Picot Part 3 Project Implementation: Evidence-Based Pressure Ulcer Prevention (Research Paper Sample)

Project Implementation
Name
Institutional Affiliation
PICOT: In the critically ill elderly patient, does nurses’ knowledge of evidence-based recommendations for pressure ulcer prevention affect the incidence and prevalence of pressure ulcers?
Evidence-based Pressure Ulcer Prevention: Project Implementation
Background
Pressure ulcers (PU) are still a major concern to hospitalized patients despite the numerous strategies developed to curb the problem (Barker et al., 2012). In fact, it is regarded among the top five causes of preventable harm to patients (Nuru, Zewdu, Amsalu & Mehretie, 2015). The risk factors of developing pressure ulcers include impaired mobility, old age (≥65 years), and pre-existing severe illness like urogenital disorders, stroke, diabetes, (Demarre et al., 2014). Pressure ulcer development is a complex, multifactorial process because it usually involves more than one of these risk factors (Demarre et al., 2014). Therefore, the critically ill elderly patients are at a very high risk of developing pressure ulcers than any other patient population.
Pressure ulcers cause a preventable burden to the patient, family and health care facilities due to the impact of health care cost, elongated hospital stay, pain and high mortality rates (Bates-Jensen & MacLean, 2007). In the United States the cost of pressure ulcer management is estimated to be over $11 billion annually due to the increasingly high prevalence. More than 2.5 million patients in the US develop pressure ulcers each year (Barker et al., 2012). The prevalence of pressure ulcers in critical care units in the US is approximately 22% (Sen et al., 2009). As a result, various prevention and management strategies have been developed. However, as mentioned in the opening statement, despite these developments, pressure ulcers remain a major threat to hospitalized patients especially the elderly and those who are critically ill (Barker et al., 2012). Research has shown that effective pressure ulcer prevention is multifactorial. Some of the factors impacting effective prevention and management of pressure ulcers include knowledge and attitude towards evidence-based recommendations as well as the actual practice of the ulcer prevention strategies.
Based on these facts, a PICOT question was posed in prior sections of this project to determine the effect of nurses’ knowledge and attitude of pressure ulcer prevention strategies on the incidence and prevalence of pressure ulcers in the critically ill elderly patients. There is sufficient evidence supporting that good knowledge and positive attitude of nurses on the evidence-based pressure ulcer prevention reduces the incidence and prevalence of pressure ulcers.
Using level II evidence studies, the author provided substantial evidence that enhancing nurses’ knowledge and attitudes towards the evidence-based prevention strategies reduces the incidence of pressure ulcers in the critically ill patients. Among the studies supporting this change include Baldelli&Paciella (2008), Campbell et al., (2010), Demarré et al., (2011), Sving et al., (2014) and Gill (2015). Most of these articles involved testing the effect of effective implementation of pressure ulcers prevention strategies on the prevalence of pressure ulcers. Therefore, health care facilities should invest in improving the knowledge and attitude of nurses and other health care professionals on the evidence-based recommendations, especially in the critical ill elderly patients as they are at an increased risk of pressure ulcer development. This paper provides a description of the implementation phase of the PICOT project.
Change Team
The PICOT question specified the major players in the effectual implementation of this project- the nurses. However, team work is a significant element of effective healthcare provision. Therefore, although the critical care nurses are the central players in this project, other members of the health care team will be involved. The hospital management has an important role in the effectual implementation of this project as it’s the major decision maker in change management. While the critical care nurses will be involved in the actual implementation (patient assessment and other interventions) the management that will provide and control the resources required for the implementation.
The other member of the change team is the change agent (Pressure ulcer champions) whose responsibility is to enhance the nurses’ knowledge and attitude towards pressure ulcer prevention as well as monitor the initial stage of implementation. Closely related to change agents’ roles, are the role of the oversight committee which will be involved in ensuring the effective and efficient implementation of the project. The oversight committee should be representative of the diverse professionals in the ICU.
Lastly, another key member of the project implementation is the external auditors. Although this may still be the pressure ulcer champion who will conduct biannual audits after his role in the initial implementation stage is over.
Table 1: Change Implementation Matrix
Objectives

