The Pressure Ulcer Prevention Education Plan aims to address incompetency issues among nursing staff and Unlicensed Assistive personnel (UAPs), that is mainly contributed by lack of proper knowledge. Prevention and management of pressure ulcers (PUs) amongst patients in skilled nursing/rehab facilities have been on the downward trend, evidenced by the increase in pressure ulcers in various stages amongst patients. To improve the prevention and management of pressure ulcers, the education plan focused on educating nurses on how to improve the well-being of geriatric patients, bed-bound, and patients with limited mobility (Lamppu et al., 2019).
During the four weeks of educating the nurses, and UAPs on pressure ulcers prevention and management, they were given a pre-test and post-test to evaluate the effectiveness and efficiency of the pressure ulcers prevention education plan. The purpose of this paper is to discuss the effectiveness of evidence-based practices in increasing the knowledge of nursing staff during the implementation of a quality improvement education plan on pressure ulcers prevention amongst patients.
Purpose of the project
One of the common problems amongst the geriatric, bed bound, immobile, unalert, and patients with limited mobility are the development of PUs. They occur when some areas of the skin do not receive an adequate amount of blood flow due to constant pressure, and as a result, the tissue is damaged (Mitchell, 2018). Pressure ulcers occurs significantly often in skilled nursing/rehab facilities due to lack of knowledge, training, and continuing education. As well as poor communication between staff in different departments within the facility, such as nursing staff, physicians, physical therapy, unlicensed assistant personnel, and the dietary department.
There should be a constant dialogue and communication between these departments to provide the best care to the patient and exude knowledge and implementation of interdisciplinary care. Nursing staff and healthcare workers should be educated on the prevention of PUs. Many times, simple indicators of the initial development are overlooked due to lack of knowledge, such as recognizing non-blanching of skin, assessing bony prominence areas, malnutrition, dehydration, and predisposed diseases.
Educating the nursing staff and unlicensed assistant personnel on PU prevention will decrease number of pressure ulcer development, increase patient’s well-being, staff teamwork, and reduce the patient’s length of stay in return reducing the cost for the facility. At the same time, according to Wung Buh et al. (2021), PUs prevention is 2.5 times cheaper than treatment. Additional complications associated with PUs include tissue infection, bone infections, cancer, and sepsis (Mayo Clinic, 2020). Thus, PUs significantly impairs the quality of life of older adults and are detrimental to their health.
Since the effects of PUs are hazardous, their avoidance is an integral part of caring for the geriatrics and patients with the inability to move and care for themselves. Key preventative measures include careful patient monitoring, timely response to complaints, assistance in movement, and changing pose (IQWiG, 2018). Other measures that help to avoid PUs include a balanced diet, skincare, and special mattresses and support surfaces (IQWiG, 2018). Such knowledge of these preventative measures can play a critical role in prevention and proper patient care. Knowledge and understanding are essential for both relatives-caregivers and nurses working with patients. Knowledgeable and trained license staff can educate families on the prevention during stay and upon discharge to continue the continuity of care.
There are common interventions that can be useful to combat bedsores. First, nutrition has been mentioned regularly, and thus, diet would be a key aspect to consider while treating or fighting growth of pressure ulcers (Townsend, 2018). 10% of persons hospitalized have this medical issue where 40% of the number have malnutrition issues that lead to the bedsores (Schoeps et al., 2016). The role of diet is clear as macro and micronutrients are needed by each organ to enable proper functioning of all body parts.
The other notable idea on how to fight pressure ulcers is foam dressing with specific agents. From the literature review, this project concur that hydrocolloid, silicone, and film foams are useful in managing this condition in geriatrics and those with challenges of freely moving with their feet (Zdzioch, 2017). Furthermore, some therapeutic interventions would be key in preventing these conditions such as static foam mattresses and cushions that help pump constant flow of fresh air. In most serious cases, surgery is undertaken to remove the damaged tissues and closing of the wound is done to prevent further deterioration of the body tissues (Burch & McCallum, 2016).
More than 38% of patients with body challenges have experienced this health problem and thus, prevention is important to ensure the comfort of the patients (Penman et al., 2020). For patients with movement challenges such as those with wheelchairs, it is important to keep on changing their position to help in blood circulation.
