Pressure ulcers are a global medical issue with complex and very many causes. Patients who are very ill, pressure ulcers are a huge threat because they are vulnerable. Despite the major advances made in using technology in medicine and the use of prevention programs that are evidence-based, the prevalence of pressure ulcers in patients who are very ill, has risen to a great extent. Most patients under ICUs, have higher risks of suffering from pressure ulcers because they are exposed to prolonged bed rests, and special medications, they are also treated with mechanical ventilation, and their consciousness is also altered (Gardiner, 2014). The initial steps to countering HAPUs is through the determination of populations of patients under high risk. Risk assessment scales have been used traditionally to predict the level of risk and also to screen patients at higher risks of contacting PUs. Braden scale has been used mostly in the risk assessment scale determination. Braden scale has six subscales which include mobility, the activity of moisture, nutrition, the perception of senses, shear and friction. The sensitivity of the Braden scale is very high, but it has lower specificity in the determination of risks for Pressure Ulcers for patients in ICUs. The assessment of risks should involve biochemical indexes to improve the capacity of predicting PUs in patients under intensive care units. Association of variables with possible outcomes can also be discovered by using a decision tree that uses automated and artificial intelligence to process data analytically. This model can easily facilitate the discovery of factors that cause diseases. Some rules can be generated using the tree model to guide decision making in clinics.
Southern California CSU DNP Consortium
Hospital-acquired ulcers are one of the major issues when it comes to healthcare. HAPUs was identified by the Center for Medicare and Medicaid services as an event that should not arise to patients while in hospital. The spinally injured individuals, have the highest risk for contacting PUs. The rates of HAPUs and also PUs have risen over the past few years. Therefore, there is the need to improve PU incidences by the implementation of the skin bundle QI project that is based on evidence and practices. The skin bundle quality improvement involves the provision of alternative skin care products, using a revised scale for Braden risk assessment and also using the tool for cause analysis in HAPU (Frumenti, 2014). The Braden Scale analysis for risk assessment has been adopted widely, and it has affirmed its ability as a reliable tool for identification of risks developed by PU. Two theories can be used in the facilitation of the quality improvement of the skin bundle initiative; the two includes Lewin's change theory and the PSDA model. The plan-do and study and act model guide the evaluation and implementation process of QI whereas the Lewin's change model initiates the promotion of behavioral change amongst the nursing staff. PUs often leads to sepsis, infections and other alarming complications. (Frumenti et.al 2014)
There are three stages of PUs which include stages I to IV, the unstageable and finally the sDTI stage. The PU is very challenging for hospital nurses because most of them are only familiar with stages I to stage IV. The individuals administering health care should begin by evaluating the extent to which the tissues are damaged as mistakes could lead to worsening of the patients situations. The QI project is effective as it leads to a drastic reduction in the number of patients with HAPUs by successfully creating awareness to staff.
Gardiner, J. C., Reed, P. L., Bonner, J. D., Haggerty, D. K., & Hale, D. G. (2014). Incidence of hospital-acquired pressure ulcers - a population-based cohort study. International Wound Journal, 13(5), 809-820. doi:10.1111/iwj.12386
Frumenti, J. M., & Kurtz, A. (2014). Addressing Hospital-Acquired Pressure Ulcers. JONA: The Journal of Nursing Administration, 44(1), 30-36. doi:10.1097/nna.0000000000000018
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