Running head: INCREASING NURSING COMPLIANCE IN PRESSURE ULCER

Increasing Nursing Compliance in Pressure Ulcer Prevention

Abstract

There are certain complications that are arise during treatment of patients while in hospitals or any other types of health centers. However, these complications can be avoided using certain preventive measures. One of the major complications that we are going to cover in this study is development of pressure ulcers. Pressure ulcers in patients can be reduced in many ways one of which is the giving of enough attention to the patients by nurses. They can devout themselves into positioning the patients well after a given duration and as the study indicates, this reduces the number of patients who experience pressure ulcers. From the study however, we learn that although turning of patients is efficient in reducing the number of pressure ulcers cases in patients, more methods should be introduces to be able to curb the problem of pressure ulcers in patients fully.

Introduction

As nurses, our primary responsibility is to advocate for a patient’s safety. Because of this, we are obligated to follow precautionary measures that could mitigate the severity of potential treatment related complications. Although preventative measures are in place, compliance with the said measures is minimal at best. Currently, the most prevalent preventable injury that occurs in the health care setting is the development of pressure ulcers. It is estimated that 1.7 million hospitalized patients develop pressure ulcers with 60% of these occurring in the acute setting (Agostini et al., 2001, para. 6).

The consequences of pressure ulcers affect not only the patient, but also the healthcare system as a whole. Pressure ulcers have a direct impact on the length of stay, cost of care and amount of nursing care provided (Agostini et al., 2001). The prevalence of the development of pressure ulcers within an institution is an indicator in the quality of care provided (Agostini et al., 2001). Because of the fact that the development of pressure ulcers at most times can be prevented, there is a great deal of preventative measures in place.

Specialty mattresses, the Braden scale, and the requirement of regular skin inspection during assessment are all used to reduce the risk of the development of pressure ulcers. While these measures are theoretically beneficial in reducing the development of pressure ulcers, they remain dependent on nursing compliance. Because of this, we proposed to research methods in which we could improve nursing staff compliance. The frequency of changes in the patient’s position made by the nursing staff was a variable that could be effectively manipulated in order to improve patient care.

Method

Purpose

The purpose of this study was to monitor the frequency of repositioning of patients.  The study was completed in three phases to determine whether the education of the nursing staff and friendly reminders would positively affect the frequency that patients were repositioned.

Participants

            Participants were selected based upon recommendations from the physical therapy team at Life Care Hospital.  Thirty participants were selected over a three-week period.  Ten participants were selected each week to be observed by student nurses from the University of Texas Health Science Center at San Antonio (UTHSCSA) Nursing School.  The participants were selected on the ability to reposition self and the type of bed used by the patient.  Only patients who needed help to reposition and those patients using non-specialty beds were considered.  Permission to observe patients was given by the house supervisor at Life Care Hospital.  A handout about pressure ulcer prevention was designed by the student nurses and given to the hospital for compensation.

Procedure

Patients were observed every two hours for an eight-hour period each week for three weeks.  In the first week, phase 1, was used to collect baseline data.  The patients were observed every two hours for eight hours to determine the baseline rate of repositioning.  No interventional methods were introduced.  During the second week, phase 2, a handout about the consequences of pressure ulcers and not turning patients was presented to the nursing staff and posted on bulletin boards throughout the hospital.  The patients were then observed every two hours to determine if education improved the frequency of repositioning patients.  During the third week, phase 3, the nurses were given a friendly, ambiguous reminder every two hours over the intercom to turn their patients.  The nurses were told that the phrase teatime would be announced over the intercom throughout the hospital to remind them to turn their patients.  The patients were then observed every two hours for eight hours to determine if the reminder was beneficial.  The three phases were completed and the data was analyzed.

In an eight-hour period, patients should be repositioned four times.  Observation of a change of position 4 times in an eight-hour period constituted a 100% rate of repositioning.  The mean repositioning rate was calculated for each phase to determine the percentage increase or decrease of repositioning from the baseline data.  The data was then used to further educate the nursing staff about the importance of turning their patients to prevent pressure ulcers.

Results

During the course of phase 1, the nurses were observed taking the proper measurements in initiating position changes for 23% of their patients.  A significant increase of 12% occurred with the distribution of information pamphlets during phase 2.  The results disclosed 35% of patients were turned as necessary within the recommended 2 hours.  After the implementation of Teatime announcements during phase 3, the amount of patients who were turned during phase 2 decreased to 29%.

Conclusion

The results indicate that the pamphlet had the biggest impact on changing the nurses’ behavior.  This is possibly because announcements are not audible inside a patient’s room.  There are other factors, however, that affect skin breakdown besides pressure relief.  Patient nutrition, different materials the patients’ skin is in constant contact with, skin moisture and even positioning techniques among others.  For these reasons, pressure ulcer prevention requires multifaceted interventions that include more than the recommended patient turning in every two hours and it should be delegated to more than just nurses and physical therapy (Blagg, 2009). Recommendations could be institution-mandated documentations separate to that in the chart to be visible inside every patient’s room. Charting should include frequency of positioning and methods and materials used since this too would prevent or cause skin breakdown.

References:

Agostini, J. V., Baker, D. I., & Bogardus Jr., S. T. (2001). Chapter 27: Prevention of pressure ulcers in the older patients (Agency for Healthcare Research and Quality, No. 43). Retrieved from Agency for Healthcare Research and Quality website: http://www.ahrq.gov/clinic/ptsafety/chap27.htm

Blagg, M. K. (2009, November/December). Preventing pressure ulcers: Proper equipment and monitoring can minimize pressure sores. Rehab Management, 20-22. Retrieved from CINAHL Plus with Full Text database.