Paper Example on Hospital-Acquired Pressure Ulcers: Causes & Risk Factors

Introduction

According to the national pressure ulcer advisory panel, pressure ulcers are injuries on the skin that are caused by prolonged pressure on the skin. In other terms, hospital, acquired pressure ulcers are necrosis or areas localized on the body surface as a result of tissue damage (Rondinelli et al., 2018). Some call them pressure sores or bedsores. It is worth mentioning that non-ambulatory patients also have the risk of developing pressure ulcers. Of concern to this issue is hospital-acquired pressure injury, also known as hospital-acquired pressure ulcers (HAPUs), localized skin injuries caused by a prolonged stay at the hospital (Richardson et al., 2017). Mostly, HAPUs are linked with other issues such as old age, nutritional problems, inability to move, the severity of illness, and diabetes.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

HAPUs have become an issue if a national concern is due to patient morbidity, financial costs of treatment, and the amount of money spent on patients who demand reimbursement from hospitals from whose hospitals they develop such localized skin injuries. Critical care patients are at a higher risk of getting developing pressure ulcers due to the long period for which they are immobilized and lain in hospital beds. Due to the increasing number of cases of pressure ulcers, there have been numerous calls for the healthcare delivery systems to improve the quality of their services to reduce the amount (Dreyfus et al., 2018). Various studies have been conducted to identify the role of implementation of quality improvement programs towards reducing the prevalence of HAPUs.

Analysis of the Problem

According to Richardson et al. (2017), the consequences that patients go through due to HAPUs makes it urgent for healthcare delivery systems to implement measures of preventing them. Such effects that patients go through include severe or persistent pain, elongated hospital stay, scarring of the body, and sometimes death. Critical care patients are at a higher risk. Health care providers also have to shoulder the financial burden and deal with reputational damage caused by increased incidences. In the UK, financial costs in the management of HAPUs cases are approximated at £1.4bn–£2.1bn per year (Richardson et al., 2017). An opportunity of reducing the number of pressure ulcer incidences in critical care as the number of hospitals acquired pressure injuries vary from 2% to 30%. Richardson et al. (2017) propose a model of predicting the risks for HAPUs in critical care patients using the Braden scale. The implementation of such a model auger well with any preventive measures that may be put in place to reduce the prevalence of HAPUs cases and the consequences that critical care patients are faced with.

Firstly, Deng, Yu & Hu (2017) mention that pressure ulcers are a health problem that the global healthcare delivery system has faced for a long time. The authors further insist that the issue is debilitating considering the fact we are in a century in which many advancements have been made both in medicine and technology, and that such advancements should be leveraged to reduce the incidences of critical care patients developing pressure injuries/ulcers (Deng et al., 2017). Further, the authors mention that the enormous financial burden that hospital-acquired pressure ulcers exert on the healthcare sector is enough to cause drastic measures of healthcare quality improvement to be taken.

Prevalence of HAPUs

According to research studies by Deng et al. (2017), the prevalence of hospital-acquired pressure ulcers among critical care patients in the US is 13.1% in intensive care units with less than 100 beds and 45.5% in ICUs in china, while that of HAPUs in teaching hospitals in Germany was 3.3% compared to 53.4% in Chinese teaching hospitals (Deng et al., 2017). Available data shows that the prevalence rate of HAPUs in the UK stands at 4-10% in every patient admitted in the intensive care unit. These statistics signify that HAPUs is not an issue that has become a concern in one country, but in every state across the globe. Also, one can deduce that countries with healthcare systems that are not well managed or underfunded are at a high risk of having higher rates of HAPUs cases.

The research conducted by Deng et al. (2017), yielded that the overall prevalence rate of HAPUs among critical care patients was 20.1% in hospitals in China. When the stage I HAPUs was excluded, the prevalence rate of HAPUs was 9.2%, when 12 hospitals in china were considered. Further, the nature of the illness or the nature of their activities. Also, implementation of quality of care improvement measures proved vital in reducing the prevalence of HAPUs in ICUs in China and the UK (Rondinelli et al., 2018). This is an indication that the implementation of such measures could reduce the prevalence of pressure injuries among critical care patients.

Financial Implications of Pressure Ulcers

Billions of dollars are spent every year in the treatment of hospital-acquired ulcers globally. A large percentage of the money is spent on the direct cost of treating ulcers that patients developed when already admitted to hospitals (Rondinelli et al., 2018). Most people who suffer from HAPUs are critical care patients. Direct costs increase because when patients develop pressure ulcers, their stay in the hospital is prolonged. Depending on their severity, the cost of treating pressure ulcers is about $2,000 for stage one HAPUs, $3000-$10,000 for phase two HAPUs, $5900-$14840 for step three HAPUs, $18,000- $21410 for stage four pressure ulcers (Dreyfus et al., 2018). Although these figures are just estimates, they represent how the prevalence of hospital-acquired pressure ulcers exerts a substantial financial burden on the healthcare systems across the globe.