Strategy/Plan

Responsibility

Completion Date

Measurable Outcome

To enhance the Knowledge and Attitude of Nurses on pressure ulcer prevention

Hire professionals (pressure ulcer champions/change agents) who are well-versed with up-to-date guidelines on pressure ulcer prevention.
Appoint an oversight committee to oversee the effective conduction of CMEs. This may include a top critical care nurse (preferably the nursing in-charge, a physician and one of the top level managers).
Conduct CMEs on evidence-based pressure ulcer prevention to critical care nurses and physicians. This includes the conduction of 3-5 educational seminars which will involve a pressure ulcer prevention test and the issuance of certificates to the participants.

The hospital’s top management will be responsible for funding the CME.
The role of the oversight committee is to ensure that every member of the health care team takes part in the CMEs and that the learning process is as effective and efficient as possible.
Change agents will assume the role of educators. They will be the involved in leading and conducting the CMEs.

The CMEs should take about 3-4 weeks.
Thus by 15/12/2015 this phase should be over.

After the seminars, all the nurses will be able to offer descriptions of all aspects pressure ulcer prevention and management as exhibited in the post-seminar tests.
The nurses will show that they are aware of the barriers to effective pressure ulcer prevention and the respective solutions to these barriers by correctly answering questions on pressure ulcer prevention.
The actual CME expenditure will be ≤ to the projected budget.

To ensure that nurses and other health care providers in the ICU implement the correct pressure ulcer prevention and management.

Deploy more nurses to the critical care unit, in case the nurse-patient ratio is below the recommendations. The recommended ratio is 1:1 (Galley &O’Riordan, 2003)
Facilitating collaboration between the pressure ulcer champions and the oversight committee in implementing the new pressure ulcer guidelines.

Hospital management will ensure enough personnel are deployed to the ICU.
The members of the oversight committee will be involved in the active supervision of their respective subjects i.e. nursing in-charge – nurses and physician- to other physicians.
The pressure ulcer champions on the other hand will offer guidance in overcoming barriers to implementation during the initial stage of implementation.
The oversight committee will compile incidence reports.
While the supervision may be covertly ongoing even after the successful uptake of the project, the supervision role of the change agents will be limited to the initial stage of integration.

Depending on the current staffing in the ICU the initial stage of implementation phase should take 2-3 months.
Thus the project should be running effectively by March 2015.

Nurse-patient ratio will be at least 1:1 by the end of the initial stage of implementation.
Nurses will exhibit correct practice of pressure ulcer prevention as evidenced by correctly documented interventions.
Incidence of pressure ulcers will be significantly reduced in the first three months.

To make the evidence-based pressure ulcer prevention the policy in the ICU (Stabilization)

Conduct biannual audits on the quality of care provided.
Quarterly performance appraisal of the ICU health care team.

External auditors will be responsible for the audits.
The oversight committee conduct the performance appraisals.

Continuous process.

There will be proper and consistent documentation of the recommended nursing interventions (All documents will be complete).
The incidence and prevalence of pressure ulcers will be significantly reduced all through the year.
Performance appraisal reports will be available.

TABLE 2: Evaluation Plan Matrix
Measurable Outcomes

Method/Tools for Measuring Outcomes

Responsibility

Timeline

After the seminars, all the nurses will be able to offer descriptions of all aspects pressure ulcer prevention and management as exhibited in the post-seminar tests.
The nurses will show that they are aware of the barriers to effective pressure ulcer prevention and the respective solutions to these barriers by correctly answering questions on pressure ulcer prevention.
The actual CME expenditure will be ≤ to the projected budget.

Post-seminar writing and pr...