Evidence-Based Pressure Ulcers Prevention Through Educational Measures

Introduction

Two of the main objectives within the medical field are improving the quality of healthcare and increasing patient safety. There are multiple risk factors that compromise the two notions, and it is essential to contribute to the mitigation of these issues. A concern that requires in-depth examination and evidence-based solutions is the risk of pressure ulcers. Pressure ulcers are common among patients with mobility issues, and as the skin experiences pressure for a prolonged period of time, the tissue may get damaged. Mitchell (2018) highlights that while these bedsores occur frequently, they are entirely preventable if the necessary measures are applied. The implemented project has proven that the implementation of a 4-week quality improvement educational plan on the prevention of pressure ulcers using evidence-based practices at skilled nursing facilities increases nursing staff knowledge.

Several different solutions were applied to contribute to pressure ulcer prevention in the medical setting. This paper expands on the idea of giving nurses additional knowledge in regards to this particular problem. A checklist and several practical exercises were implemented to assess if these measures have a beneficial connotation in regards to preventing tissue damage. Barrois et al. (2017) refer to long-term actions aimed towards problem-solving as the only solution to healthcare management. Thus, nurses were given an evidence-based checklist and applied their skills through relevant practices during four weeks. The objective of the educational plan was met since the staff that participated was able to improve in terms of theoretical and practical skills in preventing pressure injuries. As a result, the outcomes suggest that the initiative of implementing a checklist and practical experience was a practical step towards the improvement of the quality of healthcare through prevention achieved through evidence-based techniques. Thus, the paper examines the subject of pressure ulcers prevention, implementation for risk mitigation, evaluation of outcomes, and overall results from applying preventative techniques.

Statement of the Problem/Opportunity

Pressure ulcers are significant problems that correlate with discomfort and physical pain. Moreover, it is one of the most frequent tissue damage in patients within hospital and nursing homes settings. According to researchers, bedsores significantly affect the life quality of the person experiencing them (Sayilan, 2019). Tissue damage itself may lead to several negative implications such as infections, pain, scarring, and other outcomes that lower patient satisfaction and quality of life. Thus, pressure ulcers are relatively harmful health problems due to the adverse factors that these injuries correlate with. Nonetheless, preventing them may be a challenge for healthcare providers. Thus, it was essential to implement an evidence-based checklist and evaluation measures that are backed up by researchers and current literature on the topic.

While the issue certainly needed to be addressed, one of the challenges was the lack of tools nursing professionals could use to minimize the risks. Moreover, it is critical to point out that preventing tissue damage requires long-term learning, practice, and proper measures to combat the condition. As bedsores are still expected outcomes for people with mobility issues, it is inevitable that more effort should be put into teaching nurses how to minimize risks. The lack of knowledge and practice, which healthcare providers often could not obtain, was another problem that correlated with low-quality care and low patient satisfaction. However, the project’s opportunity to improve nurses’ level of skills and knowledge in regards to bedsores prevention was successfully achieved.

Another challenge was the lack of preventative guidelines that would allow nurses to follow the rules based on relevant evidence and information. According to Park et al. (2016), predicting whether an older adult is prone to experiencing pressure sores can be challenging. However, any form of effective detection and monitoring technique measure can drastically improve the overall clinical setting. Thus, the problem of a lack of proper guidelines was an issue that required the implementation of an evidence checklist, which was proven to be effective. While detecting vulnerable individuals and applying preventative measures required a complex approach, the opportunities for health improvement and high satisfaction were more important than the possible difficulties.

Background

Bedsores are extremely common due to the nature of their occurrence and the extensive need for long-term care actions to mitigate the issue. According to researchers, more than one million Americans develop bedsores every year (Saghaleini et al., 2018). Moreover, as mentioned prior, pressure ulcers are dangerous on many levels. One of the main problems is the risk of developing infections. It is also essential to mention both psychological and physical aspects linked to developing bedsores. Patients are prone to experiencing pain, discomfort, and stress, which is especially dangerous for older adults. Such harmful correlations between pressure ulcers and other conditions that are either caused or negatively impacted by bedsores highlight the risk of being vulnerable to such problems.

