Pico question examples for pressure ulcers

IMPLEMENTATION OF A PREVENTION PROGRAM v

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IMPLEMENTATION OF A PREVENTION PROGRAM TO REDUCE hospital acquired pressure ulcers

by

(name)

Evidence-based Practice Project

Submitted to the Faculty of NUR 49800 Capstone Course in Nursing

College of Nursing

of Purdue University Northwest,

Hammond, Indiana

in partial fulfillment of course requirements for the degree of

Bachelor of Science

September, 2017

© copyright

kristine de castro

2017

all rights reserved

table of contents

Section Page

table of contents iii

abstract iv

Sections

1. Introduction 1

2. Review of Literature and Synthesis of the Evidence 4

3. Plan for Implementation 18

4. Plan for Evaluation 27

5. Conclusions, Recommendations and Implications 34

references 36

List of tables

Table Page

Table 1 Summary of Reviewed Evidence 9

Table 2 Estimated Timetable Blueprint for Implementation 25

Table 3 EBP Evaluation Plan 30

ABSTRACT

Purpose: The purpose of this evidence based project is to determine if implementing a pressure ulcer prevention program, utilizing a multi-component pressure ulcer care bundle, will result in reducing the occurrence of hospital acquired pressure ulcers.

PICO question: “In hospitalized adult patients, what is the effectiveness of a pressure ulcer prevention program (or care bundle) compared to not having a pressure ulcer prevention program on reducing the occurrence of hospital acquired pressure ulcers?”

Significance of the problem: Hospital acquired pressure ulcers (HAPUs) are a serious and potentially preventable patient safety concern associated with negative patient outcomes including: pain, infection, increase hospital stays, and premature mortality. In addition to negative patient outcomes, hospital acquired pressure ulcers pose significant financial implications for healthcare facilities.

Synthesis of the evidence: A review of research and evidence suggests that an effective pressure ulcer prevention program should consist of a care bundle of nursing interventions related to: risk assessment, nutrition, repositioning/mobilization, skin care, support services/medical devices, and education. In addition, research studies have demonstrated a reduction in the occurrence of hospital acquired pressure ulcers as the result of an evidence based pressure ulcer prevention program.

Recommended implementation for practice change: Sufficient research supports that the implementation of a pressure ulcer prevention program will reduce the occurrence of hospital acquired pressure ulcers. Therefore, this knowledge should lead to the development and implementation of an evidence based pressure ulcer prevention program.

Conclusions/recommendations for practice: The recommendation is to pursue an evidence based pressure ulcer prevention program. Once developed, the prevention program should be piloted on a hospital unit with either high risk or high incidence of HAPUs. The pilot program outcomes will determine the feasibility of implementing the prevention program throughout the hospital.

Key words: hospital acquired pressure ulcer, pressure ulcer prevention program, pressure ulcer care bundle, pressure ulcer incidence

section 1

Implementation of a Prevention Program to Reduce Hospital Acquired Pressure Ulcers

Pressure ulcers, also known as pressure injuries or decubitus ulcers, can be defined as localized injury to skin and underlying tissue, usually over a bony prominence, due to unrelieved pressure, friction, or shearing forces. A hospital acquired pressure ulcer (HAPU) is any ulcer noted 24 hours or more after hospital admission (The Joint Commission, 2016). HAPUs are a serious and potentially preventable patient safety concern associated with negative patient outcomes and high healthcare costs. Pressures ulcers are a significant patient health issue and an organizational challenge addressed on a daily basis.

Purpose

The purpose of this evidence based project is to determine if implementing a pressure ulcer prevention program, utilizing a multi-component pressure ulcer care bundle, will result in reducing the occurrence of hospital acquired pressure ulcers.

Relevance

In United States acute care facilities, more than 2.5 million patients develop pressure ulcers annually, and approximately 60,000 patients die from pressure ulcer complications per year (Harmon, Grobbel, & Palleschi, 2016). High risk populations for the development of pressure injuries are individuals with reduced mobility and physical activity such as older adult, critically ill, and surgical patients. Pressure ulcers are assessed and classified from stage I (mild reddening) to stage IV (tissue loss) to determine the severity of the wound. The development of a stageable pressure ulcer can interfere with a patient’s functional recovery, cause pain and infection (e.g. cellulitis, osteomyelitis, and endocarditis), contribute to increased hospital stays, and result in premature mortality (The Joint Commission, 2016). Therefore, a pressure ulcer acquired during a hospital admission is typically considered an indicator of the quality of care delivered within the healthcare facility.

In addition to negative patient outcomes, hospital acquired pressure ulcers pose a significant financial burden on healthcare facilities resulting from additional treatment and staffing expenses. Since 2008, the Centers for Medicare and Medicaid Services announced that the additional costs incurred for HAPUs will no longer be reimbursed for those patients insured by either Medicare or Medicaid (Bauer, Rock, Nazzal, Jones, & Weikai, 2016). A hospital admission involving a pressure ulcer may incur additional annual charges of up to $700,000. It is estimated that the medical management of pressure ulcers costs the US health system $9.1 billion to $11.6 billion per year (Bauer et al., 2016).

Patient complications and financial implications related to hospital acquired pressure ulcers has resulted in an increased focus for Hospital A on prevention strategies to address this issue.

Potential Outcomes

Hospital A would like to evaluate the effectiveness of implementing a pressure ulcer prevention program (or care bundle). The potential outcome of such efforts is a reduction in the occurrence of HAPUs and ultimately, improvement in the quality and safety of patient care.

Clinical Question (PICO)

“In hospitalized adult patients, what is the effectiveness of a pressure ulcer prevention program (or care bundle) compared to not having a pressure ulcer prevention program on reducing the occurrence of hospital acquired pressure ulcers?”

Section 2