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Project Translation and Planning

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Project Translation and Planning

Introduction

Quality improvement requires planning. When nurses find a problem, and in this case, the problem is Pressure Injuries, proper education, and training could help prevent pressure injuries from occurring or at least decrease the chances of having pressure injuries in patients. Research and evidence can help reduce and prevent Pressure Injuries. Researching how pressure injuries occur and providing evidence as to why they occur can help. Applying that research to practice can improve safety, quality care, and improve patient outcomes.

Impact of nursing protocol on the Occurrence of Medical device-related pressure ulcers in critically ill patients

Critically ill patients may be at higher risk of acquiring pressure injuries due to many reasons. Some of the reasons are malnutrition, blood pressure issues such as low blood pressure, low albuminemia, decreased mobility, a decrease in sensory perception, and medications that could cause sedation and neurological issues. Therefore a full assessment of the patient and history of disease and medication use is so important to consider if the patient is at higher risk for pressure injuries. Knowing these issues can help prevent pressure injuries from forming in your patient.

Critically ill patients could be patients in the I.C.U., where devices of lifesaving origin are being used. These devices are normally secured tightly and with tape. Constant rubbing friction, and pressure from these devices can cause pressure injuries. Bodily fluids and moisture can increase pressure wounds occurring. Altered skin integrity increases the chances of pressure injuries accruing. “Medical devices commonly used in I.C.U.s include endotracheal and nasogastric tubes, cervical collars, nasal cannulas, pulse oximetry probes, immobilizers, radial artery catheters, sequential compression devices, splints and braces, face masks for non-invasive positive pressure ventilation, and urinary catheters” (Zakaria, 2018)

A proposed solution to this issue would be to establish a plan for teaching and educating the staff. Implement procedures to assess skin integrity every shift and during a shift, especially the skin around devices and the skin under the tape. Educate nurses to reposition tubing, collars, probes, immobilizers, catheters, devices, splints, braces, masks, and other devices frequently to reduce prolonged pressure on the same part of the skin for too long. Assess the patient’s history of diseases and illness and medication usage and determine if the patient is more at risk of obtaining a pressure injury. Implement the Braden score, which is a very useful tool in identifying patients who are more at risk for developing a pressure injury. The Braden System considers sensory perception, moisture, activity, mobility, nutrition, and friction. “A designed nursing intervention protocol aims to solve actual or potential patient problems, making the best use of resources, and optimizing patient care in accordance with current clinical guidelines or standards of practice of the Nevada State Board of Nursing” (Zakaria, 2018). My proposed interventions to address Pressure injuries would be implementing the Braden scoring system and assessing the patient’s history and medication usage. Assessing the patient completely A full history and medication usage and implementing the Braden scoring system will determine how at risk the patient is to develop a pressure injury. Educating the staff about skin care, skin integrity, decreased mobility, medication usage, past medical history, nutrition rubbing and friction of devices, and repositioning devices will help prevent pressure injuries from occurring. Knowing that information and educating that information could prevent pressure injuries from occurring.

Translating Pressure Ulcer Prevention into Intensive Care Nursing Practice

 “Hospital-acquired pressure ulcers (HAPUs) are one of the most serious problems in health care settings.” (Tayyib, 2017). Critically ill patients may be at higher risk of acquiring pressure injuries due to many reasons. Some of the reasons are malnutrition, blood pressure issues such as low blood pressure, low albuminemia, decreased mobility, a decrease in sensory perception, and medications that could cause sedation and neurological issues. Therefore a full assessment of the patient and history of disease and medication use is so important to consider if the patient is at higher risk for pressure injuries. Knowing these issues can help prevent pressure injuries from forming in your patient.

A proposed solution to this issue would be to establish a plan for teaching and educating the staff. Implement procedures to assess skin integrity every shift and during the shift. Assess the patient’s history of diseases and illness and medication usage and determine if the patient is more at risk of obtaining a pressure injury. Implement the Braden score, which is a very useful tool in identifying patients who are more at risk for developing a pressure injury. The Braden system considers sensory perception, moisture, activity, mobility, nutrition, and friction. My proposed interventions to address Pressure injuries would be implementing the Braden scoring system and assessing the patient’s history and medication usage. Assessing the patient completely with a full history and medication usage and implementing the Braden scoring system will determine how at risk the patient is to develop a pressure injury. Educating the staff about skin care, skin integrity, decreased mobility, medication usage, past medical history, nutrition, and rubbing and friction will help prevent pressure injuries from occurring. Knowing that information and educating that information could prevent pressure injuries from occurring.

Two-Hour Repositioning for Prevention of Pressure Ulcers in Elderly.

