May 2020 Wound and Ostomy Journal Club
PRESSURE INJURY PREVENTION IN A GERIATIRC POSTACUTE CARE SETTING: A QUALITY IMPROVEMENT STUDY.
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Describe the method used by the author of the study.
ReplyDelete- The study method utilized by the author is a quantitative quality improvement study design which involves several quality improvement methods outlined by Health Quality Ontario and the RNAO's Implementation of Best Practice Guideline Toolkit, a kaizen event, PICK charts, inter-professional working groups, patient and family partners, Plan-Do-Study-Act cycles, performance boards, and auditing. The patient population utilized were geriatrics in a 262-bed post-acute care hospital in Toronto with tracheostomies, enteral feedings, and limited mobility. Planning fot the quality improvement project involved an advanced practice nurse, a clinical manager, and a quality consultant - all of whom were responsible for determining the cause of increased pressure injuries, developing, implementing and evaluating ideas for change, and determining a realistic target for improving pressure injury occurences.
How does this research article compare to our practice, policy and/or procedure?
- This research article comapres to PSJMC's practice and policies by its goal of reducing pressure injuries in the clinical setting and determing ways to prevent pressure injuries in vulnerable patients. Interventions for prevention at PSJMC include individualizing the plan of care and educating patients and caregivers about the causes and risk factors for pressure injury development, as well as ways to minimize risk. Similarly, the article indicates that one of the main factors that led to improvement in pressure injuries is individualized planning, implementation and evaluation within the patients. Another significant factor that led to the success of the project in the article is the organization's commitment to the planning phase. Similarly, PSJMC is highly commited to reducing pressure injury occurence within the hospital in several ways. PSJMC utilizes foam rings, donuts, sheepskin, pillows, foam wedges, heel foams, etc. for pressure reduction and prevention. PSJMC also utilizes the Braden Scale to determine a patient's risk for pressure injuries and implements a plan of care for that patient accordingly. Repositioning every two hours is also vital in preventing pressure injuries, especially for those in the critical care units as they are of higher risk in suffering from pressure injuries during their hospital stay.
FERLYN NOGOY, RN
What are the advantages and disadvantages of implementing the article recommendations on your unit and or your hospital?
ReplyDeletePressure ulcers hinder recovery of patients causing pain and serious infection that lead to longer hospital stay.The cost to treat pressure ulcers is expensive and penalties are imposed for hospital acquired pressure ulcers. Implementing three change ideas prevent infections/sepsis thereby preventing extended length of hospital stay. Quality of patient's outcome is improved.Hospital cost of care are also reduced.
How does the research article compare to our practice policy and procedure?
This article implemented three change ideas.
1. Quarterly point of care nursing led PI prevalence
In PSJMC, all patients are assessed on admission and each shift to determine their risk for skin breakdown using Braden Scale. A skin prevalence study is conducted every third Tuesday of the month.Wound photos are taken every Thursday to reassess the wounds. Wound consultations are ordered as needed
2. Standardized positioning plans developed from interdisciplinary bedside assessment.
In PSJMC, each room has a patient Q2 hour turning schedule template above the bed that serves as guide when positioning patients.Similarly, our hospital uses pillows wedges and off loading devices
3. Revising a current mattress selection algorithm
In PSJMC, each medical and telemetry unit has Standard Bed Decision Tree Picture Guide.This helps the nurses which type of mattress or bed is appropriate for each patient.Ordering of mattress/bed depends on patient's Braden Score ,presence and stage of pressure injury and patient's weight, turning requirements and incontinence are also being considered.
Discuss the limitations of the article:
ReplyDeleteA limitation of the article includes the sample size and location the study took place. The sample size only includes a pool of participants from a 262-bed post acute care hospital located in Toronto, Canada. This is a small sample size that is limited to one post acute care facility, which could not be generalized to, for example the U.S. population. Although nursing care should be generalized with very similar policies and procedures across the world, there are certain changes that occur with patient care based on various factors such as demographics or cultural differences. A design flaw seen in the article was that the data found in the “prevalence and incidence” study was shared months later to the point-of care nurses caring for participants of the study. This made it difficult for the point-of-care nurses to integrate findings for individualized patient care. The article took place over a 6 month period, October to March. This could also be considered a limitation in that it could not be a sufficient amount of time to determine efficacy of this study. There could also be a flaw in that the study was not conducted during the summer months, which could alter results based on the number of patient populations in the post acute care center fluctuating during different times of year.
How does this research article compare to our practice, policy and/or procedure?
Although PSJMC is not a post acute care hospital, there are procedures that are similar to those used in the article. Similar to the article, PSJMC has a skin team, CalNoc, which rounds each month to complete a thorough skin assessment on each patient within each unit. There they will document and audit preventive measures for skin health taken by the floor nurse. PSJMC also incorporates a standardized positioning poster used in each patient’s room, similar to that used in the article. Similar to the wound RN ordering a specialty bed based on the patient's mobility level and extent of skin breakdown, the article used a standardized algorithm for specialty bed selection.
