Ulcer Prevention in Toronto-Based Hospital in Acute Medicine Unit - Essay Sample

Introduction

Pressure ulcers are sections of a breakdown of the skin and hypodermic muscles triggered by pressure, shearing or friction (RNAO, 2005). Among hospice clients, pressure ulcers are a crucial clinical concern in terms of occurrence. Pressure injury development appears in official and public circumstances and is usually observed in elderly, incapacitated and immobile, people with neurological deficits and those with extreme chronic illnesses. There is evidence backing the efficiency of some pressure ulcer preventative measures and national medical procedures for the deterrence of pressure ulcers (RNAO, 2005). The Registered Nurses' Association of Ontario (RNAO) members highly approve that effective pressure ulcer preclusion necessitates an interdisciplinary group effort. The motive of this paper is to help nurses with the delivery of evidence-oriented quality care to those people at risk of acquiring pressure ulcers. The collaboration between the nurses and the interdisciplinary health care team is essential in risk prevention. Prevention of this problem is crucial for safeguarding patients from harm and decreasing the costs of caring for them. Morbidity as a result of pressure ulcers can result in demands form more care and finances and a lengthier inpatient stay (RNAO, 2007). In some instances, late-stage pressure ulcers may even result in life-threatening infections. The focus of this paper is to review the evidence on the execution of multicomponent framework for preventing pressure ulcers and analysis of quality improvement in care provision. The paper also provides recommendations for nurses on best quality improvement practices in the area of pressure ulcer risk prevention.

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Description of the Issue

Best practice procedures are methodically designed statements to help practitioners' and clients' resolutions about suitable health. This best practice procedure helps nurses who work in a wide range of practice backgrounds to diagnose people at risk of pressure ulcers. The Registered Nurses' Association of Ontario has pledged to facilitate the implementation of the best practices based on the available knowledge. Guideline development personnel have been on the forefront reviewing extracts issued in critical records on the subject of pressure ulcer deterrence, emphasizing on systematic evaluations, RCTs and most recently issued medical practice plans on the periodical basis after original publication (RNAO, 2007).

Prevalence, use of hospital, cost and other health care resources as well the quality of life concerns are fundamental reasons for the decision to avert, mitigate and cure pressure ulcers. To progress pressure ulcer control, there is a direct necessity to offer a consistent framework across the paradigm of care that is proof-based and oriented on the demands of the person. This necessitates adoption of the most recent study outcomes, together with the incorporation of the best of the professional agreement.

Head-to-Toe Skin Assessment

Pressure ulcers often develop over bony prominences. In that case, they are the most preferred areas for risk assessment. Skin evaluation is usually grounded on a head-to-toe assessment of the parts known to be susceptible. These parts generally entail the progressive section and occiput of the skull, scapulae, ears, shoulders, spinous processes, coccyx, sacrum, knees, heels, and toes. Additionally, parts of the body encompassed by anti-embolic leggings or obstructive attire, sections where pressure, abrasion, and shear are applied during actions of everyday living and sections of the body in contact with the device are also regarded susceptible. In addition, articles are inspected as ascertained by the person's condition. The initial sign of a pressure ulcer is often a transformation in the texture, hue, and itching on the skin surface. Nevertheless, it is known that is may not be practical to view redness likened to tissue injury in individuals with dark colored skin (RNAO, 2012). The people who can engage in the assessment of their skin are usually motivated to do so after proper instruction.

Integration of Clinical Judgment and Utilization of a Consistent Risk Evaluation Tool

In the prevention of pressure ulcers, devices such as the Braden Scale for Predicting Pressure Sore Risk are used due to their validity and reliability. Interventions are usually grounded on recognized generic and non-generic risk elements and those understood by a risk evaluation tool like Braden's classes of neurological awareness, activity, agility, nutrition, humidity, and abrasion. To ascertain the client's probability of risk, the AHCPR recommendation (1992) suggests the utilization of the ideal risk evaluation tool. The Braden Scale and the Norton Scale have been tried adequately for validity and reliability to be an essential link to treatment reviews and care development.

Optimal Nutritional Support

Optimal nutrition ensures that there is a quick wound healing, maintenance of immune framework, and reduction of the risk of contamination. Majority of the wounds tend to heal with time. Nevertheless, malnourishment and medically proven deficits are risk elements for the advancement of pressure injuries and are usually likened to a deferred cure process. The deficiencies of carbohydrates, fats, protein, vitamins or minerals related to decreased dietary intake or acute losses from the wound surfaces can lengthen the healing process.

Screening for dietary deficits is a crucial part of the initial evaluation, with the objective of nutritive review and administration of wellbeing to ensure that the nutrition of the person with the pressure ulcer comprises the nutrients essential to facilitate therapy. Dietary control is an element of universal therapy for a person with a pressure ulcer. Dietary control address principles like nutritional status, dietary consumption, supplementation and deficiency (RNAO, 2016).

