Pressure Ulcers
According to Frankel & Benett (2000), a hospital acquired condition (HAC) is a detrimental condition or situation that influence a patient, which occur during a reside in a medical facility or hospital. A pressure ulcer refers to area of contained damage to the underlying tissues and skin, which is caused by shear, friction and pressure and or a mixture of these. The vital determinants of pressure ulcer growth are the duration and intensity of pressure and the lenience for pressure of the outer skin as well as it is underneath structures.
Pressure ulcers are avoidable or preventable with high-quality essential nursing care, with nothing unusual, only natural old fashioned vital nursing care. Nevertheless, nurses and nurse supporters have restrictions as to the quantity of patients they can appropriately care for at all given time. Company failure to offer adequate nurses and nurse helpers, or short recruitment, is responsible for the sudden increase in the figure of pressure ulcers, in hospitals, and nursing homes.
However, not all pressure ulcers are avoidable, at least in enduring care settings. Continuing care facilities ought to make sure that an occupant who goes into the facility with no pressure sore cannot build up pressure sores, except when the person’s clinical situation demonstrates that they were expected. Unavoidability means that the occupant begin developing a pressure ulcer even if the facility has assessed the inhabitant’s clinical situation as well as pressure ulcer threat factors; implemented and defined intrusions that are constant with occupant goals, needs, and acknowledged standards of performance; scrutinized and assessed the impact of intrusions, and amended the approaches as suitable. It is insensible to state that a pressure ulcer is preventable in one place and inevitable in a different site. In hospitals for instance, patients are more severely sick. At lowest, it is a conflicting open policy.
Several older individuals in nursing hospitals are vulnerable to the development of pressure ulcers. Via cautious recognition of prompt interventions and risk factors, evaluation and care planning, pressure, ulcers can frequently be prevented. Pressure injury is frequent in many hospital settings in Europe, and it influences every age group (Lyer 2006). According to Lyer (2006), it is expensive in terms of individual distress and utilization of resources.
With a growing population, and modifications in patterns of illness, troubles will raise unless precautionary action is used. The jeopardy of pressure damage ought to be recognized in every care setting. It is supposed that the majority of pressure ulcers can be avoided; even though there exists debate concerning whether a marginal of ulcers are unavoidable. According to Lyer (2006), pressure ulcers are 95% avoidable. According to him, (2001) nurses are vital to the endorsement of high-quality practice. Eliminating the factors causing their happening can avoid pressure. Furthermore, Pressure ulcers are debilitating, painful, and probably serious result of a malfunction to give adequate medical or nursing care.
The neglect of elder people has been offered a high open profile in current years, driven in part by the 1993 opening of the aid action on old people exploitation. Here is a rising apprehension about the care quality for susceptible older people. The midwifery and nursing council guard the community by making sure that midwives and nurses give high care quality for their clients and patients and clients. It places standards for learning and practice, gives advice for midwives and nurses and deems claims of misbehavior. It has printed a variety of papers on guidance and standards and for nurses incorporating the principles of performance, conduct, and morals which affirms that nurses have a liability to guard customers against all sorts of abuse. Avoidance consists of a jeopardy evaluation and making sure that the patient is relocated according to a personal program.
Two hours are the conventional utmost time that tissue can stand the pressure with no damage. Protracted sensory deficit, immobilization, circulatory turbulence and poor diet are recognized as vital risk factors. Pressure ulcers that was once out looked as an unavoidable result of being sick and bed ridden is of late viewed much more as a sign of the care quality provided, and is accordingly high on the health program and political programs.
Patients and their families of late are set to protest or take lawful act for the damage that is caused and any suffering and pain experienced as a result of pressure ulceration. Of late, nurses have been held responsible for pressure ulcers.
Litigation is the practice of lawful actions and entails the law of medical carelessness. Numerous of the cases that have been reported to courts have pointed out poor care standards concerning pressure ulcer avoidance. Conventionally, the only punishments for acute treatment as well as pressure ulcer growth have been public claims against hospitals and nursing homes.
Of late, government organizations in the USA have turned out to be extremely keen on this matter. The Law explains that ignorance should never be an excuse, and doctors and nurses are under a legal obligation to keep logically up to date information in their knowledge as a basic part of their lawful obligation of treatment to their patients.