Besides direct costs, there are extra costs incurred through the litigation initiated by patients who suffer from HAPUs complications against healthcare organizations. More than 17,000 pressure injury-related legal procedures are launched every year (Dreyfus, 2018). It is approximated settlement for malpractice accruing to such cases is above 250,000 dollars. Awards of settlements to patients further strain the already financially unstable healthcare problem, limiting healthcare providers' ability to implement quality care management practices that could see the prevalence rates reduced by more than half in a period of fewer than three years.

Other costs linked to pressure ulcers include penalties, reimbursements, cost of loss of lives, and additional miscellaneous costs spent by healthcare organizations to train their staff about HAPUs risk assessment and management methods. It is argued that if hospitals were able to reduce the number of HAPUs cases by just 1%, they could cut their expenditure by $1.605 million every year.

Effects

Comprehensive care is one of the initiatives of the national quality and safety standards. Numerous gaps exist when healthcare service providers fail to provide adequate consideration based on the nature of the health conditions of their patients, or terms of the settings in which they are placed to achieve a specific set of outcomes. This initiative aims to streamline healthcare systems to ensure that patients receive comprehensive care through the continued and collaborative efforts of the healthcare professionals caring for them (National Safety and Quality Health Service Standards, 2020). It also stresses the importance of healthcare professionals collaborating with the patients, caregivers, and relatives of the patients to conduct risk assessments and manage those risks, based on the patient's or their families' preferences of care. The healthcare facilities' leadership should also ensure that they communicate with the nursing team to ensure that the patient receives the best quality of care while minimizing patient harm.

Concerning hospital-acquired pressure ulcers, healthcare providers should create a plan of risk identification and prevention of pressure injuries for patients in critical care. They should ensure that a thorough assessment of patients with a higher risk of pressure injuries is conducted before they are admitted. According to the patient safety goal #14, caregivers must conduct a systematic risk assessment using tools like the Braden scale or the Norton scale for early intervention and prevention of pressure injuries (Nursing Care Center 2020 National Patient Safety Goals, 2020). Also, the goal stipulates that healthcare organizations should conduct a pressure injury risk assessment at regular intervals. Besides staff re-education and sensitization on risk identification for prevention and intervention of pressure injuries in critical care patients, healthcare organizations should come up with measures of addressing the risks identified. Caregivers should implement preventive measures such as improvement and maintenance of tissue to pressure patients in critical care. Also, essential patients of care should be protected from the adverse effects of mechanical forces.

Research studies by Deng (2017) yielded that the implementation of quality improvement measures meant to reduce the number of HAPUs related cases among critical care patients in hospitals in the United Kingdom yielded positive results. The first step in the implementation of the quality improvement program involved streamlining the nurse leadership program. Installing a new task force of nurses trained on ways of reducing pressure ulcers among critical care patients showed that the move ad a significant result in reducing the rate of HAPUs in healthcare institutions. The task force included critical care medical specialists, monitoring specialists, and a nursing professional specialized in tissue viability (Richardson et al., 2017). The task force was charged with the responsibility of developing a strategic approach to dealing with the issue that has plagued the National health service of the UK for many years. Changing the attitudes of nurses and healthcare providers that HAPUs among critical care patients are unavoidable due to the nature of their illnesses. The risk factors associated with their conditions were identified as the primary step in reducing the prevalence of HAPUs.

Further, the research identified a need to develop robust infection prevention and HAPUs prevention mechanisms. These would reduce the consequences that critical care patients that develop such complications have to endure. Also, a thorough review of the nursing guidelines was done. A new set of guidelines developed, all to reduce the prevalence rate of HAPUs, that experts a substantial financial burden on the national healthcare service. A model referred to as the Bowel Management Assessment Tool (BMAT) was developed alongside an incident reporting system known as DATIX (Rondinelli et al., 2018). Nursing professional training on ways of improving healthcare delivery for critical care systems proved that reducing the prevalence rates of HAPUs was a viable project.

Conclusion

The research materials reviewed in this study have substantiated the need to implement a quality improvement system of healthcare based on risk assessment and management to reduce the prevalence of hospital-acquired pressure ulcers (HAPUs) among critical care patients. According to the research materials, it is necessary to undertake such approaches to reduce the incidence to minimize the financial burden exerted on healthcare systems through the management of preventable causes. A robust quality based care system based on the national safety measures initiatives and the national patient safety goal #14 will go a long way in reducing the prevalen...