NRS 493 Benchmark – Capstone Project Change Proposal
Nurses have a role to ensure patient safety and quality outcomes in their practice settings and environment. Hospital acquired pressure injuries or ulcer (HAPIs) among patients in critical care settings like the intensive care unit are a critical patient safety concern due to their rising prevalence and negative effects. Evidence shows that over 2.5 million patients are affected by HAPIs with about 60,000 dying each year due to related complications and comorbidities related to them (AHRQ, 2022). Again, the healthcare system spends close to $11 billion each year on HAPIs and their related effects like increased hospital stay and comorbidities (Amirah et al., 2020). Nurses in critical care settings encounter the increased vulnerability of patients who suffer from these injuries and require interventions that are evidence-based to reduce their prevalence and susceptibility in critical care settings (Saunders et al., 2019). Patients suffering from HAPIs require these interventions to improve their quality of life and attain better outcomes from the facilities.
Ensuring that nurses can implement care bundle approach to HAPIs can enhance the quality of life for the patients, reduce their prevalence and lower the associated cost of treatment and prolonged stay in hospitals (Lam et al., 2020). The purpose of this paper is to present a capstone project change proposal aimed at reducing and preventing the occurrence of HAPIs among patients in critical care settings. The paper combines different aspects and sections of the proposed project for effective implementation and evaluation of expected outcome. Implementing a care bundle approach will ensure that nurses have different intervention based on the status of individual patient to reduce their susceptibility to HAPIs. The care bundle model will ensure that nurses have sufficient knowledge about these interventions and use an evidence-based practice approach to integrate them in their practice settings for quality care provision and better patient outcomes.
Background
As observed through existing evidence from literature, hospital acquired pressure injuries (HAPIs) are a critical patient safety concern, particularly in critical and progressive care units. These HAPIs impact the quality of patient care while also increasing nurses’ workload and costs for the healthcare system, families and patients. Pressure injuries or ulcers arise mainly due to the nature of patients in the critical care settings or units, particularly because of reduce mobility, severity of their conditions and delicate nature of their care (Zhang et al., 2020). These patients are at an elevated risk of HAPIs when there is interruption of blood supply to the brain or connected tissues. Risks also increase because of poor nutrition, poor hydration and poor sensory reception and perception.
Developing and implementing an evidence-based intervention or solution would confer benefits to patients and their families, healthcare providers, and the entire health system. Strategies like pressure distribution and repositioning of patients implore nurses to change the patents at least each one to two hours. Again, pressure distribution utilizing special devices like air mattresses are EBP strategies that can improve care and overall outcomes (Amirah et al., 2020). However, the implementation of a care bundle approach entails an organized set of interventions that lead to better compliance based on guidelines and integration of measures that are tailored to meet patient needs and situation. The care bundle approach will consist of best practices tested and proved in different settings and tailored at meeting the unique patient needs and improving the overall competencies among nurses to handle diverse situations. As stated, HAPIs are a safety issue and lead to increased cost of care patients, their families and healthcare system. Therefore, the problem requires interventions that are both nurse-driven and patient-centered to attain quality care outcomes and improve the patient conditions while in critical care settings.
Clinical Problem Statement
Hospital acquired pressure injuries (HAPIs) pose a critical threat to patient safety and quality care provision in critical care settings. The issue also results in increases cost of care and other complications like comorbidities and fatalities, in severe situations. Evidence shows that over 60,000 deaths occurs each year associated with HAPIs (Lavallée et al., 2019). HAPIs lead to increased stay in healthcare facilities which also exposes patients to other infections due to their vulnerability and susceptibility. The implication is that health care facilities and nurses need to implement interventions that will improve clinical outcomes by reducing the adverse effects of HAPIs and ensuring that patients have better conditions as they continue to stay based on their disease prognosis.
Existing studies show that a majority of HAPIs occur in critical care setting that include the intensive care unit, especially the surgical ICUs. Pitman et al. (2019) observe that despite preventive approaches, HAPIs continue to occur, particularly in critical care, raising concerns about if some of these injuries cannot be avoided. Cox et al. (2022) assert that older patients with a mean age of 63.5 years and mostly male have increased risk for getting these injuries. The study notes that the prevalence of HAPIs among critically ill patients is higher compared to other patients with those having diabetes mellitus, mechanical ventilation and vasopressor agents at the highest risk for the condition. Pitman et al. (2019) note that while unavoidable HAPIs can happen. However, in cases where preventive interventions are not identified, documented, and deployed effectively, hospitals and healthcare providers can experience HAPIs. The implication is that as a clinical problem, nurses must deploy the right interventions through care bundle to deal with the issue. HAPIs care bundle offers nurse the relevant knowledge and approaches to help patients mitigate the negative effects of the condition. Nurses require sufficient knowledge on HAPIs to develop right interventions through informed decisions and collaboration with other providers.
