Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
Problem: Pressure Ulcers
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer development revealed that risk assessments such as the Gosnell Scale, Norton scale, and Braden scale are made available for use by nursing staff at the majority of medical facilities (Lahmann et al., 2010). However, only 10% of nurses actually complete accurate inspections of the skin during their initial physical assessments of the patients (Lahmann et al., 2010). As a result, patients who are at risk of developing pressure ulcers are often overlooked by nursing staff.
Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their...