A doctor or nurse could be careless if a patient is injured because of unawareness of well recognized and accepted medical and nursing research findings. This incorporates ways of safeguarding the sick from pressure ulcer growth.
The accountability of avoiding pressure ulcers goes to every member of the healthcare panel, the sick and their families (Nollan & Schall 2007). According to Nollan & Schall (2007), patient based technique to proof based education is required. Suitable strategies ought to be customized for the pressure ulcer type. Patients and families should be educated on the sources of safe cleaning methods, pressure ulcers, good frequency and positioning, good utilization of assistive devices and the importance of diet in wound healing. The team of the healthcare ought to receive consistent education concerning skin evaluation, recognition of risk issues, and right use of the jeopardy evaluation tool, pressure ulcer enactment and good positioning. Everybody ought to be doing a similar thing. As vital as it is to modify learning to meet the requirements of patients, it is evenly vital to modify learning for employees based on their learning, skills and responsibility in pressure ulcer avoidance. To enhance proficiency with avoidance, a yearly review is recommended, recognizing skin avoidance champions on all elements and making a skin board with meetings held monthly.
Pressure ulcers are avoidable or preventable with high-quality essential nursing care, with nothing unusual, only pure old fashioned vital nursing care. The accountability of avoiding pressure ulcers goes to every member of the healthcare panel, the sick and their families. However, not all pressure ulcers are avoidable, at least in enduring care settings. Continuing care facilities ought to make sure that an occupant who goes into the facility with no pressure sore cannot build up pressure sores, except when the person’s clinical situation demonstrates that they were expected. It is evenly vital to modify learning for employees based on their learning, skills and responsibility in pressure ulcer avoidance. To enhance proficiency with avoidance, a yearly review is recommended, recognizing skin avoidance champions on all elements and making a skin board with meetings held monthly.
Pressure ulcers are skin and/or tissue injuries usually occurring at bone prominence, caused by pressure and a combination with friction. They are also called bed sores or decubitus ulcers. Pressure ulcers are common with long term care patients. They can also occur on people nursed in homes or those who stay in one place for an extended period of time. When the constant pressure is not relieved, the skin and underlying tissue are irritated eventually forming an ulcer. Pressure ulcers make up some of the most threatening conditions to patient safety. They occur in three stages. If not addressed, deep tissue injuries could occur, giving way to other infections. In patient care, a preventative approach should be taken when dealing with pressure ulcers (Duncan, 2007). Otherwise, a healthcare facility could have a significant number of its patients suffering from pressure ulcers.
The joint commission accredits almost 85 percent of the healthcare facilities in the US. Therefore, it is an authoritative entity within the healthcare industry. As mentioned above, the most preferred approach to addressing pressure ulcers is preventative measures. The joint commission expects the hospitals is accredits to have sufficient methods and knowledgeable personnel to prevent or treat pressure ulcers where they occur. The accreditation body puts this as a condition and surveys the records of preventative and treatment aspects of the hospital. The body provides information and recommendation on how to approach the issue of pressure ulcers. Hospitals which get accredited are expected to have reached a certain level of preparation in order to be accredited. This quality is surveyed among others in the accreditation survey.
According to the Joint Commission, pressure ulcers have continued to be significant shortcomings of long term patient care. The entity states that long term healthcare facilities need to be accessed and reassessed periodically to ensure that the risk of patients developing pressure ulcers is kept low and that preventative measures are implemented according to current standards. The Joint Commission issues current conditions for accreditation occasionally. In these occasional requirements, current standards are demanded. That is, the document outlines current measures of patient care that address the predominant problems identified by the body within the healthcare industry. These requirements are meant to be implemented for institutions to be accredited.
Assessment of patient care safety is carried out in ascribed health institutions periodically. Periodic checkups ensure that no hospital falls behind or neglects to implement the patient care guidelines. The occurrence of pressure ulcers is one of the elements of the patient safety assessment. This is usually undertaken on long term care facilities, where patients are likely to stay for an extended period of time. Pressure ulcers are a threat to patient safety. Therefore, for any healthcare facility to gain accreditation there is a need for the organization to meet conditions of preventing and addressing the problem. Assessment of a hospital in regard to pressure ulcers takes about six steps. These steps evaluate the hospital as well as educate the personnel on the proper approach to treating pressure ulcers (The Joint Commission, 2011).
