Paper Example on the Health Acquired Pressure Ulcer Issue

Abstract

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Pressure ulcer (PU), is referred to as an injury that occurs on the bony prominences of a patient skin surface or on the tissue that is underlying and is caused by excessive pressure on the body hence it is not a disease. Pressure ulcer is commonly acquired by patients who are vulnerable, in the Intensive Care Unit(ICU), or old and in need of extra care from their caretakers. Pressure Ulcers varies in stages depending on the amount of injury that has been caused to the skin. Pressure ulcers are costly to treat more especially if the condition is on the final stage which is severe. The purpose of this Doctor of Nursing Practice (DNP) project is to ensure the reduction of Hospital Acquired Pressure Ulcers. An action was initiated and implemented by the Pressure Ulcers Prevention Program (PUPP), tissue viability team, senior nursing management and respiratory therapists in the ICU to ensure that the HAPU is prevented and detected during the early stage of the condition. Implementation of Intensive Care Unit (ICU) skin champions is one of the methods used in the prevention of HAPU. ICU skin champions are staff members properly educated and trained to take care of the skin of the patients. The skin champions conduct a thoroughly skin assessment on patients to detect the early stages of the condition or prevent it from developing. Another method used is tilting patients on a wheelchair at 30 degrees angle to ensure comfortability hence reducing pressure between the wheelchair and the skin

Destination Zero HAPUs: Implementation of ICU Skin Champions

Health acquired pressure ulcer (HAPU) is a major health issue which affects both the patient and the family of the patient greatly. In the united states(US), 2.5 million patients are affected by pressure ulcers in accordance to healthcare 2015. Many patients acquire PU in the ICU or when recovering from a surgical process due to the limited movement during this period or no movement at all. According to the International Hill Rom Prevalence Survey 2014, a survey conducted showed that higher rates of HAPU were found in patients in spinal cord unit(10.7%), critical care units(8.6%), burn units(7.3%), and were lower in pulmonary units(7.2%). Patients affected with PU in a hospital setting are exposed to factors that may lead to patient morbidity during the hospital admission (Soban, Finley & Miltner, 2016).

HAPU is also referred to as bedsore, pressure injury, decubitus ulcers or ischemic injury. Caused by both internal and external factors. The main external factor is pressure contributed by moisture and friction, in cases of high pressure the damage is seen over a shorter period of time than in cases of lower pressure. Damage is caused when the skin and tissues are pressed against another surface cutting off blood supply hence the tissue dies. Friction between the skin and the surface causes shearing of the tissue causing stretching of the skin surface displacing blood capillaries. Internal causes of PU include poor blood supply, mobility, some type of medication, general health and age, inadequate nutritional fluid intake. These factors are measured by the Braden Scale from the National Pressure Ulcer Advisory Panel(NPUAP).

Based on the Wound Ostomy and Continence Nurses society(WONC pg.328), unavoidable pressure ulcers do occur. Unavoidable PU are defined as those which develop in patients haemodynamically unstable, terminally ill, have certain medical devices, and are non adherent with artificial nutrition. The NPUAP and the centers for Medicare and Medicaid services(CMS) has defined unavoidable pressure ulcers as injuries that have been caused even though the provider has evaluated the risk of the patient having getting a PU.

Patients who acquire PU in hospitals are forced to overstay in the hospital in order to get better treatment. According to International Hill Rom Prevalence survey, p.8,9, a PU treatment may range from $500 to $70,000 depending on the stage which is very costly. The cost of PU varies according to the stage of the PU. Stages are categorised from stage 1, which is identified from non-blanchable redness of intact skin. Partial thickness skin loss indicates stage 2 of the PU. Stage 3 is categorised by signs of a full thickness tissue loss. The final and most severe stages of all is the full thickness tissue loss with exposed bone, tendon or muscle. Stage 4 is the most expensive to treat. Family members of the patients affected are affected economically, socially, emotionally, and spiritually. They are forced to go an extra mile to take care of the treatment costs. In addition, health providers may be charged with legal and financial penalties in cases of serious harm to the patient.

