Nosocomial Pressure Ulcers in a Nursing Home, Thesis of Business Accounting

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Running Head: Task 1 C C493 Leadership and Professional Image Task 1 Western Governor’s University A1: PROBLEM OR ISSUE The problem is nosocomial pressure ulcers in a nursing home. A1A: EXPLANATION OF PROBLEM OR ISSUE I work as a registered nurse in a nursing home in Queens, NY. In my facility, it was observed that in one unit, there was a surge of nosocomial pressure ulcers. In a course of two weeks, 7 nosocomial pressure ulcers developed. The facility has a policy in place for pressure ulcers-prevention and treatment. This is a policy for patient safety. Development of nosocomial pressure ulcers are bad clinical practice and can invite lawsuits and penalties. Resident safety is compromised and can lead to other issues like dehydration, infection and failure to thrive. Pressure ulcers can not only be costly to the facility but also severely impact a resident’s life as well as prevent the prescriber from giving appropriate care and treatment to the resident (Preventing Pressure Injuries, July, 2016). A2: INVESTIGATION On investigation, it was found that that there was a CNA in one of the assignments who was not turning and positioning the residents every two hours. She was not changing the residents in a timely manner. The residents in that assignment required extensive to total assistance in activities of daily living and are dependent on staff for their daily care. When this care was not

Task 1 provided in a timely manner, they developed pressure injuries. I spoke to the staff members and we all agreed that if staff does not follow the policies, then lapses in care occur and resident care is compromised. A2A: EVIDENCE OF PROBLEM OR ISSUE The quality measures for long term residents for our facility are 10.6% as compared to state average of 9.4% and the national average of 8.1%. Pressure Ulcers are a sentinel event and are a cause of multiple lawsuits and infections in residents (Quality Measures, October 19, 2020). A3: ANALYSIS Policies are effective only when people follow them. In this case, the policy of turning and positioning and check and change was not followed. The pressure ulcers developed due to human error. Errors do happen and we should have safeguards in place to catch these errors as well as a plan to prevent them in the future. A3A: CONTRIBUTORS TO PROBLEM OR ISSUE: Facilities rely on staff members to follow the policies for resident care. People do make errors. The errors are made if staff wants to save time, energy or wanting to rush to finish the work. There are other factors which play a part in causing these errors such as floating staff, difficulty in turning and positioning and higher body weights of the residents. A4: PROPOSED SOLUTION OR INNOVATION A solution to prevent nosocomial pressure ulcers is to have a type of bed that aids in turning and positioning the resident to prevent skin shearing. There should also be an alarm that is connected to a pager that is provided to the CNAs for their patient beds that buzzes every two

Task 1 hours to alert them that the resident’s briefs need to be checked and changed and to turn and position them in the bed. The CNAs must have them signed off on the pager and at the end of the shift the RNs must sign it off as well. The CNAs and the RNs should be continuously educated and in-serviced also about the importance of frequent turning and positioning and check and changing of incontinence briefs. A4A: JUSTIFICATION OF PROPOSED SOLUTION OR INNOVATION A bed that helps with turning and positioning will offload the pressure from the skin. Pressure will be relieved from the pressure points. Alarms will prompt the checking and changing of the briefs of incontinent residents as well as render responsibility to the staff. If the residents are kept clean and dry, this will prevent many moisture associated skin breakdowns. Education and in-services will keep the staff aware of facility policies and procedures to observe. All these measures will help to keep our residents safe and free of nosocomial skin breakdowns. A5: RESOURCES AND COST BENEFIT ANALYSIS Buying special beds for turning and positioning will require approximately 250,000 dollars for the beds, pager alarms, and for training and education and in-services of the staff for frequent check and change as it will require extra staff to be posted in the units. The cost incurred on all this will pay for itself. One must think of the cost in terms of cost in lawsuits, penalties and resident care. A6: TIMELINE The timeline from when it was established that we need a system to help prevent nosocomial pressure ulcers and actual impact of all preventative measures is approximately one year. This one year will be used to educate and in-service the staff for measures to prevent

Task 1 nosocomial pressure injuries. Funds will be allocated to purchase special beds and alarms to facilitate turning and positioning. I would also allow few more weeks to set up the alarm systems. A7: IMPORTANCE OF KEY STAKEHOLDERS OR PARTNERS The staff and the residents are the key stakeholder as they are they are the ones who will utilize the new beds and alarms. Other stakeholders will be the facility administration as they make it possible for us to purchase new beds and the alarm system. Residents and the families are also stakeholders as they are benefitted by the measures taken to reduce nosocomial pressure injuries. A7A ENGAGEMENT WITH KEY STAKEHOLDERS OR PARTNERS I spoke to the staff taking care of the residents. Staff, at times, is frustrated that it takes extra time to turn and position the residents who require extensive to total assistance in ADL care. Some of the residents require two staff assistance to turn and position and check and change the briefs. Each staff member is taking care of multiple residents. After education and in-services, most of the staff members agree that this is a safety net that we require for best clinical practices. Education is very important as it also provides them new ways to take care of the residents. Facility administration was involved with allocating funds for our purchases. A7B: SUCCESS For actual success we need to have, on board, staff who are the key stakeholders. Success for the facility is to have a markedly reduced rate of nosocomial pressure injuries and prevent lawsuits and penalties.

Task 1 A8: IMPLEMENTATION Implementation of all these measures would also require a policy in place. Staff will be trained and in-serviced. Staff will also be trained to use the new beds and alarms. After the staff is trained, there will be a roll out date for implementation of the measures. Staff will continue to be in-serviced every three months and an open line of communication will be maintained. B1: ROLE OF SCIENTIST I was a scientist as I collected, sorted and researched the data. I also conducted interviews with the staff and collected my own data. This data was used to assess the problem, evaluate and find a solution. B2: ROLE OF DETECTIVE I worked as a detective as I investigated the problem and determined the need for change. Policies were developed. B3: ROLE OF MANAGER OF THE HEALING ENVIRONMENT A chance was provided to the unit to grow a culture of safety and policy change. The manager must reinforce the policy change from time to time and also make sure that all staff is participating in the education and implementation of the new policies.

Task 1 References Quality Measures. (2020, October 19). Centers for Medicare and Medicaid Services. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ NursingHomeQualityInits/NHQIQualityMeasures The Joint Commission. (2016, July). Preventing Pressure Injuries. Quick Safety: An Advisory on Safety and Quality Issues. Retrieved from https://www.jointcommission.org/- /media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission- online/quick_safety_issue_25_july_20161pdf.pdf?db=web&hash=A8BF4B1E486A6A DD5210A2F36E