DNP 820 Benchmark – DPI Project Milestone 10 Strategic Points for the direct practice Improvement Project
DNP 820 Benchmark – DPI Project Milestone 10 Strategic Points for the direct practice Improvement Project
Ten Strategic Points
| The 10 Strategic Points | |
| Title of Project | Title of Project Utilizing preventive care bundle to reduce the incidence of pressure ulcers among elderly and debilitated patients. |
| Background Theoretical Foundation Literature Synthesis Practice Change Recommendation | Background to Chosen Evidence-Based Intervention: List the primary points for six sections. Background of the practice problem/gap at the project site The demand for quality patient care is universal across health care settings. Achieving this goal obligates nurses to identify areas where quality improvement is necessary to improve patient outcomes. Pressure ulcers are a significant health problem since they hamper care quality and safety, extend hospital stays, and increase morbidity and mortality (Darvall et al., 2018; Yap et al., 2021). In response, nurses should address such problems by implementing suitable evidence-based interventions. The current site primarily relies on standard pressure ulcer prevention strategies. Although they are somewhat effective, better interventions are needed to improve health outcomes. Significance of the practice problem/gap at the project site Pressure ulcers are among the common hospital-associated infections. Since they hamper care quality and threaten patient safety, nurses must develop appropriate and sustainable solutions. As change leaders, nurses should guide their workplace settings in implementing quality improvement projects and a similar approach is needed to reduce the incidence of pressure ulcers in the practicum site. As Darvall et al. (2018) noted, preventing pressure ulcers improve patient outcomes by reducing mortality and hospitalization. Similar outcomes will be achieved by implementing the proposed intervention to reduce the gap between the present and the desired health outcomes in the facility. Theoretical Foundations Nursing theories guide health care professionals in delivering patient care and responding to complex situations. Their primary objective is to define what nursing entails. A suitable theory for the current DPI project is Imogene King’s Goal Attainment theory. According to Butts and Rich (2021), health goals under King’s theory are achieved through transactional care. In such a care process, the nurse and patient identify the health problem together, set mutual goals, and develop mechanisms to achieve the goals. A similar approach would facilitate the effective implementation of the pressure ulcers preventive bundle. The change model appropriate for the project is Kurt Lewin’s change theory, which outlines practice change as a methodical process. Lewin described the change process as phased and achieved through three stages: unfreezing, change, and refreezing (Saleem et al., 2019). Unfreezing entails preparing people for change, while the change process entails implementing the intervention. Refreezing is primarily about solidifying the change to make it sustainable (Saleem et al., 2019). Similarly, the implementation site and patients should be prepared for the change. Appropriate mechanisms should also be implemented to solidify the change to achieve long-term benefits. Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 While repositioning patients, health care professionals should optimize turns to achieve better outcomes. In response, Renganathan et al. (2019) assessed the beneficial outcomes of improving turn compliance in patients highly susceptible to pressure ulcers. In this prospective, multiphase, multicenter trial, Renganathan et al. (2019) optimized patient turns using a monitoring system that automated alerts in the intervention group. The primary finding was a lower incidence of pressure ulcers in the intervention group than in the control group (p < 0.001). The article supports the DPI intervention by underlining the importance of patient turns and demonstrating how they can be optimized. Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 In this study, Hassan et al. (2020) assessed the effectiveness of body repositioning in reducing pressure ulcer incidence. Through a quasi-experimental approach, Hassan et al. (2020) subjected all immobilized patients in a public hospital in Pakistan to a 2-hourly repositioning and recorded the incidence of pressure injuries. The main finding was a reduced incidence of pressure injuries after implementing the project. The article supports the DPI intervention by confirming the effectiveness of repositioning in reducing the incidence of pressure ulcers in critical care settings. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Protective dressings are a vital component of a preventive care bundle for pressure ulcers. In response, Hahnel et al. (2020) conducted a randomized controlled trial to evaluate the effectiveness of appropriate dressing in reducing pressure ulcers. In the intervention group, areas susceptible to pressure ulcers such as the sacrum and the heels were covered using protective dressing. Patients in the control group received standard care only. Hahnel et al. (2020) confirmed the effectiveness of protective dressings by finding that pressure ulcers were lower in the intervention group (2.8%) than in the control group (10.5%). The study underlines the importance of protective dressings as a component of a preventive care bundle for reducing pressure ulcers. Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 In this quasi-experimental pre-and-post intervention, Zhang et al. (2021) assessed the effectiveness of a pressure injury care bundle in reducing the incidence of pressure injuries in ICUs. Essential components include skin care, repositioning, and continuous risk assessment. The primary finding was a reduction in pressure injury incidence from 13.86% to 10.41%. These findings confirm the beneficial effects of a preventive care bundle in reducing the incidence of pressure injuries, as conjectured in the DPI intervention. Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 The purpose of this study was to evaluate the effectiveness of preventive dressings. Santamaria et al. (2018) conducted a randomized controlled trial where the intervention group (n= 138) received protective dressings (multi-layer silicone foam) besides standard care applied to the control group. The primary finding was a higher pressure ulcer incidence in the control group than intervention group (p = 0.004). The study supports the DPI intervention by confirming the importance of protective dressing as a protective care bundle component. . Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention Nurses have a professional mandate to improve patient care standards in health care facilities. Practice change through implementing quality improvement projects is instrumental in improving patient care outcomes. Similarly, the preventive care bundle for pressure ulcers will improve care standards in the practicum site by reducing the incidence of pressure ulcers. Therefore, it is an excellent opportunity for producing more desirable health outcomes than the current practices Summary of the findings written in this section. As a significant problem in critical care settings, the incidence of pressure ulcers can be reduced through a preventive care bundle. The annotated research stresses the need for a multicomponent care bundle for reducing the incidence of pressure ulcers in the practicum site. Recommended practices include repositioning, evidence-based skin care routine and protective dressings. Technology can be used to automate alerts to optimize patient turns and compliance during repositioning. The inference is that the care bundle should include different practices, and the explored research confirms such an approach effective in reducing the incidence of pressure ulcers. |
| Problem Statement | Problem Statement: It is not known if the implementation of pressure preventive bundle would impact pressure injury among the elderly and debilitated patients. |
| PICOT to Evidence-Based Question | PICOT Question Converts to Evidence-Based Question: In elderly and debilitated patients, will the implementation of a pressure preventive bundle reduce the incidence of pressure injury within 60 days? Evidence-Based Question: Provide the templated statement. To what extent will the implementation of a pressure preventive bundle reduce the incidence of pressure injury among elderly and debilitated patients in the long-term care facility? |
| Sample Setting Location Inclusion and Exclusion Criteria | Sample, Setting, Location Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers). Sample and Sample Size: The target group is elderly and debilitated patients with pressure ulcers or at risk of their development. It is expected that 50 patients will participate and provide a reasonable sample for the DPI intervention.Setting: The setting for the study is a long-term care facility Location: suburban Maryland CityInclusion Criteria All participants should be of sound mind. Since informed consent is critical in studies involving humans, only the patients willing to participate will be included. Importantly, they should not be participating in another study. Exclusion Criteria Illiterate patients and those not meeting the inclusion criteria described above will be excluded. Besides, patients likely to leave the country during the study will also be excluded. |
| Define Variables | Define Variables:Independent Variable (Intervention): application of preventive care bundle for pressure ulcers (preventive interventions)Dependent Variable (Measurable patient outcome): incidence of pressure ulcers. |
| Project Design | Project Design: This project applies a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each). Quality Improvement: Quality improvement typifies the continuous strive for better health care processes and outcomes. As a result, health care professionals engaging in quality improvement seek to standardize processes to achieve better health outcomes by reducing variations (CMS.gov, 2021). In health practice, quality improvement is achieved by implementing evidence-based research.Research: Research is primarily about developing new knowledge for practice use. Generally, researchers concentrate on studying and testing phenomena to prove or disprove different hypotheses. The knowledge developed through research is the foundation of evidence-based practice. Clinicians implement such knowledge to improve health outcomes.Summarize: The current project characterizes quality improvement. The initiative seeks to reduce health variations by reducing the incidence of pressure ulcers in the long-term care facility. Findings from previous research will be implemented to improve care quality. |
| Purpose Statement | Purpose Statement: Provide the templated statement. The purpose of this quality improvement project is to determine if the implementation of a Care Bundle Intervention would impact pressure ulcer prevention among elderly and debilitated patients in a long-term-care facility. The project will be piloted over an eight-week period in a suburban Maryland city in a long term care facility. |
| Data Collection Approach | Data Collection Approach:Vital patients’ demographics like age, education level, and gender will be collected. Patients’ understanding of the pressure care bundle will also be assessed.Baseline data on the incidence of pressure ulcers in the facility will be obtained from the electronic health records (EHRs).Pre- and post-intervention data related to the incidence of pressure ulcers will be collected.Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.Record the subjects’ vital demographics such as age and genderRetrieve baseline information from the electronic health recordsMeasure pre- and post-intervention incidence to compare outcomesMake the necessary inferences from the findings: a reduction of the pressure ulcers incidence by over 50% will be considered statistically significantSecure data from unauthorized access Potential ethical issues involving human subjects include their protection, informed consent to promote voluntary participation, and data privacy will be observed. All data will be treated as confidential and used primarily for the DPI intervention’s purposes.The project must adhere to ethical principles of beneficence, non-maleficence (no harm), and autonomy. It is designed to benefit the patients by improving health outcomes and presents no harm whatsoever. Human subjects will also be allowed to make independent decisions to avoid biased results. |
| Data Analysis Approach | Data Analysis Approach: Data will be analyzed through comparative data analysis. The difference between the incidence of pressure ulcers before and after the project implementation will be used to compute the percentage difference. Statistically significant outcome: a reduction of pressure ulcer incidence by 0.5 (50%) Clinically significant outcome- value above 10% reduction in pressure ulcer incidence. |
| References | CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations. Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 Saleem, S., Sehar, S., Afzal, M., Jamil, A., & Gilani, S. A. (2019). Accreditation: Application of Kurt Lewin’s Theory on Private Health Care Organizationanl Change. Saudi Journal of Nursing and Health Care, 2(12), 412-415. doi: 10.36348/sjnhc.2019.v02i12.003 Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.or |
