DNP 815 DPI Project Milestone: Outline of 10 Strategic Points
10 Strategic Points Document for a Quality Improvement Project
Ten Strategic Points
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| The 10 Strategic Points | |
| Title of Project | Title of Project Utilizing preventive care bundle to reduce the incidence of pressure ulcers among elderly and debilitated patients. |
| Background Theoretical Foundation Literature Synthesis Practice Change Recommendation
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Background to Chosen Evidence-Based Intervention: In the context of the selected evidence-based intervention, it is crucial to outline the primary considerations across six sections. One key aspect is understanding the background of the practice problem or gap at the project site. Regardless of patient conditions, age, or other factors, the provision of quality care is paramount for all individuals. Nurses, as primary care providers, are tasked with identifying opportunities for quality improvement within practice sites to ensure comprehensive patient care. Notably, pressure ulcers pose a significant threat to patient safety and care quality, leading to increased morbidity and hospitalization (Darvall et al., 2018). Consequently, it becomes imperative for nurses to identify and implement evidence-based interventions to enhance the overall quality of care. While the practicum site relies on routine pressure ulcer prevention, there is a recognition that outcomes can be further improved through the incorporation of creative practices.
Significance of the Practice Problem/Gap at the Project Site: As elucidated earlier, pressure injuries present a substantial risk to patient safety, contributing to heightened morbidity, costs, and increased hospitalization. This not only impacts the functioning of healthcare organizations but also strains patient-provider relationships and diminishes patient trust in care providers. Nurses, assuming the role of change leaders, are tasked with guiding organizations in implementing quality improvement projects to enhance health outcomes. The introduction of a preventive care bundle emerges as a pivotal strategy in reducing the incidence of pressure ulcers, thereby fostering improved care outcomes. Its implementation signifies a concerted effort to bridge the gap between existing and desired health outcomes. Theoretical Foundations: Nursing theories serve as organized knowledge frameworks that delineate the essence of nursing and provide rationale for nursing actions. In this project, Imogene King’s Goal Attainment theory is deemed fitting to guide implementation, with its conceptual framework serving as the foundation for the project’s change model. The fundamental principle of King’s theory revolves around the transactional nature of nursing care, emphasizing that health is achieved through the reciprocal nurse-patient relationship (Butts & Rich, 2021). In the context of this project, alignment between nurse and patient goals and functions is paramount. This necessitates a mutual understanding of needs, objectives, and expected outcomes related to the preventive bundle and associated interventions. Annotated Bibliography: 1. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Darvall et al. (2018) conducted a study evaluating the effects of changing patient turn frequency from 5 hours to 3 hours on pressure injury incidence among critically ill patients. Prolonged immobility was identified as a significant risk factor, and the study found that the change in turn frequency halved the incidence of pressure injuries. 2. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., et al. (2020). Hahnel et al. (2020) assessed the effectiveness of preventive dressings in reducing pressure ulcer incidence among high-risk intensive care unit patients. The intervention group showed a significantly lower incidence compared to the control group, highlighting the importance of appropriate dressings in prevention. 3. Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Lavallée et al. (2019) investigated the effectiveness of a care bundle in preventing pressure ulcers in nursing homes. The study affirmed the potential of the intervention, emphasizing the positive impact of ulcer prevention techniques included in the care bundle. 4. Pickham, D., Berte, N., Pihulic, M., et al. (2018). Pickham et al. (2018) evaluated a wearable patient sensor’s effectiveness in preventing pressure injuries in acutely ill adults. The study demonstrated that optimizing turning practices through the wearable sensor had a significant protective effect against pressure injuries. 5. Yap, T. L., Horn, S. D., Sharkey, P. D., et al. (2021). Yap et al. (2021) investigated the clinical effectiveness of varying repositioning intervals in preventing pressure injuries in nursing home residents. The study found that repositioning intervals of four hours were more effective in reducing pressure injuries compared to shorter intervals. Practice Change Recommendation: Continuous improvement of patient care standards is essential, and quality improvement projects play a pivotal role in achieving positive outcomes. The proposed preventive bundle, surpassing routine pressure ulcer prevention strategies, offers an excellent opportunity to reduce pressure ulcers and overall care costs. This underscores the significance of implementing the preventive bundle as a means to achieve more desirable outcomes. Dont wait until the last minute.Provide your requirements and let our native nursing writers deliver your assignments ASAP. Summary of Findings: The annotated research highlights the advantages of a preventive care bundle in diminishing the incidence of pressure ulcers. Recommended practices encompass changes in turn frequency to enhance mobility, optimized turning practices through wearable sensors, repositioning, skin inspection, and support service checks. Collectively, these studies confirm the effectiveness of a preventive bundle comprising diverse practices in reducing pressure injuries. |
