Running Head: PRESSURE ULCER PREVENTION PRESSURE ULCER PREVENTION USING SKIN BUNDLE By Name Introduction Pressure ulcer, also known as bed sore, is a skin lesion that usually forms in the body of a patient who has been bedridden for a long time. It is officially defined by the National Pressure Ulcer Advisory Panel as a “localized injury to the skin or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction” (cited Baranoski & Ayello 2008, p…
Once the skin succumbs to bacteria or sustains injuries from friction and shear, healing takes longer because reduced flow of blood brings nutrients and removes wastes more slowly. Ischemia due to unrelieved pressure is usually observed in the elderly, malnourished patients, patients reduced to immobility because of their medical condition, fecal incontinence, and patients under less than conscious condition (Mauk 2009, p. 501). Pressure Ulcers: Incidence, Prevalence and Prevention In 2004, the National Home Survey reported that for every 10 residents in nursing homes all over the United States, 11% have succumbed to pressure ulcers with stage 2 pressure ulcer as the most common (see Fig. 2). Both whites and non-whites had equal percentage with the males edging the females at 13% and 10%, respectively (Park-Lee & Caffrey 2009). In 2007, the Centers for Medicare and Medicaid Services reported some 257,412 preventable pressure ulcers as secondary diagnoses at cost averaging at $43,180 for every stay in the hospital. This compelled Medicare to give up shouldering pressure ulcer costs so as to encourage its prevention (Mauk 2009, p. 501). The Institute for Healthcare Improvement has recommended a set of simple interventions collectively known as ‘bundle’ for pressure ulcers prevention in 2003. Hospitals are encouraged to develop their own “bundle” in approaching pressure ulcer prevention (Paciella 2009, p. 43). The SKIN bundle, which is an acronym for Surface, Keep Moving, Incontinence and Nutrition, was developed by the Ascension Health facilities in 2004. In the succeeding pages a sample of change in practice program is outlined for a fictitious hospital ward called HTMC for the prevention of pressure ulcer using the SKIN bundle. Change in Practice for Pressure Ulcer Prevention Name of Ward (fictitious): East Wing 13 Holy Trinity Medical Center (HTMC) Demographics: 24-bed unit, 10 private and 14 semi-private; Staff is composed of ARNP, RNs, patient care technicians, nutritionists, therapists, and others Scope of Service: Patients in the ward are admitted for the following conditions: strokes and seizures, multiple sclerosis and other diseases that make them prone to develop pressure ulcers. A. ASSESSMENT In the first quarter of 2010, the East Wing 13 of the HTMC had reported 27% incidence of pressure ulcer cases compared to the National Database of Nursing Quality Indicators or NDNQI’s report of 3.8%, for Stage I-IV and 2.7%, for Stage II-IV for the year 2010. This is not a good development, not only because the ward’s statistic paled in comparison with the NDNQI’s but also because the CMS has stopped shouldering costs for pressure ulcers that are acquired in the ACFs. B. LINK The US DHHS recommended several measures in the prevention and care of pressure ulcers. These recommendations can be used by the East Wing 13 to reduce the percentage of pressure ulcer incidence. They include the following: skin inspection of patients at least once daily; skin cleansing in accordance to the needs of each patient; skin care such as moisturizers for dry skin and less exposure to humidity and cold; moisture due to incontinence, perspiration, or wound ...
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One of such health problem is Pressure Ulcer. In conformity to the explanation by the Arkansas State University College of Education (2008), the theoretical framework of most of the sources discussed in this review “establishes a vantage point, a perspective, a set of lenses through which the researcher views the problem.” Generally, the deep tissue injury theory was used by researchers with the view that ulcers occur, starting from areas around the bone till they get to the epidermis – thus beginning from the deepest level.
Being confined in the hospital is normally not a wanted experience, but when a patient does go to a hospital, or when they are somehow required to stay there for a length of time, normally, patients expect a level of care from the medical staff as well as a level of sanitation and cleanliness that prevents complications or further issues from occurring.
Braden scale evaluates the level of risk for getting pressure ulcers and those discovered to have or at risk of developing the ulcers are given preventive care. According to Braden (2009), the Braden scale consists of six subscales/areas that can be completed in one minute.
However, guidelines are meant to be modified or adapted depending on the situation. It is thus vital to consider the capabilities of both the caregiver and the setting to implement all the steps. Goals should be set, from which the success of the guideline is compared to.
Effectiveness of Risk Assessment in Preventing Pressure Ulcer. The research question for the study will be: Does increased risk assessment and early detection reduce the prevalence of pressure ulcers in healthcare institutions? The independent variable is risk assessment and detection of ulcers while the independent variable is prevalence of ulcers.
Braden scale evaluates the level of risk for getting pressure ulcers and those discovered to have or at risk of developing the ulcers are given preventive care. According to Braden (2009), the Braden scale consists of six subscales/areas that can be completed
This begs the question why its nearly impossible to have a sustained pressure ulcer prevention in the geriatric patient. This research topic tends to settle down this question by determining the attitude and knowledge of nurses on geriatric