Pressure Ulcers - Term Paper Example

?Pressure Ulcers Hospital acquired conditions What is meant by the term “hospital acquired condition”? A hospital-acquired condition is a condition that the patient may get affected with during the stay in the hospital. Usually hospital acquired conditions are faults arising from improper treatment of the patient and would usually not arise if proper protocols are being followed. According to the CMS, a patient who has a hospital acquired condition cannot be billed for any additional amounts nor can Medicare pay for such additional amounts, for any condition that has been acquired from the hospital (US HHS 2012). 2. Is the condition you selected always preventable? Why or why not? Pressure ulcer or bedsores or debucitus ulcer refers to lesions that are formed on the skin due to several factors such as unrelieved and constant pressure, friction, temperature, application of shearing forces, or using certain medications on the body. It usually develops in areas where bony prominences are present such as on the elbows, knees, sacrum, ankles, etc. The condition can be prevented and treated and documented evidences are present that the condition can be prevented when the patient is being turned every 1 to 2 hours (Mayo 2012). However, in frail and elderly patients the condition is difficult to be prevented as the systemic factors (such as health condition, nutritional status, etc) tend to increase the risk of getting affected with the condition. The National Pressure Ulcer Advisory Panel has classified pressure ulcers into 4, namely stage 1, stage 2, stage 3 and stage 4, based on progression. Stage 1 is a superficial lesion, stage 2 extend to the epidermis and some portion of the dermis, stage 3 involves the full thickness of the skin and some portion of the subcutaneous tissue, and stage 4 extends to even the muscle, cartilage or bone below (NPUAP and EPUAP 2010). 3. How does reducing or preventing this condition indicate quality healthcare practices? The European Pressure Ulcer Advisory Panel and the National Pressure Ulcer Advisory Panel have developed pressure ulcer prevention protocols. These include 5 basic measures:- 1. Repositioning of the wheelchair 2. Repositioning of the bed 3. Skin care 4. Effective hydration of the patient 5. Proper nutrition 6. Other requirements (NPUAP & EPUAP, 2012) This guideline has been made to assist the healthcare provider about the decisions in healthcare mainly to prevent a disorder and improve the quality care. This guideline cannot be utilized in all circumstances and the decision to utilize it would have to be made by the healthcare provider based on the circumstances. The research supporting this guideline is strong. Besides, often there are special populations that need additional precautions and hence effective use of this guideline in healthcare is a quality measure (NPUAP & EPUAP, 2012). Legal implications: 1. What role does communication between the healthcare team and the patient/family play in preventing this condition? For the proper assessment, prevention, management and patient satisfaction, accurate and timely communication between the healthcare providers and the patients or family is vital. It has been found that a positive interpersonal relationship between the family and the providers can have a positive effect on the family satisfaction, acceptance, clinical improvement and collaboration. Direct communication is needed between the caregiver and the client, and special communication may be required to stimulate better quality care, improve outcomes and increase satisfaction. Some of the tools that can be utilized during communication include collaborative meetings, checklists/sheets, tools like SBAR, Pressure ulcer prevention protocols for special communication. Communication is not only required between the healthcare provider and the family, but between the healthcare provider themselves, between the provider and the patient and across care settings (NJHA 2006). 2. Why might a healthcare provider be reluctant to discuss the development of this condition with the patient and family? The main reason why the healthcare provider may not like to discuss the development of this condition is mainly because the patient or the family may blame the development of this condition as an error from the nursing or clinical staff. The lesions do not have a very good appearance. Secondly, following the development of the condition the chances of complications are very high especially with the development of sepsis, cellulitis, bone and joint infections, carcinoma (marjolin’s ulcer), meningitis, etc. Sepsis, cellulitis and meningitis may be life-threatening conditions, and the healthcare provider understands that these are huge risks when developing pressure ulcers (NJHA 2006). 