HAPU is a condition that is considered preventable through the implementations of measures that have been put by health institutions and organizations such as the Pressure Ulcer Prevention program (PUPP). For a low rate of PU to achieved, nurses were to be careful and provide high quality care to patients. The use of PUPP reduced the total HAPU by 81% and by 90% in heel HAPU rates. A study conducted by Morehead and Blain in the ICU showed that the rates of HAPU were reduced.

Due to legal charges and financial penalties on health facilities due to serious cases, many health facilities have focused on the implementation of measures put in place for the reduction of HAPU. Although attaining zero HAPUs is very difficult, the measures put in place have reduced the rates of the condition. Some of the measures put in place to reduce the rates of include the implementation of ICU skin champions, creating awareness to the staff, patients, family members of the patients and consulting of the Certified Wound Ostomy Nurses.

The purpose of this project is to perform and evaluation of the condition of this problem using narrative and methods of statistics and ensure that the results of the comprehensive evaluation are communicated properly and accurately to help in determination of the sustainability. This paper will provide a proposal for a future practice setting that will identify a practice problem, provide the evidence related to quality improvement plans to detect, prevent and manage HAPU cases .

Significance of the Practice Problem

Hospital Acquired Pressure Ulcers is increasing over the years in the hospital sectors in the recent years . Patients who were old, out of a surgical process and are vulnerable were more likely to develop the condition. From the statistics conducted on HAPU by the National Quality reveal a rise of the condition by 86.4% between the year 1993 and 2006 . This brought about financial and resource implications to both the patients, caregivers and the families to the affected. An estimated value of $11 billion per year was used in the treatment of the HAPUs.

Although most of the HAPU can be preventable and avoided by providing good care to the patients, there has been cases of unavoidable circumstances of the Pressure Ulcers. Unavoidable HAPU has been defined as an injury that occurs to a patient despite of taking all the measures to prevent it by the Strategic Health Authority 2012. However, it is a manageable condition and it is treatable as much as it is costly to treat.

Implementation of ICU skin champions is a very important measure to undertake in the prevention of HAPUs. The skin champions are highly trained to take care of the patients in order to prevent injuries. Requirements of the skin champions is to reposition the patients to avoid prolonged stay at one place hence reducing the pressure impact on the skin that is likely to cause Pressure Ulcer. The champions are also required to provide a skin assessment on the patients on the whole body. Black skinned patients should be skin assessed regularly as areas injured are not easily visible. Most affected parts are the sacrum, hips, heels, spinal vertebrae, head, elbows according to Collier 1995. Patients on a wheelchair are also required to be tilted at a certain angle to ensure comfortability of the skin and underlying tissues against the wheelchair.

Pressure exerted on the skin with friction which is a main external factor that leads to the skin injury is painful to the patient. The skin is the largest organ on the body and it is sensitive. Patients suffer due to the injury as it is an open wound and any slight exposure may lead to other severe infections. Patients continue to stay in the hospital to get treatment even as the initial problem that made them to come to hospital has been treated. This affects the patients way of life they are forced to stay in the hospital when they should be working or leading their lives economically, socially, and spiritually.

The cost of treating HAPU is very costly to patient, families to the patient and even the caregivers involved. To avoid this costs the best strategies is to a implement the measures put in place in order to prevent the injuries. Various researchers have come up with effective methods of preventing HAPU one of them being gaining considerable notice among modern day health care practitioners. Health facilities are also affected financially affected too as they are obligated to provide quality care to patients as they may be sued due to neglecting. Quality resources and equipment are required by the health facilities which may be costly to buy. WOCN and support staff are hired in order to ensure the patients are given all the care they need to prevent the skin injuries.

Society is in return affected directly or indirectly. Educating the people on the HAPU and how it can be prevented requires participation of the society. People are required to volunteer in educating of others about HAPU. Others may volunteer to help in taking care of the patients to save the families the agony on deciding whether to take care of their loved ones or working to provide for other family members or to come up with the amount of money needed for the treatment of the condition.