Geriatric patients are especially prone to tissue damage caused by extended pressure. Skin elasticity plays a certain role, but the sedentary or immobile lifestyle is a more prominent factor. Older adults are often limited in terms of physical activities. Thus, it is inevitable that bedsores are common within this particular demographic. While older adults are more likely to experience such issues, researchers point out that most evidence-based measures for prevention are intended to be used on young people (Lozano-Montoya et al., 2016). Current information on the topic is not always applicable in settings with a predominantly older demographic. Nonetheless, since older adults are vulnerable to this kind of skin damage, it is unclear why there is a lack of evidence-based interventional techniques frequently assessed by researchers. Moreover, geriatric patients are often considered in the risk category due to the prevalence of certain diseases and conditions. Since pressure ulcers can lead to the worsening of other existing health issues, addressing the subject was especially critical during the project.

Nurses have struggled with providing preventative care for older adults prone to developing bedsores. While there was enough information on how to treat active wounds and sores, predicting and mitigating the risk for their development was more problematic. It required daily activities, long-term commitment, and following specific guidelines. Thus, providing instructions on how to minimize this problem was a vital task that was achieved by implementing an effective educational and practical plan. Due to the importance of this field of gerontological care, nurses who had the relevant techniques and information were able to improve the overall quality of care patients were receiving.

Significance of the Project

Bedsores, while extremely common, especially in patients of older age, are also dangerous. Researchers highlight that more than 60,000 people in the US die due to complications related to such tissue damage every year (Saghaleini et al., 2018). Thus, pressure ulcers are one of the most common severe problems in the structure of nosocomial complications. They are difficult to treat, hard to prevent, and challenging to manage. Moreover, treating such skin tissue damage can be significantly more challenging due to the fact that patients who are immobile are still putting pressure on their skin, making the condition worse. Thus, preventing the worsening of the condition was vital in mitigating such risks as skin infection, scarring, and other adverse outcomes linked to open wounds.

It is certain that the medical field is preoccupied with focusing on patient-centered care. One of the main aspects was increasing safety and preventing risks. By implementing the checklist and educational measures, the overall level of care increased, alongside patient satisfaction. The general outcome was the improvement of the overall environment as perceived by patients and staff members. It is certain that while bedsores are major issues within the healthcare systems, preventing them was challenging yet rewarding from multiple perspectives.

Researchers specifically refer to the appliance of evidence-based care alterations as effective in addressing certain concerns. Specifically, Simon et al. (2016) stated that the integration of educational and practical techniques in gerontological pressure ulcer prevention can boost the management of care. Therefore, the significance of the project was manifested in its precise focus on the geriatric group, which had fewer to no evidence-based care access regarding the most common and problematic issue of pressure ulcers. The success of the implementation opened the door for the appliance of new policies that focus on the education of the healthcare staff. Furthermore, it contributed to the creation of new evidence-based checklists for the improvement of other patient focus care, such as avoiding errors.

Literature Review

Since pressure ulcers are prevalent, especially in gerontological care, medical professionals and researchers are interested in covering the topic while examining the best solutions to the issue. Any new initiative which correlates with health issues and potentially life and death situations requires evidence. Only evidence-based information, relevant research, and objective data can become primary drivers of alterations in care. Scholars have been conducting research in regards to the factors that exacerbate pressure injuries and ways to prevent them. Moreover, there have been recent suggestions that add more insight into ways of minimizing adverse outcomes and maximizing quality nursing care. Basing the educational and practical framework on relevant information has guaranteed a positive outcome since it has been the case during previous examinations by reputable scholars.

Methods of Searching

The literature review was conducted using electronic sources of information available online on specific databases. The main platform that was most effective in providing the needed information was Google Scholarly. Moreover, certain studies published on PubMed were assessed and examined for a deeper understanding of the topic of preventing skin pressure injuries. Keywords were used to access information that was helpful for the project. Pressure injury, pressure injury training, pressure injury nursing, and other similar searches have helped organize information that was later used in practice. Moreover, all the studies used to examine the topic are less than five years old. Thus, the articles were chosen based on content, language, year of publication, and availability. The articles with available abstracts that were publicly posted were then accessed in case the initial overview appeared to have the information necessary for the paper.

Review of the Literature

Risk factors for pressure ulcers including suspected deep tissue injury in nursing home facility residents

The article was a literature review reflecting on the current data on the causes of pressure ulcers in nursing homes. The researchers have examined datasets from 2012, assessing the information about Medicaid-certified NH residents in the US. In the overview of the available information, the total number of patients that have developed PrU (Pressure ulcer) of varying stages of severity was a little over 10% (Ahn et al., 2016). The literature review findings illustrated that black and Hispanic patients were more vulnerable to developing pressure-related skin injuries. Additionally, researchers referred to the correlation between bedsores and the occurrence of other health issues, including system failure, breaches in skin integrity, infection, and disease (Ahn et al., 2016). The review provided relevant information in terms of data on people prone to such conditions and the common problems linked to pressure ulcers.