3. What are the potential ramifications of not discussing the development of this condition with the patient and family? Communication, leadership, instituting specific care objectives, having educational programs, identification and advocating changes, promoting support and building communication channels are very much needed in the management of pressure ulcers. The communication should be accurate and consistent. If the communication is ineffective there could be various ramifications including:- Development of complications of pressure ulcers (sepsis, bone/joint infection, cellulitis, meningitis, marjolin’s ulcers), Poor efficacy of treatment High mortality rate from complications of pressure Better institution of preventive guidelines Fewer treatment choices, several of them ineffective Greater resistance from the client to turn and hence prevention may not be enabled (NJHA 2006) 4. How might members of the healthcare team present this information to the patient and family? The communication between the healthcare provider and the family has to be accurate and consistent. The patient and the family should be included in the process of giving treatment towards the pressure ulcers. In all education and explanation sessions the healthcare providers have to include the patient and the family. All concerns need to be emphasized and addressed. The family members and the patient should be given choices and should be able to negotiate with the healthcare system. Since culture and spirituality places an important role with pressure ulcers, cultural, religious, spiritual, and work-based needs have to be addressed (NJHA 2006). 5. What, if any, is the link between disclosure and litigation? If the disclosure of the presence of pressure ulcer is not present, there is a huge chance that the patient would consider that the condition has developed due a compromise in the quality of healthcare provided or negligence from the healthcare provided. Besides, if the disclosure is not made early, there are chances that the complications can develop from which the patient could be affected leading to poor quality in the healthcare. The family or patient can sue the provider for not providing the right quality of care. Besides, there are chances that from the treatment provided for pressure ulcer, the patient may develop further complications (from the treatment provided) which may be a matter of litigation in the courts. Lastly, there are chances that a patient may develop so serious complication and would have to undergo amputation of limb. Due to failure of disclosure of the condition at the right time, the patient may sue the provider (Iyer 2006). Accreditation expectations: 1. The Joint Commission accredits 82% of the hospitals in the United States. (Sollecito & Johnson, 2013, p. 516). The Joint Commission was founded in 1917 and provides accreditation early its history. However, the accreditation was official only since 1956, and in 1965, the federal government decided to consider hospitals that had Joint Commission accreditation to meet the requirements of providing Medicare, the same time around which HFAP also appeared. However, in 2010, the Joint Commission requirements have been removed by the CMS, and the CMS has given the Joint Commission a certain period of time to comply with this. Since 1997, the Joint Commission has been providing international accreditation to several hospitals across the world. Most of the hospitals in the US are inspected by surprise whereas outside the US, the hospitals are given information in advance of the inspection process (Joint Commission, 2008). Compared to other accreditations, the Joint Commission accredits the most number of organizations including 80% of the allopathic hospitals. On the other hand, the HFAP accredits most of the osteopathic hospitals. 2. What expectations does the Joint Commission have with regards to the condition you selected? The Joint Commission strongly aims to achieve a certain quality standard by preventing the development of pressure ulcer – stage 3 and stage 4. Since there is strong evidence that the condition can be prevented by known techniques during nursing care, Joint Commission studies the quality standards provided by the hospital in preventing the development of the disorder in patients. The Joint Commission strongly considers monitoring as a major mean of identifying and preventing the disorder that may be at a risk to develop when the conditions and momentum are changed. Beside, since the ulcers are painful, expensive to treat and cause unnecessary harm, the effort should be on by the hospital to achieve zero morbidity from the condition. Some of the hospitals have separate programs or step-wise processes that take care of pressure ulcer prevention (Joint Commission Resources 2011). 3. How is it assessed by surveyors during an accreditation survey? In the Joint Commission, the surveyors are employed by the company and have immense technical knowledge and know the requirements for fulfillments of accreditation. Many of these surveyors are employed in other hospitals and healthcare organizations. In Ontario Canada a pressure ulcer monitoring system has been developed. The surveyors can perform a risk appraisal, assessment and a chart scan, to identify cases in the system (Joint Commission 2008). Outcomes related to cost and quality: 1. What continuous quality improvement strategies might you use to involve members of the healthcare team in planning and implementing improvements related to this issue? A continuous quality improvement program would be utilized in the hospital so as to prevent the development of pressure ulcers. Some of the measures of this program