- Nursing staff and UAPs will demonstrate effective knowledge of evidence-based practice on PUs prevention and management by the end of week four as evidence by a 75 % retainment on the post-test assessment.
- Nursing staff and healthcare workers will demonstrate knowledge of an interdisciplinary approach to coordinate care for the patient by the end of week four.
- Nursing staff and UAPs will demonstrate knowledge on how to accurately reposition a patient using proper body mechanics by the end of week four as evidenced by verbal teach- back methodology.
- Nursing staff will demonstrate how to correctly educate patients and families on an effective approach to manage existing PUs and decrease the acquirement of new PUs by week four.
- Nursing staff will demonstrate knowledge on how to accurately assess for PUs and signs and symptoms by the end of week four as evidence by a 75 % retainment on the post-test assessment.
To improve the prevention and management of pressure ulcers, the intervention plan focused on educating nurses on how to improve the well-being of geriatric patients, bed-bound, and patients with limited mobility (Lamppu et al., 2019). During the four weeks of educating the nurses, and UAPs on pressure ulcers prevention and management, they were given a pre-test and post-test to evaluate the effectiveness and efficiency of the pressure ulcers prevention education plan. The purpose of this paper is to discuss the effectiveness of evidence-based practices in increasing the knowledge of nursing staff during the implementation of a quality improvement education plan on pressure ulcers prevention amongst patients.
In a study that involves an individual’s health information, the main ethical issue is always the respondent’s privacy. In this study, both nurses’ privacy, UAPs, and the patients were adequately observed. Nurses and UAPs were asked to conceal patients’ information and avoid using patients’ names when responding to pre-test and post-test (Dale & Helton, 2018). As well as, during the question-and-answer discussion portion of the education plan staff are asked to avoid using patients’ information to protect their privacy. To affect this, nurses and UAPs signed consent and privacy non-disclosure form.
Similarly, nurses’ and UAPs’ privacy were also observed, and all were asked to avoid their identity when submitting their tests. To observe the privacy of nurses and UAPs, nurses were asked to submit their responses for the tests through a sealed box. Following these guidelines, the pressure ulcers prevention plan complied with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rules that regulate protected healthcare information disclosure.
The ability to gauge the likely benefits of the available preventive strategies and compare their cost–effectiveness is essential to making evidence-based decisions about the selection and implementation of preferred methods (Ocampo et al., 2017). As seen in the budget table below the cost of this project is cost-effective and requires a sum of $1424.75 for the education, implementation, and evaluation process.
The budget table will include a detailed breakdown of the cost, description, and its sources. The knowledge assessment and educational portion which consist of a pre-test, post-test, and presentation will cost $100 for the supplies needed. The in-service and live demonstration will come from the facility’s payroll department, and staff will be paid their regular hourly wage as well as any overtime incurred for their attendance or facilitation.
The intervention program is based on thee budget items – education, training and payroll. Education will be divided into 3 stages – the initial presentation, which will consist of video and PowerPoint and cover the topic of pressure ulcer prevention, nutrition, and management. The proposed sources will include facility’s library, which means that it will cost $0. Further, the education aspect would include pre-test for baseline assessment and post-test for staff retainment. The supplementary materials needed for the tests will cost $100 with $50 on each test.
Second budget item is training for 2 registered nurses (RNs), 3 licensed vocational nurses (LVNs) and 5 certified nursing assistants (CNAs). The estimated budget is calculated by multiplying hourly rate with 3.5 hours of training length. For RNs its 83*3.5*2=581, for LVNs 35*3.5*3=367.5, and for CNAs 21.5*3.5*5=376.25. In total 581+367.50+376.25=1324.75
Estimated cost is $1324.75
Finally, the payroll budget item will be calculated by the hourly rate X training length, hence the stuff will be compensated for the training from their department.
The plan of action for the project is to increase the knowledge retainment of nursing staff on pressure ulcers prevention by using evidence-based practices. The education and implementation of the nurses and UAPs will go for four weeks. They will be educated on the prevention and management of pressure ulcers on the specified population of patients. The targeted population includes malnourished, immobile, geriatric, limited mobility, and other vulnerable patients that can easily develop pressure ulcers. During the four weeks of implementation, nurses will be supplied with learning materials, knowledge, and education required to help prevent and manage PUs. Nurses and UAPs are assessed using Piper’s pressure ulcers knowledge test before and after the implementation phrase to assess their baseline knowledge and retainment.