Risk factors for pressure injuries among critical care patients: A systematic review

The study’s purpose was to examine and identify whether critical care and pressure ulcers are interconnected. The researchers have examined more than 1750 abstracts to analyze the field of critical care and the correlation with bedsores (Alderden et al., 2017). The findings of the research revealed that the authors had noticed a particular vulnerability of patients in critical care and skin integrity problems. Individuals who have been identified as most prone to developing such conditions are older adults with mobility issues, poor perfusion, and those receiving a vasopressor infusion (Alderden et al., 2017). The study is significant due to the focus on the gerontological demographic and patients receiving treatment in a particular department. Thus, the researchers have highlighted that older patients with certain health problems have to be considered as the primary receivers of prevention measures when those are implemented in the healthcare system.

A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management

The researchers have focused on pressure injuries from the perspective of the nurses rather than the patients. Furthermore, nurses were interviewed and asked about their opinions on bedsores and the importance of health management in such cases. Particularly, 20 nurses participated in the research (Barakat-Johnson et al., 2019). The healthcare providers were already assigned with pressure ulcer management, so it is certain that the participants were experienced in this domain. The findings reveal that nurses believe pressure traumas to be extremely common and vital to address. Moreover, the general opinion highlighted that preventing such tissue damage is a complex set of activities. The insight was beneficial in regards to presenting the complexity of the different strategies that have to be applied when managing pressure injuries. As the primary caregivers of pressure ulcer treatment and prevention, nurses agreed that applying measures that would minimize the risk is essential for the overall safety and health of the patients prone to such issues.

Pressure injury risk factors in critical care patients: A descriptive analysis

Similar to the research review analyzed previously, this study focused on the topic of pressure injury in critical care. However, the researchers came to slightly different conclusions and found contrasting correlations. The study identified other potential risk factors among its observed demographic of 57 critically ill patients within one intensive care unit. Immobility, septic shock, vasopressor use, head-of-bed elevation greater than 30°, sedation, and mechanical ventilation for more than 72 hours were all significant risks for patients’ developing pressure-related injuries (Cox et al., 2018). Other existing studies strongly supported these particular findings since the outcomes are similar. Thus, it is certain that a lack of mobility and high head elevation are vital factors in developing pressure ulcers. The research’s importance was the guideline that implied attention to mobility and bed elevation as a way for nurses to prevent patients from developing skin tissue issues. The authors have suggested which factors contribute to the occurrence of bedsores, and the information is essential since it can be used as prevention instruction. In this case, the conclusions illustrated the need to avoid strong sedation if not crucial and high raising of the head of the bed to mitigate the risk of light headiness.

Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design

Researchers have decided to test the current level of knowledge nurses have in regards to pressure ulcer prevention. Thus, more than 200 nurses were evaluated in terms of professional competency and skills to implement preventative measures for the patients. The testing implied that each participant was administered a test with questions about bedsores, the reasons they occur, and ways to minimize the risks. The results were then compared with mean averages and evaluations from the previous testing. After examining the outcomes, researchers stated that only 10% of the participants had the necessary knowledge while the rest were compromising the patients’ safety due to an informational gap (Ebi, 2019). Ebi (2019) also highlighted that no in-depth training or education was given to the nursing staff, which might have been one of the factors that led to such poor testing outcomes. The study’s significance was portrayed by the researcher’s attention to the importance of nursing education and training in regards to pressure injury prevention. Since nurses did not receive the academic tools to be able to deal with the severity of the frequency of pressure ulcers, no effective preventing was possible.

Evidence-Based Practice for Nursing: Evaluating the Evidence. Research Guides

The resource in question presented a framework of the most efficient regulations for integrating evidence-based practices in nursing. The guidelines suggested that nurses benefit from constantly improving their current knowledge, resourcing new and reliable information, and keeping up with the newest customer demands. By utilizing patient-centered, evidence-based approaches and evaluating recent data in all aspects of their practice, nursing professionals could reach high standards of professional excellence (ECU Libraries, 2021). While the resource highlighted the importance of evidence-based approaches in every medical field, its significance in this paper was the appliance in gerontological pressure ulcer prevention. Thus, the guide allowed for an understanding of the significance of utilizing existing information from outside sources in the internal environment. Since pressure ulcers are frequently the problem in facilities primarily dealing with gerontological care, the article supported the importance of evidence-based implementations in nursing homes and similar environments.

