Executive Summary
Mary Job
Grand Canyon University
NRS 451 V
Dinwiddie Sandra
April, 22, 2012
Pressure ulcer prevention (PUP) in surgical patients has become a major interest in acute care hospitals with the increased focus on patient safety and quality of care. A pressure ulcer is any area of skin or underlying tissue that has been damaged by unrelieved pressure or pressure in combination with friction and shear. Pressure ulcers are caused due to diminished blood supply which in turn leads to decreased oxygen and nutrient delivery to the affected tissues (Tschannen, Bates, Talsma, &Guo, 2012). Pressure ulcers can cause extreme discomfort and often lead to serious, life threatening infections, which substantially increase the
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The vulnerable bony areas prone to pressure ulcer are back, heels, hip, spine, elbows, shoulders and back of head. Studies have proved that total operating time and overall number of surgical procedures are significant predictors of pressure ulcers. A research conducted by Lindgren et al found that 14.3 % of surgical patients acquired a pressure ulcer during the time from surgery to twelve weeks after surgery. For every thirty minutes the surgery went beyond four hours, the risk for a pressure ulcer increased by approximately thirty three percent.
As we are all aware that there is no reimbursement for a hospital acquired pressure ulcer and the cost for each pressure ulcer has to be absorbed by the facility. A patient’s development of a pressure ulcer while under the care of health care provider or facility is viewed as grounds of a professional liability law suit. The mere existence of pressure ulcer is often viewed as a physical evidence of medical negligence. The cost to treat pressure ulcers are expensive, the United Sates (US) health care system spends more than one billion dollars annually to treat pressure ulcers. It has been estimated that the cost of treating pressure ulcers is 2.5 times the cost of preventing them (Whitehead &Trueman, 2010). In order to reduce the strain on hospital budgets caused by pressure ulcers, we need to implement a planned approach to PUP and
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et
Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.
Pressure ulcers during a hospital admission are preventable. Assessment and early intervention can stop skin breakdown before it begins. Many factors regarding Mr. J’s condition placed him at a high risk regarding nursing indicators. Mild dementia, recent fall and a fractured hip all require a high level of nursing care and indicates preventative practice. Upon assessment, precautions should be in place to deter further complications. The elderly are more
While University Hospital is already on the brink of completely preventing pressure ulcers I would still recommend implementing all of the current practices but also add new additions to the team. Currently, we have a wound care team that diligently treats at risk and affected patients. Adding a nutritionist into the team to guarantee treatment from within along with prescribed medications. This will make the team and the strategies multidisciplinary. In addition to that, each treatment should be customized for each patient in regards to cost options and best treatment for their health. The project would also have to be performed repetitively without error to ensure that it is actually helpful. Patients’ skin should continue to be examined thoroughly in common places where ulcers could arise, the standardized pressure ulcer risk assessment should be used, and the proper care should be distributed once evaluated. The team should continue to record its progress and also provide company update emails to inform the facility, as well as send the appropriate data to the higher ups for public posting.
While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).
Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced
Pressure ulcers are a serious health care problem and it is crucial to assess how patients acquire pressure areas after admission to the perioperative environment (Walton-Geer, 2009). In the operating room factors related to positioning, anaesthesia and the durations of surgeries along with individual patient related factors can all contribute to pressure ulcer development. This essay aims to review current standards of recommended practice regarding pressure ulcer prevention efforts for the surgical patient.
According to Compton et al, (2008), 5% of ICU budget goes to the treatment of pressure ulcer. Courtney, Ruppman, & Cooper (2006) continue to say that an average of $4,000 is spent to take care of one patient with pressure ulcer. The price of treatment varies because there are different stages of pressure which range from stage 1 to unstageable stage which can lead to septicemia and death.
Pressure ulcers are a commonly seen problem among elderly hospitalized patients. Despite new findings about the causes and approaches to treatment, the incidence of these wounds is still increasing. Scott, Gibran, Engrav, Mack and Rivara (2006) revealed that during the thirteen years of their study, the incidence of pressure ulcer development has more than doubled. As our elderly population becomes greater in number, and older in age, this problem is expected to escalate. It is of great importance for the patients as well as for the
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the
Pressure ulceration has been considered a major health problem not only in the UK but worldwide. Several studies and trials were conducted in order to identify the most effective measure in pressure ulcer care. A number of policies and guidelines that underpin clinical practice highlighted the importance of pressure ulcer prevention (Department of Health, 2011). According to NICE guidance (2014), all patients are potentially at risk of developing pressure ulcers and has made recommendations on prevention, which includes risk assessment and some preventive measures like repositioning and use of pressure-redistributing devices. However, these recommendations can only be made available to the patients with the help of the multidisciplinary team
This observational cohort study was conducted for 9 years in TNH, 370 beds in Melbourne, Australia. Sample data were divided into 3 parts in the hospital pressure ulcers. First, the point of prevalence from 1045 patients gathered in 2003, 2004, 2006, 2007 and 2011. Point prevalence survey were trained and bedsores were strictly confidential and hospital-acquired when the pre-existing admission. Second
If pressure ulcer occurred, it can cause decreased quality of life, infection, pain and disfigurement, alteration to sleep, delayed healing, increased morbidity and mortality rates, an increased need for intensive nursing and medical care, an increased workload for healthcare workers, and, as a consequence, increased healthcare costs
Previously known as Pressure Ulcer is now being called Pressure Injury (PI), according to the National Pressure Ulcer Advisory Panel (2016). The name was changed due to the different formation and presentation of PI. What many appear as intact clear skin may actually be deeply damaged within the tissues making it invisible to the naked eye. PI is acquired through ischemia the skin on bony prominences of the body usually from pressure. Pressure to the area within 1-2 hours can cause PI, thus the importance of repositioning our patients every 2 hours is emphasized nationwide. However, other contributing factors also play a major role in the formation of PI, the problems of pressure, shear, friction, immobility worsens the condition and it
Thomas, D.R. (2001). Issues and Dilemmas in the Prevention and Treatment of Pressure Ulcers: A Review. The Journals of Gerontology, 56 (6), M328-M340. doi: http://dx.doi.org/10.1093/gerona/56.6.M328