Quality Improvement Project: Pressure Ulcers in Healthcare Facilities

Quality Improvement Project: Pressure Ulcers in Healthcare Facilities
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Abstract
One of the pressing issues in healthcare is the development of pressure ulcers, especially among those confined in healthcare facilities, because it results in significant mortality and morbidity. International organizations exerted effort to reduce its incidence throughout time, and their strategies were effective, especially those with only stage 1 or 2 (superficial) pressure ulcers. However, a status quo was demonstrated in patients with either stage 3 or 4 pressure ulcers. Since this affects the individual patient and affects the healthcare workers, their families, the economy, and the general public, strategies must be continuously employed. Prevention strategies are on top of the treatment regimen, including skincare, nutrition, patient education, and frequent reassessments. Moreover, the provision of medical devices, materials, and medications should be given to reduce its incidence continuously, especially among those with stage 3 or 4 pressure ulcers.
The Clinical Issue
Pressure ulcers develop due to repeated shear forces or friction that result in localized wear and tear of the skin area in contact with the specific surface. Typically, this can be found over a bony prominence, and the risk of acquiring it increases with old age (greater than 65 years old, immobility, poor nutrition, increased moisture, and other comorbidities. The risk factors related to old age are decreased sensation and cognitive impairment (Al Mutair, 2020; Stadnyk et al., 2018).
It commonly affects the sacrum and heel, primarily when confined to a healthcare facility or a hospital. Its pathophysiology lies with capillary occlusion related to the increased pressure exerted perpendicular to the bony prominence, leading to the lack of blood supply, eventually resulting in tissue necrosis. The shear force is often parallel to the skin, resulting in half the direct pressure caused by stresses over the bony prominences (Al Mutair, 2020).
Frequently, pressure ulcers can be developed in healthcare facilities, such as hospitals, long-term care facilities, and acute care facilities. According to the International Pressure Ulcer Prevalence (IPUP) survey, its overall prevalence in the United States reduced by 4.2% (from 13.5% to 9.3%) between 2006 and 2015, while those developing in the facilities decreased from 3.1 to 3.4%. The study has also shown that the disease has a varying differences when it comes to its stages. Stage 1 or 2 or the superficial pressure ulcers) demonstrated diminished prevalence between 2011 and 2015 from 3.7% to 2.9%. Conversely, stage 3 or 4 or (full-thickness pressure ulcers) deep-tissue and unstageable, respectively, did not have a change in prevalence and were deemed constant from 0.9% to 1.2%, respectively, between 2011 and 2016 (Kayser et al., 2018).
The Need to Change the Status Quo
The disease presents with a global impact not just for the patients but for the other stakeholders. The patients suffer from its consequences secondary to its negative impact on one’s physical, psychological, and social well-being and the overall quality of life. This is because pr...