Prevalence and Analysis of Medical Device-Related Pressure Injuries: Results from the International Pressure Ulcer Prevalence Survey

The research touched upon the occurrence of pressure ulcers as a result of the use of medical devices. The researchers analyzed the medical data of more than 100,000 patients in the US. According to the findings, pressure tissue damage occurred much faster if it was exacerbated through the use of medical devices, creating an urgency for healthcare providers to mitigate the risk of infection (Kayser et al., 2018). Thus, the extensive or incorrect use of specific medical devices was a factor that negatively impacted individuals prone to developing bedsores. The conclusions did not suggest that nurses have to avoid medical devices altogether since they serve an essential purpose depending on the circumstances. However, the research gave excellent insight into one possible preventative measure, which was limiting the use of certain medical devices if possible. Moreover, as medical devices are considered risk factors, nurses have to be more careful when using them during examination and procedure.

A blinded clinical study using a subepidermal moisture capacitance measurement device for early detection of pressure injuries

This particular research was different compared to the others since it illustrated a nuanced preventative measure for pressure ulcers. Researchers used the measurement of subepidermal moisture (SEM) before comparing the results with regular skin and tissue assessment (STA) (Okonkwo et al., 2020). The findings illustrated the efficiency of the method. However, the authors were aware of the limitations that came along. The suggestion was to use this technique alongside the standard STA for more accurate results. The study reflected on a relatively new idea, which needs more in-depth clinical testing in order to become the only measurement during risk for pressure ulcer prevention. However, the research illustrated the importance of being up to date since new technology and information may be revolutionary for the nursing field. There was not enough scientific data to confirm the high validity of the test in contrast to STA, but medical innovations often enter the industry, and it is critical to keep up to date with the new findings.

Back to Basics: Preventing Perioperative Pressure Injuries

The journal article reflected on pressure injuries under the specific circumstances when the patient was in the preoperative state or was being operated on. Both of these aspects were found to be significant risks for developing skin sores due to immobility. The authors stated that medical operations often correlate with the development of pressure ulcers (Spruce, 2017). The researchers did not mention limiting surgeries as a preventative measure but rather suggested a more precautious patient-centered system that would minimize the issue. It was specifically highlighted that elderly patients have to be addressed first and foremost due to the vulnerability of this demographic. The article’s importance was presented in the illustration of another factor to take into consideration during plan implementation, which is operation and pre-operational state.

Pressure injury prevention and management practices among nurses: A realist case study

The research referred to the different practices that nurses have to prevent and manage pressure ulcers. The authors have found out that such measures are based on cooperation among nurses and teamwork (Teo et al., 2018). Pressure injury prevention is a complex procedure that requires day-to-day effort. Thus, the authors mentioned the importance of communication and collectivity within the work environment. The findings revealed that patients are less likely to experience tissue damage if more than one person frequently attends and assists them. Based on the author’s research, nurses who were able to cooperate and communicate regarding patients who need care and monitoring were able to minimize the risk of pressure ulcer occurrence.

Findings

The literature review illustrated the various difficulties nurses meet while trying to mitigate the risks of pressure injuries and ways to minimize the challenges. However, a significant risk factor that compromised the possible positive outcomes was a lack of knowledge on the subject of pressure wound prevention. According to Ebi et al. (2019), multiple nurses do not know how to approach the problem of tissue damage vulnerability as a result of pressure due to a lack of education and skills.

There was also an emphasis on the need for evidence-based practices, specifically due to the scientific background of the techniques previously tried in other medical settings (ECU Libraries, 2021). Moreover, researchers mentioned one of the factors that increase the risk for developing these skin conditions as the use of certain medical devices (Kayser et al., 2018). Another risk factor was found to be pre-operational and operational settings (Spruce, 2017). Thus, nurses should be especially cautious of any of these aspects are to occur and put their patients in danger. It is important not to underestimate pressure ulcers. Researchers found correlations between bedsores and other severe conditions (Ahn et al., 2016). Thus, cooperation turned out to be critical when it came to applying preventative measures and techniques work (Teo et al., 2018). Each researcher analyzed different demographics, hospital settings, and circumstances, yet the common idea was the importance of implementing the necessary tools to mitigate the risks.

Outcomes, Approach, and Budget

Preventing pressure ulcers was a complex yet rewarding procedure due to the multiple positive outcomes that correlate with certain risk-mitigating factors. In order for the new strategies to have had a successful integration into the system, it was vital to create and follow a strict budget planned beforehand. Moreover, the approach and the desired outcomes gave an understanding of the possible beneficial results that have later occurred occur within the medical setting. Identifying outcomes was beneficial during the assessment of the results as the contrast between the two was evident.