A screening device can be utilized by nurses to diagnose individuals at dietary risk. Nevertheless, the recommendation to those individuals with skills in dietary interventions is essential to create a suitable therapy plan. Early diagnosis and interposition to correct malnourishment can change the healing course in a patient with ulcers. A comprehensive and individualized dietary plan is essential in preventing pressure ulcers and necessitates a multidisciplinary method. Additionally, the participation of the interdisciplinary team and the patient in dealing with dietary objectives is crucial for a practical outcome. Dietary interventions are initiated to fulfill the nutritive demands of a person and shift from screening, tracking of intake and complementation to more comprehensive therapies such as parenteral nourishing. In cases where there are straightforward intervention assessments of older people with advanced pressure ulcers, standard oral dosage result in a substantial decrease of injury area and an advancement in a wound state in 21 days (RNAO, 2005).

Adoption of Intraoperative Pressure Management Devices

Persons undergoing surgery experience numerous risks for pressure ulcer acquisition. These risks entail the length of time of the process, any hypotensive occurrences during the surgery, low core temperature in the process of operation and restricted mobility on the first postoperative day. It is notable that pressure injuries are not often observable promptly and can occur three to five days after surgery, making it hard to diagnose causal factors openly. However, pressure ulcers usually occur more constantly in clinical patients in the first week of admittance than in clinical, nervous and geriatric patients. Therefore, the utilization of a pressure-relieving cushion on the operation table is highly recommended. Notably, a quality support surface is suggested for those people undergoing surgery for more than one hour and a half (Health Quality Ontario, 2012). The high frequency of pressure injury acquisition in surgical patients proposes that deterrence interpositions emphasize on the preoperative and quick postoperative era must be adopted quickly on admittance to the medical facility to prevent pressure ulcer occurrence.

Analysis

In reviewing the guideline for pressure ulcers prevention, there were multiple gaps in the research literature. According to RNAO (2016), some of the potential areas for research include:

• The effect of soreness on pressure ulcer development and therapy process
• The most successful surface during the intra-operative stage in the process of pressure ulcers prevention
• The efficacy of pressure releasing therapies for pressure-linked ulcers to the toes
• The effectiveness of positioning timetables for the people acquiring care on pressure relieving surfaces
• The optimal incidence and efficiency of positioning timespans.

Most RNAO in acute care facilities report feeling the pressure from impending alterations in reimbursements to execute pressure ulcer prevention strategies. However, there has been a limitation for higher diagnosis-linked team disbursements for individuals with stage three and four hospital-attained pressure ulcers. Constructive elements in the prevention of pressure ulcers entail a stakeholder's dedication to advance patient results and an objective to be identified as a quality provider of patient services. The advent of new procedures from the Registered Nurses' Association of Ontario increased the interest in preventing and curing pressure ulcers. Harmful elements for the documentation of stage four pressure ulcers showed that pressure ulcer prevalence surpassed the national yardstick by almost a half (RNAO, 2016).

From the analysis of the framework on the prevention of pressure ulcers, it is clear that there is a need for a future study to explore deeper into the daily care procedures to better comprehend their impact on results. Restrictions of the proof entail the lack of data on processes of care and their computation. The prevention framework fails to describe the limitation or explain effectiveness and barriers to execution. It is clear that from long-term and acute care settings, the most viable interventions are those that are institutionalized. For instance, therapies that are less reliant on adequate staffing, (e.g., transforming to pressure-reducing mattresses and utilizing risk evaluation tool) are more natural to maintain than interventions that are more reliant on ensuring every patient is turned after two hours (RNAO, 2012).

The Canadian government, hospitals, and health-care experts are expected to be proactive in dealing with the overpowering expenses likened to pressure ulcers. In Ontario's case, numerous pressure injury preclusion strategies are initiated to enhance the documentation of pressure ulcer prevalence. Compulsory public documentation of pressure ulcers is also a stipulation in the lasting care sector across Ontario through frameworks like Home Care Reporting System, Continuing Care Reporting System and lasting care frameworks which offer credibility across Canada. It is also notable that Accreditation Canada, at the national level supplemented pressure ulcer inhibition as a primary administrative practice for critical care, multi-faceted care, therapy, and constant care. Framework initiatives highlighted above can promote the health care area to impose, track and document on pressure ulcer deterrence and therapeutic approaches (Health Quality Ontario, 2012). Additionally, those programs may start to highlight some of the framework gaps and prospects that exist to advance access to and provision of evidence-oriented, inter-professional, individual-centered pressure ulcer prevention and therapy.

The professional panel notes that most pressure ulcers are prev...