would include:- Using frequent repositioning of the patient, nutrition, frequent assessment, etc, which are evidence-based methods Having a multifaceted approach so that 100% of all staff can be involved Frequent reminders Using computer system to collect the raw data on pressure ulcers Providing the professionals with feedback on patient outcomes Newsletters and articles on pressure ulcer prevention More resources at the hospital on pressure ulcers (Elliott 2008) 2. Provide examples for each of the following performance improvement levels: localized improvement, organizational learning, process reengineering, and evidence-based medicine. Localized improvement – In the ICU setting, there would be an improvement following incorporation of the pressure ulcer prevention program Organizational learning – Frequent feedback provided to all employees on cases of pressure ulcer on the way that errors were being managed in the past Process reengineering – in the ICU, one healthcare professional (mainly nurse) would be involved in the process of Pressure ulcer prevention and be monitoring patients for the condition, conducting assessments and be performing repositioning and other required measures Evidence-based medicine – Documented cases show that repositioning of the patient on the bed or on the wheelchair along with other measures such as adequate nutrition, skin care, fluid management, etc, can help reduce the incidence and severity of pressure ulcers (Elliott 2008) 3. What role does education, research, collaboration, information technology, leadership, and teamwork play in addressing this issue? Education – Can be used to educate the patient or family and take care to prevent pressure ulcers at home in a patient with chronic illness Research – Identify new methods and process of effectively preventing the disease Collaboration – Collaboration between various healthcare professionals and also with the patient and the family is required for effective prevention IT – Can help to study the raw data that is available on the disease and identify the trends that are existent in the hospital Leadership – Effective nursing leadership is required for any kind of pressure ulcer prevention program, and identification of solving problems concerning patients who develop the disorder Teamwork – The patient, physician, nurse, and other healthcare professionals should work towards constantly monitoring the patient for the disorder and take steps to effectively prevent it (Joint Commission Resources 2011) 4. Of the strategies listed which one do you believe would generate the best outcomes and cost the least to implement? Explain your opinion. There are several strategies to help prevent the development of pressure ulcer. However, the most cost-effective and beneficial one would be the repositioning of the patient every 1 to 2 hour on the wheelchair or the bed. Based on the requirement, one nurse can be assigned to do this task, and she can be provided an effective hourly reminder. The task can be performed on all the patients in the ICU at one time, and for several patients it would not take more than 10 minutes. Such a nurse can effectively be involved in other measures required for pressure ulcer prevention (Joint Commission Resources 2011). Bibliography CMS (2012). Hospital-Acquired Conditions. Retrieved on March 28, 2012, from Web. https://www.cms.gov/hospitalacqcond/06_hospital-acquired_conditions.asp Elliott, R. Et al (2008). ‘Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit’, AJCC 17(4): 328-334. http://ajcc.aacnjournals.org/content/17/4/328.full Iyer, P. W. (2006). Nursing home litigation: investigation and case preparation. Lawyers & Judges Publishing Company, London. http://books.google.co.in/books?id=C3HHpaUNIJIC&dq=disclosure+in+pressure+ulcer+litigation&source=gbs_navlinks_s Joint Commission Resources (2011). Pressure Ulcers (stage III & IV decubitis ulcers). Retrieved on March 28, 2012, from Web. http://www.jcrinc.com/Pressure-Ulcers-stage-III-IV-decubitis-ulcers/ Joint Commission (2008). Common Questions and Answers Regarding JCI Accreditation, Clinical Laboratories, and These Standards, Retrieved from the Web March 28, 2012. http://www.google.co.in/url?sa=t&rct=j&q=common%20questions%20and%20answers%20regarding%20jciaccreditation%2C%20clinical%20laboratories%2C%20and%20these%20standards&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fwww.jointcommissioninternational.org%2Fcommon%2Fpdfs%2Fjcia%2FQuestionsandAnswersCL.pdf&ei=qlguT9yJLcvhrAeGvKTYDA&usg=AFQjCNHso-BfBgcVqozP5sTN3mwADpNtsA Mayo (2012). Pressure Ulcers. Retrieved on March 28, 2012, from Web. http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=prevention NJHA – Sirota, T. (2006). How effective communication among professionals, clients and families facilitates pressure ulcer care. Retrieved on March 28, 2012, from Web. http://www.njha.com/qualityinstitute/pdf/882006105307AM26.pdf NPUAP & EPUAP (2010). Pressure Ulcer Prevention. Retrieved on March 28, 2012, from Web. http://www.npuap.org/Final_Quick_Prevention_for_web_2010.pdf US HHS (2012). Glossary. Retrieved on March 28, 2012, from Web. http://www.hospitalcompare.hhs.gov/staticpages/help/hospital-glossary.aspx?Choice=H&AspxAutoDetectCookieSupport=1 Read More