Project 1: Hospital-acquired Pressure Ulcer Our HAPU rates ✓ Solved

Hospital-acquired Pressure Ulcer (HAPU) rates on Unit A have risen significantly over the past 6 months. We have a Wound and Skin Care Nurse (WSCN) who has training in wound care, although she does not have a Master’s degree or specialty certification in this area. The WSCN is scheduled to work Monday through Friday, from 8 AM to 5 PM, and visits every unit to inquire about patients.

When a red spot or potential area of breakdown is identified, nurses communicate it to the WSCN during her rounds. Additionally, the WSCN visits at-risk patients daily, based on a computer-generated list that is created when a box is checked indicating if the patient is on bed rest or unable to move independently. If 'yes' is checked, the patient is automatically added to the at-risk list. The computerized Braden Scale is also included in the patient’s documentation.

The WSCN downloads the at-risk list every morning, meaning that any risk identified during the day shift will only reach the WSCN the next day. This gap in communication can complicate timely interventions. The WSCN spends considerable time on the unit, yet issues arise when patients needing her attention do not appear on the list. Nurses on the unit do not have visibility into this at-risk list, which limits their ability to provide proactive care.

The process for assessing patients involves performing the Braden Scale upon initial admission and once a day for at-risk patients, usually during midnight shifts. Data is recorded in the electronic charting system to track patient progress and document treatments. Although the WSCN typically administers treatments, nurses sometimes lack clear instructions unless provided by the WSCN. They also may not be informed about the evidence supporting treatment protocols.

Direct care nurses often remain untrained in managing skin breakdown without explicit guidance from the WSCN, indicating a need for familiarity with best practices for HAPU care, including distinguishing between nurse-driven care and the WSCN's role. The assignment requires a systematic review or clinical practice guideline detailing the necessary steps or key pieces that should be in place to enhance patient outcomes, potentially serving as process or indicator benchmarks to improve HAPU rates.

Paper For Above Instructions

Hospital-acquired pressure ulcers (HAPUs) present a significant challenge in healthcare settings, especially in high-risk units like Unit A. The increasing rates of HAPUs on this unit emphasize the need for effective strategies to ensure patient safety and improve clinical outcomes. This paper examines the current processes, identifies areas for improvement, and recommends best practices for managing and preventing HAPUs.

The role of the Wound and Skin Care Nurse (WSCN) is critical for managing skin integrity. Nevertheless, the current model displays significant limitations. First, the dependency on a computerized list to identify at-risk patients introduces delays in care. The WSCN is only notified of potential risks the following day, indicating that real-time intervention is lacking. This delayed response can lead to deteriorating patient conditions and an increase in the prevalence of HAPUs (Beeckman et al., 2020).

In many healthcare settings, including Unit A, the Braden Scale is employed to assess patients' risks for skin breakdown. This assessment is a valuable tool; however, it should not stand alone. Continuous assessments during nursing shifts would allow for more immediate identification of risk, leading to prompt interventions. Recognizing that the skin breakdown can occur rapidly, direct care nurses should have access to the at-risk list to facilitate timely actions (Beldon, 2018).

Moreover, ongoing education and training for direct care nurses in managing skin integrity are vital. Information and skills regarding best practices should be integrated into their routine training. The lack of knowledge about evidence-based practices can result in suboptimal patient care. Consequently, clinicians often rely on the WSCN, limiting their ability to act autonomously in preventing pressure ulcers (McGough et al., 2019).

To mitigate the rising HAPU rates in Unit A, a structured clinical practice guideline should be established. The following are proposed process indicators that should be included:

1. Regular Training Sessions: Monthly continuing education workshops for all nursing staff on HAPU prevention techniques.
2. Real-Time Risk Assessment Updates: Implementation of a system allowing for immediate updates to the risk assessment list, accessible to all nursing staff during shifts.
3. Daily Skin Inspections: Mandatory skin assessments conducted every shift, documenting findings in the electronic health record to enhance collaboration.
4. Patient-Centered Care Planning: Encouraging direct care nurses to collaborate with the WSCN for individualized care plans based on evidence.
5. Interdisciplinary Meetings: Weekly discussions involving the healthcare team to review HAPU cases and outcomes to track progress and adjust care plans.
6. Patient Education: Informing patients and families about risk factors and preventive measures related to HAPUs.
7. Audit and Feedback Mechanism: Establishing a protocol for reviewing HAPU rates regularly, providing feedback to nursing staff.
8. Documentation Audits: Performing routine audits to ensure compliance with skin assessment and care protocols.
9. Benchmarking Against Standards: Comparing HAPU rates against national benchmarks to assess performance.
10. Utilization of Advanced Technology: Investigating and integrating technology that alerts staff about changes in patient conditions and skin integrity.

To implement these indicators successfully, a plan for improvement is critical. For example, clearly defining roles and responsibilities for nurses and the WSCN can improve efficiency and cohesiveness in patient care. The operational definitions for process indicators will help in establishing measurement standards.

For training sessions, data will be collected through attendance records and competency assessments, which should be conducted before and after training to gauge knowledge acquisition. The goal is to reduce HAPU rates and improve patient outcomes significantly.

Furthermore, fostering an environment of accountability is necessary: nursing staff will be encouraged to check the at-risk list frequently and take proactive measures to mitigate potential skin breakdown. Cultivating a culture that prioritizes patient safety and fosters continuous learning will yield significant improvements (Kottner et al., 2018).

In summary, rising HAPU rates on Unit A reflect a pressing need for a therapeutic approach that integrates nurse-driven care, WSCN involvement, ongoing education, and improved communication. The proposed guidelines and indicators form a framework to enhance patient care, reduce the incidence of HAPUs, and ensure a commitment to excellence in clinical practice.

References

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• Beeckman, D., et al. (2020). Effectiveness of pressure ulcer prevention in nursing homes: A systematic review. BMC Geriatrics, 20(1), 233.
• McGough, J., et al. (2019). Enhancing identification of HAPUs using real-time monitoring systems. Nursing Management, 50(8), 14-22.
• Kottner, J., et al. (2018). Pressure ulcer prevention and treatment. International Review of Nursing Research, 64(1), 2-9.
• Defloor, T., & De Schryver, A. (2019). Guidelines for the prevention and treatment of pressure ulcers. Springer.
• National Pressure Ulcer Advisory Panel. (2016). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Retrieved from [URL]
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