 Patient Safety or Elderly Abuse

 Is repositioning patients every two hours patient safety or abuse? Many question this method. When working in a Nursing Home facility as a C.N.A. in my younger years, this was a huge topic of discussion. Most patients are different. Most patients have different skin integrity, some are frailer than others, and some have no way of moving and are totally dependent upon staff to help them. Some patients have poor skin integrity, which means their skin is frail, paper thin, and tears more or seat more. All these issues cause the skin to break down more frequently. These are the patients that must be repositioned more often, possibly every 2 hours or more, to prevent pressure injuries. Some patients are lucky not to have these issues and could go longer without repositioning. Patients who require less repositions are patients with good skin integrity and patients who may have behaviors due to being repositioned. You must weigh the risks and benefits. Some elderly patients have Alzheimer’s dementia or other behavioral problems. Repositioning them every two hours can provoke a behavior to occur, causing the patient or staff harm. When a patient becomes combative, the patient could cause harm to themselves and might have to be restrained to prevent harm to themselves. Combative patients, especially in a behavioral facility such as an MHMR facility, can lead to restraints. This puts the patient at an even bigger risk of pressure ulcers. Restraining can harm skin integrity and can cause unnecessary friction on the mattress and sheets, which can increase the chances of pressure injuries. Some patients have behaviors in the night if awoken to reposition. This all could be classified as abuse, according to the article. Therefore it is so important to assess your patient properly and know their skin integrity. Some patients may go longer than others and need less repositioning, and it is important to know if a patient with underlying behaviors is one of them. More harm than good could come from repositioning every patient every two hours. It should be patient-centered, and the patient’s plan of care should know all there is about the patient. Identify current guidelines or best practices relating to your proposed solution, or if there are protocols, the current standard of care.

I propose a full assessment of the patient’s skin integrity and mental integrity to know if a patient can withstand repositioning every two hours or if the patient can go longer spans of time to prevent behaviors due to repositioning. A full assessment of the patient’s skin and behaviors and knowing your patient’s skin integrity could be prolonged repositions, which would allow the patient to go longer in between repositions, which would allow uninterrupted rest and decrease chances of hostility and behaviors. This could reduce the chances of behaviors, reduce chances of further harm to the patient and to staff, and alter the skin integrity of the patient.

Conclusion

In conclusion, each of these quality factors; technology, communication, collaboration, shared decision-making, and laws and regulations and policies, work hand in hand with each other and are essential to each other. They ensure safe and quality care for the patient. Using these factors together, and correctly and efficiently, will help patients and providers achieve their goal of improved patient outcomes.

References

Sharp, Catherine A. 2019. Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? Two-Hourly Repositioning for the Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? – P.M.C. (nih.gov)

Tayyib, Nabla. 2017. Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice. Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice: Overlaying a Care Bundle Approach With a Model for Research Implementation – PubMed (nih.gov)

Zakaria, Ahmed Y. 2018. IMPACT OF A SUGGESTED NURSING PROTOCOL ON THE OCCURRENCE OF MEDICAL DEVICE-RELATED PRESSURE ULCERS IN CRITICALLY ILL PATIENTS. Pressure education 7.pdf Copyright of Central European Journal of Nursing & Midwifery is the property of Central European Journal of Nursing & Midwifery.

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Question 

There are 2 parts to this summative assessment. You completed Part 1 in Week 3. Now it’s time to complete Part 2.

Part 2 – Project Translation and Planning

Identify the solution that you determined would be most effective in resolving the stated problem and define the intended outcomes of implementing the change (e.g., your improvement goal). For quality to improve, a change must occur. That change must be quantifiable. In other words, it must be measurable.

Project Translation and Planning

Create an implementation plan in which you:

Explain how you will measure the change and how you will know when you have reached your improvement goal.

Create a list of outcomes required to reach your outcomes goal. This will allow you to determine the actions needed and the priority of tasks that will result in the desired outcome.

Determine who will be responsible for each outcome (typically, each is assigned to a team member who is motivated to see the successful implementation of the plan).

Determine the actions needed to take place for each outcome to occur. Questions to consider when determining what action needs to take place:

Develop an overall time frame for the project.

Develop a risk management plan.

Establish a budget, roles, and who will be responsible for what.

Determine how you will monitor progress. This will provide you with the means of tracking actions as they are completed and will make you aware of actions that are late or off track.

Create an evaluation plan. Your evaluation plan will define the standard of measurement for progress and will include the following:

Format as one of the following:

Include a reference page with an APA-formatted citation for each article.

Combine Part 1 and Part 2.

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