A clear advantage of the Pressure Ulcer Prevention Plan is that it protects patients from harm associated with pressure ulcers. According to Lavallée et al. (2018), increasing knowledge of an interdisciplinary approach amongst nurses reduces patients’ susceptibility to pressure ulcers by up to 45%. Once patients are infected with pressure ulcers, it takes a long time to heal. This makes the treatment of pressure ulcers patients costly. It cost the hospital approximately $40,000 to treat each occurrence of pressure ulcers (Rutenberg et al., 2019). Moreover, the occurrence of pressure ulcers increases a patient’s hospital stay by 12 to 20 days. Therefore, it is crucial to prevent pressure ulcers to avoid cost implications on patients and their families.
The plan had several limitations on quality enhancement in healthcare delivery. One of the limitations is the short length of the project that was only restricted to four weeks. The short duration can produce a biased result that is either a false-positive result or an over-estimated magnitude of association in the result (Berete et al., 2021). Another substantial limitation of the research is the use of a small study population. The study was conducted in a single skilled/rehab facility with a nurse population of less than 100. The smaller the sample size of the study, the higher the margin of error. An increase in the margin of error reduces the accuracy and the power of research.
The outcome from the test results showed significant improvement in the tested areas. At the beginning of the project, the Piper’s Pressure Ulcers pre-test indicates that only 60% of the nursing staff demonstrated effective knowledge in evidence-based practice on pressure ulcers prevention. At the end of the fourth week, 92% was recorded on the post-test outcome. On the interdisciplinary approach, 74% was recorded on the pre-test and 96% on the post-test (Gaspar et al., 2019).
When it comes to knowledge on the repositioning of patients, 55% was recorded on pre-test and 95% on post-test. In mastering the steps for pressure ulcers assessment, only 40% of the nursing staff were able to outline all the steps, and after four weeks, 90% were able to identify all the assessment steps. The improvement in knowledge retainment among nursing staff is reflected in the pressure ulcers incidences in the healthcare facility. The pressure ulcer cases reduced from 4.2% before education to 3.2% after education.
The presentation aimed to outline the strategies and the results of the pressure ulcers prevention education plan. One significant advantage of educating nursing staff on the prevention and management of pressure ulcers is that it significantly reduces the incidences of pressure ulcers among patients. From the result obtained, all the study areas incorporated in the project resulted in a massive improvement in preventing and managing pressure ulcers. Despite the positive outcome, the accuracy of the project is reduced by the small sample size used in the project, which tends to increase the margin of error. According to Dale and Helton (2018), the credibility of a study is based on its relativity to the set universal standards, which the project lacks. A comparative analysis helps in getting more diverse and comprehensive information about research.
Berete, F., Heyden, J. V. D., Demarest, S., Charafeddine, R., Tafforeau, J., Oyen, H. V., & Renard, F. (2021). Validity of self-reported mammography uptake in the Belgian health interview survey: Selection and reporting bias. European Journal of Public Health, 31(1), 214-220. Web.
Dale, M. C., & Helton, M. R. (2018). Nursing Home Care 20. Chronic Illness Care: Principles and Practice, 245.
Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. Web.
Lamppu, P. J., Laurila, J., Finne-Soveri, H., Laakkonen, M. L., Kautiainen, H., & Pitkälä, K. H. (2019). Training nursing home staff to improve residents’ end-of-life care: Design and baseline findings from a randomized controlled trial. European Geriatric Medicine, 10(4), 649-657. Web.
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79-89. Web.
Moore, Z., Avsar, P., Conaty, L., Moore, D. H., Patton, D., & O’Connor, T. (2019). The prevalence of pressure ulcers in Europe, the European data tell us: A systematic review. Journal of Wound Care, 28(11), 710-719. Web.
Rutenberg, T. F., Assaly, A., Vitenberg, M., Shemesh, S., Burg, A., Haviv, B., & Velkes, S. (2019). The outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population. Injury, 50(7), 1347-1352. Web.