| Problem Statement | Problem Statement: Describe the variables/groups to project in one sentence. The preventive bundle is expected to reduce the incidence of pressure ulcers in the facility but the magnitude of the impact can only be established after implementing the project and analyzing the outcomes. |
| PICOT to Evidence-Based Question | PICOT Question Converts to Evidence-Based Question: In elderly and debilitated patients, will the implementation of a pressure preventive bundle reduce the incidence of pressure injury within 60 days? Evidence-Based Question: Provide the templated statement. To what extent will the implementation of a pressure preventive bundle reduce the incidence of pressure injury among elderly and debilitated patients in the long-term care facility? |
| Sample Setting Location Inclusion and Exclusion Criteria | Sample, Setting, Location Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers). Sample and Sample Size: the sample will contain elderly and debilitated patients with pressure injuries or at risk of pressure injuries. A sample size of 50 participants is reasonable to implement the current project.Setting: The setting for the study is a long-term care facility Location: suburban Maryland CityInclusion Criteria Participants should be patients of sound mind, willing to participate in the study, and not part of another related or unrelated study. Exclusion Criteria Participants unwilling to participate, of unsound mind, or likely to leave the country within the study period will be excluded. Those unable to read and write will be excluded too. |
| Define Variables | Define Variables:Independent Variable (Intervention): application of preventive bundle (preventive interventions)Dependent Variable (Measurable patient outcome): incidence of pressure injuries. |
| Project Design | Project Design: This project applies a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each). Quality Improvement: Quality improvement initiatives focus on improving care. Health care practitioners implement quality improvement projects to standardize processes to improve patient outcomes and reduce variation (CMS.gov, 2021). The initiatives use knowledge from evidence-based research.Research: Research involves the quest for new knowledge. Researchers usually study and test phenomena to prove or disprove hypothesis. The knowledge developed through research is used in quality improvement projects.Summarize: the current project is a quality improvement initiative since its objective is to reduce outcome variations. Patient care outcomes will improve after reducing the incidence of pressure injuries through a preventive care bundle. |
| Purpose Statement | Purpose Statement: Provide the templated statement. The purpose of this quality improvement project is to determine if the implementation of a Care Bundle Intervention would impact pressure ulcer prevention among elderly and debilitated patients in a long-term-care facility. The project will be piloted over an eight-week period in a suburban Maryland city in a long term care facility. |
| Data Collection Approach | Data Collection Approach:Essential patients’ demographics such as age, gender, education level will be collected. Their knowledge of the intervention will also be evaluated. The incidence of pressure ulcers will be measured, and the baseline data will be sourced from electronic health records (EHRs).Data pre- and post-intervention will be collected while primarily focusing on the incidence.Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants. 1. Record patients’ essential demographics. 2. Obtain the baseline data from the EHRs. 3. Measure the incidence of pressure ulcers before and after the intervention and compare outcomes. A reduction of incidence by over 50% will be considered statistically significant. 4. Ensure the data is inaccessible to unauthorized personnel Various potential ethical issues include protection of human subjects, voluntary participation, and privacy. All data will remain confidential and no participant should be coerced for any reason. The project must adhere to ethical principles of beneficence, non-maleficence, and autonomy. It is designed to benefit the patients by improving outcomes and presents no harm. Participants will also be allowed to make independent decisions to avoid biased results. |
| Data Analysis Approach | Data Analysis Approach: Data will be analyzed through comparative data analysis. The difference between the incidence before and after the project will be used to compute the percentage difference. Statistically significant outcome: a reduction by 0.5 Clinically significant outcome- value <0.5 |
| References | CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations. Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & Social Care in the Community, 27(4), e417-e427. https://doi.org/10.1111/hsc.12742 Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19. https://doi.org/10.1016/j.ijnurstu.2017.12.012. Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 |