Outcomes

The aim for the project was to fulfill the following five outcomes and measure their impact after the project is fully implemented:

• Healthcare Staff had to demonstrate retention knowledge of pressure ulcer prevention methods, as evidenced by the post-tests 80% passing rate.
• The in-service had to show effectiveness in training healthcare staff, as evident by 80% compliance noted in the self-assessment questionnaire.
• The proposed budget requirement ($505) had to remain at the predicted cost by the end of week six.
• Healthcare staff was to demonstrate effective training on the usage of the evidence-based checklist by applying practical skills by the end of week five.
• Healthcare staff had to demonstrate knowledge on proper patient and family teaching of pressure injury prevention as evident by the verbal teach-back method.

The set outcomes were the initially planned goals that were then compared with the actual results. Thus, identifying the desired outcomes was beneficial in terms of having an exact list of concepts that the program aimed to achieve. However, by the end of the educational initiative, it was inevitable that the results turned out to be even more beneficial than expected. This illustrates that the outcomes were reasonably set at an achievable percentage rate.

Approach

As mentioned prior, it was critical to have a practical approach to achieve the set objectives. The goal was addressed through the comparison between the implementation outcomes and the rate of bedsores occurrence. Researchers specifically highlighted the importance of having a relevant assessment tool (Sayilan, 2019). Thus, several different measurements were taken into consideration. In particular, the frequency of bedsore occurrence was examined by analyzing the results post-implementation of the checklist. Moreover, nurses were interviewed regarding their opinions on the new tools.

The second outcome was achieved through the evaluation of the in-service training effectiveness. Thus, nurses were given self-assessment questioners to examine the learning objectives with compliance. Moreover, Key performance indicators (KPIs) were used to examine the performance of the medical staff. Nurses were also interviewed in regards to satisfaction with the new implementation, possible difficulties, and overall perception. The approach contributed to the improvement of the program when participants expressed issues.

The third outcome was achieved through maintaining the budget throughout the project. No additional items were added, and the predicted cost was similar to the one planned ahead. Moreover, no additional timing, experts, or resources were needed during the active phase. The goal was successfully fulfilled due to the detailed budgeting and effective planning before the checklist was applied. Thus, no challenges and constraints were met in this particular domain.

The fourth outcome was evaluated through the show-me method. The team demonstrated the practical ability to follow the instructions specified in the checklist and proved its correct appliance. Practical evaluation is critical for ensuring the policies are being effectively used by team members (Etafa et al., 2018). Moreover, the post-test measured the retention level in regards to the new information. Thus, the improved competency was effectively examined and analyzed.

The last outcome was evaluated by assessing how effectively the nurses can share information about pressure ulcer prevention with family members. Thus, the assessment included a verbal tech-back method. All the nurses had to verbalize the checklist instructions as they would in the presence of patients and their close ones. This technique was effective because nurses were able to retain the information successfully and practice sharing it with others (Shi et al., 2018). A verbal test was a beneficial way of examining how nurses approach this issue when talking to visitors.

Budget

All the necessary expenses have been assessed and planned out beforehand to avoid constriction issues related to unexpected costs during project implementation. Budget planning took into consideration such expenses as pre and post-test expenses, in-service training, and other additional costs. The total cost of all the necessary items and services was $505. The budget considered the materials provided by the facility or already available.

Table 1. Budget Requirements.

Note. This table represents the budget required for the Preventing Pressure Ulcers project.

Strategies and Results

Several strategies aimed towards pressure ulcer prevention were put in place. The technique involved the use of evidence-based instructions during the educational framework in which nurses participated. Moreover, it was important to assess the level of knowledge retention during the theoretical and practical training. The results have highlighted the efficiency of the program and the possibility for improvement in terms of patient safety.

Strategies

The plan of action included the appliance of an assessment tool to examine the level of information retention. Thus, each nurse had been questioned and evaluated in regards to the newly acquired skills and knowledge. In addition, nurses have been evaluated in regards to their skills with a pre-implementation test. This strategy was applied for a clear picture of the results. It became less challenging to compare the initial situation with the improved one. Moreover, another strategy was implementing an evidence-based checklist with the necessary instructions. Last but not least, the verbal test was used to assess how effectively the nurses can share relevant information to family members who also assist with pressure ulcers prevention.

