommendation identified some similarities, including the emphasis on risk assessment tools (e.g., Norton scale in Elli et al., 2022), the importance of staff education and adherence to guidelines (Haavisto et al., 2022), and the effectiveness of preventive measures such as repositioning and specialized mattresses (Yun & Park, 2020). Each of these studies underscored the importance of evaluation and ongoing prevention measures as integral parts of an evidence-based intervention.

Some notable differences in the research relate primarily to the studies’ specific focus areas, with some of the studies examining biophysical factors (Arisandi et al., 2020) while others focused on broader safety cultures in healthcare settings (Abusalem et al., 2021). Notwithstanding these differences in focus, the consistency and quality of results were generally rated as high, with most of the studies reviewed for this evidence-based recommendation being rated as Level II or III evidence.

Recommendation for Change in Healthcare or Practice:

Based on the findings that emerged from the research, a multifaceted approach to pressure ulcer prevention in long-term care facilities is recommended. This approach should include the implementation of regular risk assessments using validated tools such as the Norton scale, as highlighted by Elli et al. (2022). In addition, there should also be a strong focus on staff education concerning timely, evidence-based prevention practices as emphasized by Haavisto et al. (2022).

While every long-term care setting and their resident base are unique, the recommended prevention program should incorporate structured repositioning schedules and the use of specialized mattresses, which were found effective in the study by Yun & Park (2020). In addition, integrating nurse practitioners into long-term care settings can significantly improve overall care quality and contribute to pressure ulcer prevention as noted by Kilpatrick et al. (2020).

Stakeholder Influence:

The successful implementation of this comprehensive pressure ulcer prevention program relies heavily on various stakeholders, each with their unique contributions and potential hindrances. Nursing staff are crucial for the day-to-day implementation of preventive measures but may actively resist changes to their established routines. Likewise, other members of a transdisciplinary healthcare team also play important roles in identifying high-risk residents and tailoring prevention strategies to individual needs. Facility administrators control the organizational resources that are necessary for implementation, but like other stakeholders, facility administrators may be concerned about the economic costs that are associated with the prevention program.

In addition, family members and caregivers also have a vested interest in the program’s success, as they advocate for their loved ones’ care; however, these stakeholders may require thoughtful education and support to fully understand and participate in prevention efforts. Moreover, while patients and their families stand to benefit significantly from improved care, they may have varying levels of engagement and understanding concerning the importance of the recommended prevention strategies.

Beyond the foregoing, policymakers have the power to influence regulations and funding that could support or hinder the program but these stakeholders may also have competing priorities in healthcare resource allocation. Indeed, a scarcity of organizational resources (together with the nursing staff’s resistance to change) may represent the most significant constraint to the successful implementation of this initiative notwithstanding its potential benefits for all stakeholders. Therefore, recognizing and addressing the perspectives and concerns of each unique stakeholder group is essential for the successful implementation and sustainability of the prevention program.

Communication:

Effective communication of the solution and implementation plan is vital for engaging all stakeholders and ensuring successful adoption. For nursing staff and other direct care providers, regular staff meetings and comprehensive training sessions should be conducted to explain the new protocols and their importance. In addition, written materials and formal presentations should be prepared for facility administrators and policymakers, focusing on the long-term benefits and cost-effectiveness of the prevention program. For patients and their families, educational sessions and easy-to-understand informational materials should be developed to explain the importance of pressure ulcer prevention and how they can participate in the care process. This multi-pronged communication approach ensures that all stakeholders are well-informed and can contribute effectively to the program’s success.

Resources and Barriers:

The implementation of this pressure ulcer prevention program can leverage several existing resources, including the expertise of current staff, potential quality improvement funding, and available evidence-based guidelines and assessment tools. However, several barriers need to be addressed for successful implementation. These include limited time and staffing in long-term care facilities, potential resistance to change among staff, and financial constraints that may limit the acquisition of new equipment or additional training.

In order to overcome these barriers, a phased implementation approach can be adopted to manage workload and allow for gradual adaptation. Continuous education and support should be provided to staff to address resistance and ensure proper adherence to new protocols. Additionally, a detailed cost-benefit analysis should be conducted and presented to administrators and policymakers to justify the necessary investments in prevention measures, highlighting the long-term savings from reduced pressure ulcer incidence.

Timeline:

A proposed timeline for this evidence-based recommendation is as follows:

· Month 1-2: Planning and stakeholder engagement;

· Month 3-4: Staff training and education;

· Month 5-6: Implementation of new assessment and prevention protocols;

· Month 7-12: Monitoring and data collection; and

· Month 13: Evaluation of outcomes (e.g., percentage reductions in the incidence of pressure ulcer in long-term care facilities).

Dissemination Strategy:

While the above-described evidence-based recommendation is appropriate at various levels for all of the stakeholders (e.g., patients and family members will need difference educational strategies than healthcare providers), the target audience for the recommendation will be the National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC). The dissemination strategy will include a presentation at the annual conference and ongoing publication in their journal concerning the findings from pilot studies that have implemented the recommendation. This method is appropriate because it reaches key decision-makers in long-term care settings. In addition, the presentation and publication will adhere to the principles established by the Standards for Quality Improvement Reporting Excellence guidelines to ensure the timely and comprehensive reporting of this quality improvement initiative.