The plan for preventing pressure ulcers in patients in the discussed unit will involve multiple steps and require support from nurses and leaders. The main activities will be based on the FOCUS-PDSA model and implement such strategies as education, visual aid, and standardization of materials, records, and schedules. According to Berlowitz (2014), the most helpful way of measuring the outcomes of the intervention is the incidence of pressure ulcers.
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It accounts for patients who develop bedsores while staying at the hospital. Moreover, the stage of pressure ulcers may also be mentioned in the calculations to determine the risk of neglect from clinicians in the unit. The plan’s steps include new scheduling for turning of patients at risk, education about patient assessment for nurses, and color-coded visual aids for patient data about pressure ulcers.
The FOCUS-PDSA framework implies that much theoretical research should be performed before developing the quality improvement initiative. The previously found information has allowed one to identify that nurses (including nurse leaders), patients, and management can play roles in implementing the plan. The FOCUS part of the model defines the evidence-based practice and particular issues of the practice environment. The following guidelines and steps are offered as a solution to the high incidence of pressure ulcers in the unit.
First of all, the program should start with preparing nurses for new practices. Thus, nursing education is the initial step of the intervention (Sving, Högman, Mamhidir, & Gunningberg, 2016). The nurses should be assessed before the day of training begins. The Agency for Healthcare Research and Quality (AHRQ, n.d.) provides a questionnaire that contains inquiries about pressure ulcers screening as well as a test that measures nurses’ current level of knowledge. After evaluating the staff’s level, the teaching day should begin – it will include the introduction of new processes for the unit such as color-coded marks on patients’ bedsides and documents, turning schedule, and assessment requirements.
The practical portion of the plan will start with recovering data about all involved patients and determining their risk of pressure ulcers. All patients who are at risk of developing bedsores according to the Braden score should be marked with colored signs. Red color will signify high-risk patients (9 or less points), yellow – medium-risk patients (12 or less points), and green – low-risk patients (more than 12 points) (Gill, 2015).
This step will be followed by daily reassessments of patients’ skin condition (AHRQ, n.d.). The important areas of assessment will be covered in the educational step, including mobility, pressure relief portions, nutrition, incontinences, skin condition, treatment, and pain. Finally, nurses’ schedule of patient repositioning will be implemented, stating that every patient at risk of pressure ulcers should be moved, repositioned, or offloaded every two hours.
The compliance with this change will be monitored and documented by the project development team. The educational step will be assessed with the help of questionnaires, while the coloring and scheduling changes will be measured by nurses’ compliance and the rate of bedsores’ incidence. The interventions’ results will be evaluated on a weekly basis with the help of reassessments. As a result, the patient’s incidence rates are expected to decrease. If the pilot stage of the intervention is successful, it can be adjusted and introduce in other areas of the practice setting.
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The developed plan includes training and practice-based efforts which require high levels of compliance from nurses. Data gathering and analysis are the initial steps of the FOCUS-PDSA model that are then implemented into the planning process. The first step of the actual project lies in education – nurses will go through a training day that will provide them with information about the new activities and the importance of pressure ulcers’ prevention. Second, a new system of patient assessment will be disseminated, followed by color-coded stickers and a new schedule for patient repositioning. Overall, the intervention will be measured by nurses’ compliance, pre- and post-testing, and incidence rates of patients developing pressure ulcers.
Agency for Healthcare Research and Quality. (n.d.). Preventing pressure ulcers in hospitals: A Toolkit – Section 7, tools and resources. Web.
Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In D. R. Thomas & G.A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 19-26). Totowa, NJ: Humana Press.
Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Open Quality, 4(u205599.w3015), 1-5.
Sving, E., Högman, M., Mamhidir, A. G., & Gunningberg, L. (2016). Getting evidence-based pressure ulcer prevention into practice: A multi-faceted unit-tailored intervention in a hospital setting. International Wound Journal, 13(5), 645-654.