Pressure Ulcer Prevention: Evidenced-Based Practice Change

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Table of Contents

Organizational Readiness for Change
Opportunity for Change: Hospital-Acquired Pressure Ulcers (HAPUs)
Evidence-Based Idea for Change
Knowledge Transfer Plan
Dissemination Strategies
Measureable Outcomes
Lessons Learned: Critical Appraisal
Lessons Learned: Evaluation Table
References

Organizational Readiness for Change

Before conceiving an evidence-based practice (EBP) intervention to address a current problem, one has to evaluate the medical organization’s readiness for change. In this project, the framework for the evaluation is borrowed from Vaishnavi and Syresh (2020). Based on the criteria provided by the authors, the organization has culture appreciative of change and an acute awareness of mission and goals. At the same time, personnel is not necessarily aware of the new trends in healthcare as it pertains to preventing hospital-acquired pressure ulcers specifically, hence the room for change. Finally, acquiring the necessary financial resources can also prove problematic in the chosen setting and reduce the organization’s overall readiness for change in this respect.

Opportunity for Change: Hospital-Acquired Pressure Ulcers (HAPUs)

An opportunity for change is the prevalence of hospital-acquired pressure ulcers (HAPUs) in clinical settings. First of all, these are a statistically common complication the percentage of which can reach double figures (Beal & Smith, 2016). Moreover, it demonstrates an increased incidence in older patients due to the thinning of epidermis, thus posing additional risks to a vulnerable population group (Fremmelevholm & Soegaard, 2019). Apart from that, there is currently no specific program for HAPU reduction and prevention in place in the chosen setting. Based on these factors, an EBP intervention designed to reduce the incidence of HAPUs in patients addresses an acute and current problem.

Evidence-Based Idea for Change

The evidence-based idea for change in this respect includes two phases. The first phase should involve a careful literature review and the analysis of EBPs used to reduce HAPU incidence so far. The development of organizational guidelines for the prevention of HAPUs should proceed based on this analysis and the identification of best practices (Beal & Smith, 2016). Second phase should include the establishment of a specialist nurse position and the dissemination of developed guidelines (Fremmelevholm & Soegaard, 2019). A transition to air mattresses as opposed to standard hospital surfaces is also a part of this phase (Shi, Dumville, & Cullum, 2018).

Knowledge Transfer Plan

Knowledge is to be created through the afore-mentioned literature review and EBP analysis. Dissemination of said knowledge should primarily happen through the distribution of the developed HAPU prevention guidelines among the staff (Beal & Smith, 2016). Additionally, a publication in a peer-reviewed journal should cover the intervention results. As for the implementation, it would happen through two primary avenues at the same time. First of all, nurse orientation should cover HAPU prevention, and, secondly, the appointed specialist nurse should act as a consultant in HAPU-related matters (Fremmelevholm & Soegaard, 2019).

Dissemination Strategies

The two main dissemination strategies chosen to distribute the knowledge developed and acquired through the intervention are organizational guidelines and a publication in a peer-reviewed journal. The obvious advantage of organizational guidelines as a strategy is their practice-oriented nature ensuring they would be a concise and straight-to-the-point source of information on the matter. Their applicability in practice is also a crucial advantage in this respect (Beal & Smith, 2016). A publication in a peer-reviewed journal, on the other hand, has the advantage of disseminating knowledge to a larger community of practitioners and help addressing the problem on a greater scale.

Measureable Outcomes

There are four measurable outcomes associated with the proposed EBP change. The first is the overall HAPU prevalence in patients, measured as a percentage to evaluate the effect of the proposed intervention, as used by Fremmelevholm and Soegaard (2019). The second outcome is the prevalence of the most severe 3&4 stage HAPUs, as used in Beal and Smith (2016). The third one is HAPU prevalence in patients using air mattresses. It is meant to be compared to HAPU prevalence in patients using standard hospital surfaces to test the findings of Shi, Dumville, and Cullum (2018).

Lessons Learned: Critical Appraisal

Speaking of the lessons learned from the critical appraisal of the articles studies for this project, two stand out as the most important. First of all, this assignment was a valuable experience for the identification of an inexplicit conceptual framework. It is an important skill because, in certain articles, authors do not explicitly proclaim the theoretical framework used for the study. In such cases, the readers have to deduce this information by themselves (Fremmelevholm & Soegaard, 2019; Beal & Smith, 2016). Another valuable lesson was a better understanding of the network meta-analysis methodology on the example of Shi, Dumville, and Cullum (2018).

Lessons Learned: Evaluation Table

As for the lessons learned from the evaluation table part of the assignment, the first of those was the development of the skill of identifying qualitative or quantitative study design. Articles studied for this assignment were all identified as either qualitative or quantitative, with no mixed-methods studies (Shi, Dumville, & Cullum, 2018; Beal & Smith, 2016; Fremmelevholm & Soegaard, 2019). Among other things, the important lesson learned from the study by Fremmelevholm and Soegaard (2019) specifically was the crucial importable of managerial support for the successful implementation of evidence-based changes in a given clinical setting.

References

Beal. M. E., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence-based practice.Worldviews on Evidence-Based Nursing, 13(2), 112-117. Web.

Fremmelevholmm A., & Soegaard , K. (2019). Pressure ulcer prevention in hospitals: A successful nurse-led clinical quality improvement intervention.British Journal of Nursing, 28(6), S6-S11. Web.

Shi, C., Dumville, J. C., & Cullum, N. (2018). PLOS One, 13(2), e0192707. Web.

Vaishnavi. V., & Syresh, M. (2020). Assessment of healthcare organizational readiness for change: A fuzzy logic approach.Journal of King Saud University – Engineering Sciences, in print. Web.

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