NRS 493 PICOT Question Paper
Hospital acquired pressure injuries (HAPIs) or ulcers among patients in critical care units are becoming a core patient safety concern because of their increased prevalence and adverse outcomes like lengthened stays leading to higher cost of care. Over 2.5 million patients are affected by HAPIs with close to 60,000 dying each year due to complications and comorbidities associated with them. The healthcare sector spends close to $11 billion annually on the issue (Tilmazer et al., 2020). As such, it is essential to get an evidence based solution and nursing intervention about the issue. The purpose of this paper is to present a PICOT framework for the issue and propose an appropriate evidence-based solution and nursing intervention.
- PICOT Question
PICOT framework is an evidence-based approach to addressing a nursing problem. The acronym stands for;
Population– Hospitalized patients in critical care unit with hospital acquired pressure injuries (HAPI)
Intervention– Care bundle
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Outcome– Reduction of HAPIs by 40%
Among hospitalized patients in critical care unit with hospital acquired pressure injuries (HAPIs) (P), does the implementation of care bundle (I) compared to normal measures (C), reduce HAPIs by 40% (O) within three months (T)?
- PICOT Problem & Evidence-Based Solution
As posited based on evidence and facts from different sources and government agencies, hospital acquired pressure injuries (HAPIs) or ulcers are a major patient safety concern, especially in critical care and progressive care units. These ulcers affect the quality of patient care, increase a nurse’s workload and are expensive for the patients, their families and the healthcare system (Zhang et al., 2021). Pressure ulcers emanate mainly due to the nature of patients in critical care settings, especially their immobility and delicate nature. Patients are at increased risks of HAPIs when there is interruption of blood or death of brain tissue. Others are also at risk of HAPIs due to poor nutrition, poor hydration and poor sensory perceptions.
Having an evidence-based solution would be critical to helping patients and healthcare providers deal with the problem in critical care unit (Coyer et al., 2022). Measures like pressure distribution and repositioning of patients requires nurses to change the patient at least every one to two hours. Pressure distribution using special devices like air mattresses are effective approaches that occur in clinical setting. However, having a care bundle entails an organized set of interventions that encourages compliance based on guidelines and best practices and devices like the Branden scale aimed at improving quality of care (Floyd et al., 2021). The care bundle will entail best practices from exiting literature, especially guidelines and integration of measures tailored to meet patient’s unique needs and improve nurse’s competencies to handle diverse patient concerns and requirements.
At the core of this paper is to develop an evidence-based practice approach led by nurses to address the problem of HAPIs among patients in critical care who have limited to no mobility. The care bundle will entail different well-planned interventions tailored for each patient based on their needs and status. The nurse should have sufficient understanding of the care bundle approach and the areas that they will find appropriate for each patient (Zhang et al., 2021). For instance, pressure redistribution and repositioning may work for certain patient but not others while skin assessment and care, use of pressure-reducing devices and nutrition may be effective in others. Therefore, the nurse must tailor interventions to meet patient needs based on their requirements (Mohamed Mayhobo et al., 2021). These interventions will improve outcomes when compared to patients who are not receiving them as demonstrated by existing evidence. The timeframe required to implement the changes is three months.
Summary of Clinical Problem & Patient Outcome
Hospital acquired pressure injuries (HAPIs) pose a threat to patient safety and quality care provision. The problem also leads to increased cost of care and comorbidities as well as fatalities as over 60,000 deaths associated with it occur each year (Lavallée et al., 2019). The implementation of evidence-based practice interventions led by nurses like the care bundle will enhance patient outcomes. Through this approach, the patients with HAPIs will reduce in the care setting leading to a decline in adverse events and poor outcomes. Again, the proposed approach would increase nurses’ competence and inter-professional collaboration.
A care bundle approach to HAPIs entails an organized set of guidelines and evidence-based practice (EBP) interventions to reduce and prevent pressure ulcers among hospitalized patients. Therefore, the proposed nursing intervention would be appropriate in the selected setting because it will help nurse customize care to meet individual patient needs. The outcome from the initiative would also help reduce overall care costs.
Coyer, F., Cook, J. L., Doubrovsky, A., Campbell, J., Vann, A., McNamara, G., … & Fulbrook,
P. (2022). Implementation and evaluation of multilayered pressure injury prevention strategies in an Australian intensive care unit setting. Australian Critical Care, 35(2), 143-152. https://doi.org/10.1016/j.aucc.2021.03.005
Floyd, N. A., Dominguez-Cancino, K. A., Butler, L. G., Rivera-Lozada, O., Leyva-Moral, J. M.,
& Palmieri, P. A. (2021). The effectiveness of care bundles including the Braden scale for preventing hospital acquired pressure ulcers in older adults hospitalized in ICUs: A Systematic review. The Open Nursing Journal, 15(1): 74-84. DOI: 10.2174/1874434602115010074
Lavallée, J. F., Gray, T. A., Dumville, J. C., & Cullum, N. (2019). Preventing pressure injury in
nursing homes: developing a care bundle using the Behavior Change Wheel. BMJ open, 9(6), e026639. http://dx.doi.org/10.1136/bmjopen-2018-026639
Mohamed-Mayhob, M., & Abdelsalam Amin, M. (2021). Effect of Implementing Care Bundle
on Preventing Pressure Ulcers Development among Immobilized Orthopedic Patients. Egyptian Journal of Health Care, 12(4), 1675-1680. DOI: 10.21608/ejhc.2021.227151
Tilmazer, T., & Tuzer, H. (2019). Pressure ulcer prevention care bundle: A Cross-sectional,
Content Validation Study. Wound Management & Prevention, 65(5):33-39. DOI:10.25270/wmp.2019.5.3339
Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care
bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14: 2435-2442. DOI: https://doi.org/10.2147/RMHP.S292579
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