Pressure Injury Prevention in a Geriatric Post-Acute Care Settings, A Quality Improvement Study
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
In this article, the advanced practice nursing team implemented three change ideas. 1. Quarterly point-of-care nursing-led pressure injury prevalence and incidence studies. 2. Standardized positioning plans developed from interdisciplinary bedside assessment and 3. A revised current mattress solution algorithm. Similarly, PSJMC has protocols on how to reduce HAPI. A skin prevalence study is conducted every third Tuesday of the month. Skin champions conduct skin assessment, take photos, and report the number of patients with HAPI. Wound consultation is also ordered. Patients unless contraindicated are turned every two hours especially for patients with Braden scores of 12 or less or those who are at high risk for developing pressure ulcers. Rooms have a patient turning schedule template that serves as a guide. Pillows or wedge pillows are utilized to relieve pressure points. Certain mattresses are recommended for pressure ulcers. The standardized mattress that are currently used is the Hill ROM accumax quantum. This mattress offers a therapy solution for patients at the low to moderate risk of skin breakdown. Waffle mattress is also used for some patients. For high-risk patients or patients with stage III, IV, DTI or unstageable PU , Versa care P-500 mattress low air loss bed is recommended.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Implementing the three change ideas in the journal to our unit will significantly bring down the number of HAPI cases, decrease the number of hospital stay, and reduce hospital cost.
Describe the method used by the author of the study
ReplyDeleteThe study method used a quantitative quality improvement study, several quality improvement methods outlines by Health Quality Ontario and the RNAO's implementation of Best Practice
Guideline toolkit were used throughout the assessment, development, implementation, and evaluation process. It includes a kaizen event, PICK charts, interprofessional workinh groups, patient and family partners,
Plan-Do-Study-Act cycles, performance boards and auditing.
How does this research article compare to our practice, policy and/or procedure?
In this article, the advanced practice nursing team implemented three change ideas.
1. quarterly point-of-care nursing-led PI prevalence and incidence studies
2. standardized position plans developed from inter disciplinary bedside assessments
3. revising a current mattress selection algorithm.
At our ministry, we have a strong wound care team that overlooks and leads the nurses into skin assessments.
Every unit has a skin team who meets once a week to assess and follow up on pt's skin.
Wound consultation can be ordered as protocol.
PRESSURE INJURY PREVENTION IN A GERIATIRC POSTACUTE CARE SETTING: A QUALITY IMPROVEMENT STUDY.
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
PSJMC has implicated policies and procedures to prevent pressure ulcers, or hospital acquired pressure ulcers (HAPU) in hospitalized patients. There are skin bundles in place for preventing ulcers in the acute care setting. A team of registered nurses form a skin prevalence study once a month where they evaluate the skin of patients and enter information into a systemize data log. The team also meets once a week, to follow up on patients who are most at risk. The ostomy nurse who over sees the department, receives consultations to see patients on the units. A Braden score of 12 or less, flags the patient as high risk. Patients who are at high risk for pressure ulcers are place on an air mattress or low air loss, Versa Care P500, waffle mattress, or centrella bed. These patients are turned Q2 hrs and prn. The article’s study in quality improvement, implemented three changes. First, a quarterly point of care prevalence and incidence studies. Second, standardized positioning plans developed from interdisciplinary bedside assessment. Third and lastly, revised current mattress solution algorithm.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
There are many advantages in implementing the three charges mentioned in the article. Preventing pressure ulcers in critically ill patients is ideal in cutting lengthy hospital stays. It is much cheaper and easier to prevent pressure ulcers, than it is to heal them. The disadvantage is cost, education and the uses of resources.
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ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
ReplyDeleteAt PSJMC and on 6NE in particular, a lot of focus is put on reducing HAPIs. This is done by charting/documenting assisting a patient to shift their weight every two hours, apply preventative foam dressings to boney prominences, and using a scheduled turn team to assure that a weight shift is being performed every two hours. In addition, patients are evaluated every shift for risk of skin breakdown and given a Braden score, which is updated every twelve hours. I noticed that this article recommended having a mattress selection algorithm, something that PSJMC does not have. Our current standard practice is to evaluate a person's Braden score and work in conjunction with the wound nurse to choose whether or not to obtain orders for a waffle mattress or a specialty bed, I think having a standard algorithm would help streamline this process.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
I think the advantages of implementing standardized positioning posters and surface selection algorithms would result in an easy streamlined process for implementing skin breakdown interventions. However, like the study discusses in their ultimate results, it is difficult to affect change and ideas that remain permanent. Nurses can be resistant to the addition of more algorithms/etc because it is perceived that it will take up more time/encumber the nurse's workflow.
1. Describe the Method used by the Authors of the study.
ReplyDeleteThe method that was used was quantitative quality improvement study design. This includes quality improvement methods that were outline by Health Quality Ontario and the RNAO’s Implementation of Best Practice Guideline Toolkit.
2. Discuss the sample size used in the article.
The sample size was adequate enough for the study. The total sample were 90 patients in a geriatric academic teaching hospital with many of which were diagnosed with cerebrovascular accidents, Parkinson’s disease, dementia, and/or diabetes and some of them have limited mobility which increases their risk of having pressure injury.
Maryliza Chata, RN, BSN, CCRN