There were several advantages to the plan of action which benefited patients, nurses, and the facility. Researchers refer to the long-term positive effects of long-term projects aimed towards injury prevention (Barrois et al., 2017). One advantage was the reduction in the rate of patients prone to tissue damage. Moreover, nurses were able to acquire new knowledge and apply it in practice. Due to the minimal risk factors correlating with pressure skin injuries, the facility became a safer environment. Moreover, as family members received relevant information, the patients were able to reduce their hospital visits.

Certain limitations had to be addressed in order for the implementation to be successful. Researchers point out that maintaining tissue integrity can be a costly preventative project (Avşar & Karadağ, 2017). Moreover, some of the nurses participating in the program have met the implementation with rigidity due to the amount of new information that needed to be learned. The training project was relatively time-consuming, which decreased satisfaction in some cases. The limitations, however, did not negatively affect the overall results.

A prominent risk was that the project would not lead to equal information retention for the healthcare providers. Lavallée et al. (2018) pointed out that the rate of knowledge in terms of pressure ulcers prevention differs drastically from one nurse to another. Thus, there was a risk that individuals with strong initial skills were more likely to be efficient during the training. Moreover, an ethical issue that was addressed was the possible challenges in communication with family members of the patients. There was a chance that the recommendations would appear to be too intrusive and condescending. However, nurses approached the subject objectively and professionally, which minimized such ethical limitations.

Results

The expected outcomes have been assessed and achieved, which was highlighted through the scoring on the tests given to staff members, questioners, and show-me methods. The compared data showed the difference in knowledge before and after the training examined through practical activities and the tests given to staff members. The results have shown that pre-test scores illustrated a 60% passing rate among 80% of the participants. The post-test measures showed a 90% passing rate among 80% of participants. The percentage of improvement was 20%, which is an excellent number based on the initial aim to increase the number to 80%.

Another expected outcome was the successful show-me procedures where participants were putting their knowledge into practice. The results showed that most of the participants were successful during this examination and proved an understanding of all the pressure ulcer prevention measures (90%). The primary goal was achieving 80% compliance, which means that the objective was met more efficiently than expected. Moreover, the questioners illustrated a satisfactory result in terms of training satisfaction and improvement in current knowledge. 85% compliance noted in the self-assessment questionnaire was evident in 100 % of participants by the end of the training, which was higher than the initially planned 80%.

The next improvement resulting from the implementation was the communication with the patient and family members regarding preventative measures. The verbal teach-back method showed a 100% compliance with the checklist, a number more satisfactory to the planned 80%. Every participant was efficient in providing individuals with the necessary tools to perform preventative actions towards the mitigation of risks correlating with pressure ulcers. According to researchers, effective teaching can minimize risks for future problems related to tissue damage (Schoeps et al., 2016). The overall results were satisfactory, which illustrated that the plan of action was effectively implemented. The strategies were practically applied by most healthcare providers who participated in the training and will continue to use the new risk prevention methods.

Conclusion

Preventing pressure ulcers was the critical objective of the project since it facilitates safe, patient-centered care in which risks are minimized. Moreover, activities correlating with the prevention of such skin injuries correlate with patient satisfaction (Boonpracom et al., 2018). Thus, facilities applying such measures benefited from approaching the issue of pressure ulcer risk before infections, skin damage, and pain compromised patients’ well-being. However, in order for the initiative to be successful, it was essential to use evidence-based methodologies. Thus, the techniques applied during the project were previously examined and concluded to be efficient by researchers.

The most important objective was acquiring an improved set of skills and relevant information that would help nurses approach bedsore prevention with success. Researchers point out that healthcare providers require specific education due to the complexity of dealing with skin injuries (Brent et al., 2018). As a result of the checklist implementation and practical training, the nurses have shown excellent results in terms of knowledge retention. The evaluation has led to excellent advancement in comparison to the initial level of knowledge. Thus, it is certain that the objectives were fulfilled successfully.

Considering that all the set objectives were achieved as a result of the frameworks applied to the facility, it is inevitable that more healthcare facilities have to adopt the same strategy. The paper exemplifies that prevention measures lead to positive changes and facilitate patient safety. Furthermore, the non-occurrence of bedsores correlates with a more negligible risk for infections, costly procedures, and lengthy hospital stays. The fulfilled outcomes presented in this paper refer to the urgency for more research to be conducted and for more facilities to follow a similar guideline. Such initiatives, as proven in the report, were beneficial both for patients and healthcare providers.

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