Health and Nursing Reduction of Bedsores Through Capstone Project

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Health and Nursing

Reduction of bedsores through implementation of Hospital wide turntable

Does the implementation of a hospital-wide turntable team have a positive impact on the reduction of bedsores?

Reduction of Bedsores

A pressure ulcer (PU) or bedsore can be defined as an injury to underlying tissue of the skin that occurs due to pressure or friction. In most cases, the injured tissue sores due to the pressure exerted over a prominent bone. PU has also been defined as areas of necrosis due to tissue compression amid the bony prominence and the extracorporeal surface for a prolonged time period (Gray & Krapfl, 2008). It is therefore apparent from these definitions that exposure to pressure for a lengthy time is the primary cause of bedsores.

To prevent or minimize bedsores therefore, it is imperative upon medical practitioners to put intervention measures in place that will reduce exposure to pressure. The human sensory system is naturally equipped with prompts that enable them reposition automatically from time-to-time to avoid damage to tissues. However, for invalids and even healthy individuals, who are exposed to immobility are prone to PU. These circumstances require the intervention of medical practitioners who can employ a number of preventative measures such as redistribution of pressure, alleviation of factors that contribute to PU such as moisture and poor nutrition, enlightening of patients, reduction of friction, and risk assessment measures. Repositioning patients frequently, however, has been widely accepted as a method of preventing PU (Gray & Krapfl, 2008).

To find out how effective repositioning is to patients, this paper seeks to answer the question; does the implementation of a hospital-wide turn team have a positive impact on reduction of bedsores? A review of five research papers carried out was meant to try to answer this question and find out how frequently the repositioning should be implemented.

Problem statement

Patients who are immobile and/or unable to feel any pain are largely affected by PU in hospitals or at home. It is also common for PUs to be more prevalent in areas with prominent bone presence such as the pelvis, the sacrum and the heels. Therefore, patients who are chair-bound and those who are confined to a side-lying position are most vulnerable to bedsores. There are many costs, emotional and resource implications associated with PUs. For instance, the Australian government uses an estimated $350 million annually for treatment of PUs (Sharp, Burr, Broadbent, Cummins, Casey, Merriman, 2000). In the U.S., the cost of treating PU patient is estimated at $2.2-$3.6 billion annually (Kaitani, Tounaga, Matsui, Sananda, 2010). This amount of money goes a long way to portray just how massive the problem associated with the treatment of PUs is. Moreover, nurses and other medical personnel are expected to deliver quality care services to their patient and may face legal ramifications in case a patient develops a bedsore while in hospital (Sharp et al., 2000). It becomes mandatory for these practitioners to adhere to a strict routine and implement proven measures to prevent occurrences of PUs.

Literature review

A review of five research papers concerning the causes and prevention of bedsores in terms of PICOT (Patient problem, Intervention, Comparison, Outcomes) revealed the following.

i. Patient problem

Patients suffering from PUs (bedsores) are always bedridden and may not be able to reposition themselves or may not have the feeling of pain. Due to this, the supply of oxygen to tissues in close proximity to areas with bone prominence is hampered due to compression. The affected area therefore becomes incapable of healing and this develops into an ulcer. Furthermore, PUs tend to affect the elderly patient more as compared to other patients (Gray & Krapfl, 2008; Vanderwee et al., 2007; Sharp et al., 2000; Kaitani et al., 2010). Usually, the PU's are chronic wounds, which can be referred to as debilitating, and studies reveal that the problem is affecting over 10% of the patients who are hospitalized and the patients who are not hospitalized have the problem too (5%). There numerous risks connected to the problem, including affected functional disability, and has in most cases led to high mortality rates.

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The patients are negatively affected by their psychological and social well-being (Gorecki, et. al., 2009).

ii. Intervention Repositioning was identified as the most appropriate intervention measure to reduce the magnitude of PUs. Regardless of its costly nature, the problem is preventable, if the right measures and strategies are put in place. In the move and urge to curb the negative situations, the agencies of government and the organizations that deal with healthcare have always published outlined guidelines for the PU control measures. This is to be used by the health care organizations to help prevent future related problems. The main focus is the quality improvement (QI) of those already affected, and those yet to suffer from the problem's effects (Soban, Hempel & Munjas, 2011).

iii. Outcomes At the end of the study period of six months, the number of PU occurrences will reduce by half of the current cases. Though the PU's have proven to be a perennial challenge especially in the countries that are still developing, there is hope of curbing the situation, through the application of trained personnel who understand the problem better. The main issue that may hinder the best outcome is the fact of inadequate preventive facilities and measures, which are mandatory to the maintenance of this dreadful problem of PU's (Ikechukwu, et. al, 2012).

Comparisons

Evidently, the frequent repositioning strategy is working out in most cases, and has remained to be the best recommendation when it came to controlling the problem. When repositioning is compared to the other preventive measures, repositioning after every four hours and ensuring the appropriate surface that was pressure redistributed, is efficient, rather than the two hours regime that is frequently given (Krapfl & Gray, 2008).

Methodology

A list of keywords was identified and then searched through electronic libraries (PubMED and EBSCOs). The keywords were pressure ulcer(s), reposition, and turning and a list of 74 research papers was recovered. Further analysis of these papers narrowed it down to five papers that were reviewed independently.

Findings

Although this repositioning was found to be affected by a couple of variables such as the surface upon which the patient is lying (or sitting for chair-bound patient), posture, and the frequency of turning. However, regular repositioning was found to effectively prevent PUs and turning two hourly on a normal hospital mattress and four hourly on visco-elastic mattresses (which are specifically designed to reduce pressure) was sufficient to reduce PU lesions. Further recommendations encouraged that proper posture, such as a supine, semi-Fowler's 30 degrees position also reduced the prevalence of PU occurrences. For lateral position, it also followed that posture at 30 degrees laterally also resulted to the lowest occurrences of PUs. In general, repositioning was found to be most effective with unequal intervals with longer periods being the ones the patient lays on his/her back and shorter periods laterally, for optimum results on reduction of PU occurrences (Gray & Krapfl, 2008; Vanderwee et al.,2007;Sharp et al., Moore & Cowman, 2010; Kaitani et al., 2010).

Recommendations and conclusion

Recommendations based on the findings of this research paper have shown that a hospital-wide turn team will have a positive impact on the reduction of bedsores. This is because, this turn team will be instrumental to ensuring that a stringent system of repositioning patients is incorporated and adopted, since it will avail the required personnel. With better quality of service, the hospital management can be able to avoid any legal or moral issues that may arise as a result of occurrences of bedsores. Moreover, use of visco-elastic mattresses that are designed to reduce pressure will enhance the service of the turn team and also lower on the costs since less time will be spend….....

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