The first step in the evaluation involves creating a plan on how to identify the risk of and prevention of pressure ulcers. The evaluation team comes up with a plan that outlines how the evaluation should proceed. This plan is essential as it guides the rest of the process. The plan outlines the methods used to identify the risk level of patients acquiring pressure ulcers. It also states what preventative measures to look for in the healthcare institution being surveyed.
The second step involves initially assessing the patients at admission, identifying in the process, the residents with the highest risk of acquiring pressure ulcers. Initial assessment assists the surveyors to narrow down their survey. When the patients at the highest risk are identified, the survey concentrates on them. This saves time and ensures the focus of the survey on pressure ulcers and their prevention.
A systemic risk assessment for decubitus ulcers is conducted in the third step. This steps seeks to assess the risk factor further using valid risk review methods. The validity of these methods is essential, since it allows a constant means of evaluation. Common methods used include the Norton Scale and the Braden Scale.
The fourth step involves reassessing the risk of pressure ulcers at intervals that are set by the organization. This step ensures that complete information concerning the healthcare facility on pressure ulcers is collected for analysis. This is the last step of the evaluation.
The fifth step involves steps actions for addressing the risks identified in the survey. The guideline suggests that appropriate actions be taken to prevent injury to patients through maintenance and improvement of preventative measures and protection against external mechanical forces.
The sixth step in the assessment done by the Joint Commission involves education of staff on identifying risks for and prevention of pressure ulcers. This step is essential in improving long term patient care in the health facility.
Prevention of pressure ulcers is an essential part of patient care. Each healthcare organization is required to have measures that guarantee the patients’ safety. Quality improvement in patient care should alleviate the problems associated with pressure ulcers. The organization should use strategies that eliminate or reduce pressure ulcer risks. For instance, patients with the highest risk for pressure ulcers should be constantly moved and their skin should be periodically checked for pressure ulcers. This strategy could reduce the cases of pressure ulcers in a healthcare organization. The use of new technology and high quality bedding materials should also reduce the pressure ulcer cases. In health institutions with nurse shortages, the hospital should incorporate the help of the relatives to ensure safe movement of the patient.
Performance improvement at the localized level is essential in patient care. For instance, an improvement in each patient’s care in terms of checking for ulcers and movement would impact on the overall rate. Organizational learning ensures that the staff of the healthcare facility is aware of modern methods of treatment and prevention of pressure ulcers. Changing the process followed in respect to pressure ulcers can highly alter the prevention of pressure ulcers within the organization. The incorporation of medical practices that have been evidentially proven would ensure that the hospital carries out safe and proven practices in addressing the problem of pressure ulcers (Harrison, Mackey & Friedberg, 2008 ).
Addressing pressure ulcers in a health organization requires the incorporation of information technology, education, research, leadership, teamwork and collaboration. Patient care requires the medical staff to use resources availed by these elements to improve the pressure ulcers prevention in the health organization.
The best strategy to implement in terms of quality and cost would be the preventative approach. Prevention ensures that the patients in the healthcare facility are not subjected to the treatment of effects of pressure ulcers. These patients are concerned with their various ailments, and should not be subjected to other ailments acquired at the hospital.
References
Frankel, H. and Benett, P. (2010). Bedside procedures for the intensivist. New York: Springer
Lyer, P. (2006). Nursing home litigation: Investigation and case preparation. New York: Lawyers & Judges Publishing Company,
Nollan, K. and Schall. M. (2007). Spreading improvement across your health care organization. New York: Joint Commission Resources.
Duncan, K. D. (2007 ). Preventing Pressure Ulcers: The Goal Is Zero. Joint Commission Journal on Quality and Patient Safety, Volume 33, Number 10, October 2007 , 605-610.
Harrison, M. B., Mackey, M. and Friedberg, E. (2008 ). Pressure Ulcer Monitoring: A Process of Evidence-Based Practice, Quality, and Research. Joint Commission Journal on Quality and Patient Safety, Volume 34, Number 6, June 2008 , 355-359.
The Joint Commission. (2011). National Patient Safety Goals Effective January 1, 2012. Long Term Accreditation Program: The Joint Commission.
