Pressure Ulcer

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Pressure Ulcer Prevention Evidence Based Practice
Tasha Braggs
Chamberlain College of Nursing
NR351 Transitions to professional nursing
Summer 2011

Professional paper

. Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The fundamentals of EBP are in research. Nursing research provides nurses with qualitative research findings to establish nursing practice based on scientific evidence. Researching and utilizing research findings and implementing them in nursing practice provides optimal patient outcomes. The practice of EBP includes multiple steps such as, formulating a well-built question, identifying articles and other evidence-based resources that answer the question, critically appraising the evidence to assess its validity, applying the evidence and re-evaluating the application of evidence and areas for improvement. (Retrieved from http://hsl.lib.umn.edu/learn/ebp/mod01/index.html) At many clinical settings, skin integrity is a critical nursing diagnoses patients and nurses face daily. To increase optimal patient outcomes in regards to skin integrity EBP, researching, creating and implementing new skin care guidelines should be incorporated into daily nursing tasks. Maintaining optimal skin integrity and prevention of pressure ulcers are a challenge to the nursing staff on a surgical floor daily. Many patients have procedures with many surgical incisions and puncture wounds that must heal without complications. This is one responsibility to the nursing staff that is very critical to a positive patient outcome. The European Pressure Ulcer Advisory Panel (EPUAP) defines a pressure ulcer as “an area of localized damage to the skin caused by pressure, shear, friction and/or a combination of these” (EPUAP, 2003). Nurses often see patient populations that consist of elderly people with thin fragile skin. This type of skin impairment can lead to deterioration of the skin quickly to the bedbound patient. Pressure ulcers are a problem and can lead poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43180” ( M. Jackson, et al.,2011) There are many other skin complications as well such as moisture lesions, dehisced wounds and infections. Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients' recovery from illness or injury. (Gardiner L, et al.,2008) Prevention of all of these complications are daily nursing tasks.

The nursing staff utilizes many different methods in prevention of skin breakdown and pressure ulcers. EBP shows that one line of defense used to prevent skin breakdown is appropriate documentation.” Inconsistent documentation or inadequate use of admission, transfer and discharge data have the potential to lead to omissions of assessment, a lack of detection of risks, inappropriate care and/or discontinuities in maintaining healthy skin care. (Gardiner L, et al.,2008) Appropriate documentation and referral to a wound team nurse as well as a photo are the first line of defense clinical nurses can use to initiate the healing process. EBP shows that the Braden Scale was adopted to assess risks to skin integrity in conjunction with the preventative care practices. The Braden Scale assists clinicians with identifying at risk patient population upon the initial assessment of the patient. EBP shows that in some studies “skin integrity risks identified at the time of initial assessment increased from 16.5% to 44.6%.”(Gardiner L, et al.,2008) When risk is identified immediate action is imperative to minimize risk of pressure ulcer development. Once the...
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