Pressure Ulcer Prevention Paper
Pressure ulcer prevention is an important clinical issue in the renal unit that causes patients in the hospital setting unnecessary pain and discomfort, an increased risk for infection, and an increased need of resources for treatment. According to the American Journal of Critical Care (AJCC, 2012), hospital admissions are “resulting in annual costs of $11 billion for treatment related to the ulcers.” Another issue that hospitals have come across with the prevalence of pressure ulcers is the responsible party that will pay for the extended hospital stay. According to the Centers for Medicare and Medicaid, “hospitals are no longer reimbursed for care related to stage III and stage IV pressure ulcers that develop during a hospital admission”
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(AJCC, 2012). In the renal floor at Kaweah Delta Health Care District, the percentage of stage two and higher hospital acquired pressure injuries (HAPI) prevalence for the first quarter of 2016 was 0.00 and the percentage of the second quarter of 2016 was of 4.00 (KDHCD, 2016). Kaweah Delta has shown initiative to decrease the prevalence of hospital acquired pressure injuries through thorough skin assessments and pressure ulcer prevention strategies that have been made into policies. However, due to the increase in HAPI on the renal floor, a plan must be developed to study this issue more deeply.
The most current best practice recommendations for pressure ulcer prevention per Agency for Healthcare Research and Quality (AHRQ, 2014) begins through identification and prevention by initiating a thorough head to toe skin assessment upon admission.
Therefore, identification is the most current best practice recommendation. The most common tool used for identifying patients at risk for developing pressure ulcers is the Braden Scale. However, “quantification of the relationship between Braden Scale score and nursing interventions indicates the need for a more comprehensive and fundamental approach” (JAN, 2010). The Braden Scale is divided into six categories: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of 18 or less indicates that the patient is at risk for pressure ulcers. The rationale for these recommendations is that identifying a patient upon admission for being at risk allows the nurse to begin a prevention plan as soon as identified. The nurse needs to implement interventions to prevent the formation of a pressure ulcer. If the practice of identification upon admission is not followed, prevention is delayed and pressure ulcer formation begins. This causes the patient unnecessary pain, increases their risk for infection, and extends the hospital stay. Pressure ulcers are easier to prevent than to
treat.
Kaweah Delta use the most up-to-date Centers of Medicare and Medicaid and Wound, Ostomy, Continence Nurses Society strategies for the prevention and treatment of pressure ulcers. At KDHCD, policy PC.230 is used for prevention and treatment of wounds including pressure ulcers. PC. 230 was originally written on December 03, 2014 and approved in February 24, 2015. This policy can be found in online resources available to nurses through an application named Policy Tech or nursing order sets. Charge nurses are valuable to help locate these policies. These policies are also located in a folder in the Renal Unit nurse’s station. The policy states that a registered nurse must assess the patient for existing pressure ulcers. The registered nurse must use the Braden Scale Risk Assessment Tool upon admission into the hospital and for every shift. The Braden Scale is the same tool used by AHRQ. A score of eighteen or less labels the patient at risk for developing pressure ulcers. Upon finding a pressure ulcer, documentation must be inputted into the patient’s medical record. Photography of the wounds must be taken once noted and a follow up photography must be taken monthly, upon discharge, and if a change is detected. If the patient is considered at risk, a pressure ulcer prevention plan is initiated (KDHCD, 2013).
(AJCC, 2012). In the renal floor at Kaweah Delta Health Care District, the percentage of stage two and higher hospital acquired pressure injuries (HAPI) prevalence for the first quarter of 2016 was 0.00 and the percentage of the second quarter of 2016 was of 4.00 (KDHCD, 2016). Kaweah Delta has shown initiative to decrease the prevalence of hospital acquired pressure injuries through thorough skin assessments and pressure ulcer prevention strategies that have been made into policies. However, due to the increase in HAPI on the renal floor, a plan must be developed to study this issue more deeply.
The most current best practice recommendations for pressure ulcer prevention per Agency for Healthcare Research and Quality (AHRQ, 2014) begins through identification and prevention by initiating a thorough head to toe skin assessment upon admission.
Therefore, identification is the most current best practice recommendation. The most common tool used for identifying patients at risk for developing pressure ulcers is the Braden Scale. However, “quantification of the relationship between Braden Scale score and nursing interventions indicates the need for a more comprehensive and fundamental approach” (JAN, 2010). The Braden Scale is divided into six categories: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of 18 or less indicates that the patient is at risk for pressure ulcers. The rationale for these recommendations is that identifying a patient upon admission for being at risk allows the nurse to begin a prevention plan as soon as identified. The nurse needs to implement interventions to prevent the formation of a pressure ulcer. If the practice of identification upon admission is not followed, prevention is delayed and pressure ulcer formation begins. This causes the patient unnecessary pain, increases their risk for infection, and extends the hospital stay. Pressure ulcers are easier to prevent than to
treat.
Kaweah Delta use the most up-to-date Centers of Medicare and Medicaid and Wound, Ostomy, Continence Nurses Society strategies for the prevention and treatment of pressure ulcers. At KDHCD, policy PC.230 is used for prevention and treatment of wounds including pressure ulcers. PC. 230 was originally written on December 03, 2014 and approved in February 24, 2015. This policy can be found in online resources available to nurses through an application named Policy Tech or nursing order sets. Charge nurses are valuable to help locate these policies. These policies are also located in a folder in the Renal Unit nurse’s station. The policy states that a registered nurse must assess the patient for existing pressure ulcers. The registered nurse must use the Braden Scale Risk Assessment Tool upon admission into the hospital and for every shift. The Braden Scale is the same tool used by AHRQ. A score of eighteen or less labels the patient at risk for developing pressure ulcers. Upon finding a pressure ulcer, documentation must be inputted into the patient’s medical record. Photography of the wounds must be taken once noted and a follow up photography must be taken monthly, upon discharge, and if a change is detected. If the patient is considered at risk, a pressure ulcer prevention plan is initiated (KDHCD, 2013).