The Flower of Services for Gleneagles Hospital Essay

The Flower of Services for Gleneagles Hospital Essay.

Gleneagles hospital Kuala Lumpur provides clear information about direction to service site on the websites. The address of Gleneagles hospital Kuala Lumpur is No 282 & 286 Jalan Ampang, 50450 Kuala Lumpur. Gleneagles hospital describes the location of the hospital where is located on Embassy Row on the main Jalan Ampang, Kuala Lumpur. The hospital location is central and easily accessible by the inner ring roads of Jalan Tun Razak and Jalan Ampang; the MRR (middle ring road) and AKLEH (Ampang-Kuala Lumpur Elevated Highway) by cars taxis or buses.

Gleneagles Kuala Lumpur is near to Jelatek stop of Putra LRT station, it take less than 5 minutes by taxi to the hospital. The location map provided on the official website of Gleneagles. Gleneagles also provide information of regular visiting hours run from 9am to 10 pm. The visiting hours for Intensive Care (ICU) / Coronary Unit (CCU) / High Dependency Units (HDU) is 9. 00am to 2. 00 pm and 4. 00pm to 8. 00 pm. Gleneagles operates 24 hour daily for accident and emergency on the ground floor of the hospital.

Gleneagles list out the price of executive screening programme such as basic screening for male and female is RM423, comprehensive screening for male and female is RM920, premium plus screening for male is RM1217, premium plus screening for female is RM 1364, etc. Gleneagles also provide information of prices for women wellness programme such as basic gynaecological screening cost RM115, breast screening cost RM192, etc. Gleneagles remind the customer to bring the following items to ensure a smooth admission:

* passport/ identity card health insurance card and written letter of guarantee from health insurance company if the person is covered by insurances * doctor’s referral note, past or present medical records, x-rays, or prior test results (if the person physician has requested them) * Medications that have been prescribed to the person * A copy of your advance directives (if any) Gleneagles give warning to visitors, do not send flower to patient in ICU because ICU is a sterile place and should be kept free from possible contaminant.

Order-taking The patients can book an appointment with Gleneagles through official website of Gleneagles. The patient need to fill in their particulars such as nationality, patient’s name, gender, date of birth, NRIC / Passport number, telephone number, mobile number, fax number, e-mail address, and patient’s current medical conditions / symptoms / diagnosis . The patient also needs to fill in preferred appointment period and time slot either morning or afternoon sessions.

Lastly, Gleneagles require the person who book an appointment answers a question for additional information for Gleneagles and Gleneagles require these information to process the customer request. After complete fill in the details, the customer click submit button, the appointment is successfully book. Billing Gleneagles deliver the bill for individual who do medical services at their hospital. The bill contains information address of Gleneagles, bill number, bill date/time, bill prepared by who, account number, credit term and contact number.

The bill also state clearly about the medical service charge such as charge for bed, CSSD, cath lab, medical record, laboratory, pharmacy, medical/surgery supply, equipment charge, nursing and doctor consultation / procedure charge. Payment The patients can make payment at registration counter when check out from hospital by using credit or debit card. Pre-payment is required for all check-up programs. Gleneagles also accept the cash for the payment and changes will give back to the customer for overpayment.

The patient also can make payment for medical service provided through online to Gleneagles Hospital Kuala Lumpur SDN. BHD. &cross account. For self-paying patients, 1. 5 percent interest will be charged per month is the amount due after 30 days. Gleneagles charge parking fee for the vehicles park inside the hospital. Gleneagles using machine at entry gate for gives the parking ticket to the driver who want parking inside the hospital. Therefore, the visitors and patient parking inside Gleneagles need pay the parking fee by insert cash into machine in order to drive out from the hospital.

The Flower of Services for Gleneagles Hospital Essay

Uses of Statistical Information Essay

Uses of Statistical Information Essay.

Abstract

For this assignment, I will be looking at the different uses of statistical information used in the healthcare setting. Statistics in healthcare are used in many areas including human resources, employee retention, patient satisfaction, and too many others to name. Hospitals use this information to look at areas that need improvement, to save money, and to improve different workflows. In today’s healthcare environment, it is much easier to look at these statistics with the implementation of the electronic medical record.

Statistics that would have taken days or even weeks to obtain can now be filtered through a computer and retrieved in a matter of minutes or seconds.

Statistics Used In the Workplace

Statistics measure a wide variety of items in the workplace. I will focus on those typically used in the emergency department. One statistic used is for stroke patients. It measures the length of time it takes from arrival at a community hospital to the time they are transported to a hospital with a higher level of care.

Another statistic that my hospital measures is the door to discharge time. This measures the amount of time it takes for diagnosis, treatment and discharge. Hospitals monitor this closely because insurance companies only allow patients to stay a certain number of days depending on the diagnosis.

The patient stays longer than what the insurance company will pay for, the hospital is losing money. The last statistic but I will talk about that is measured in my hospital – patient satisfaction. This statistic is collected and compiled by CMS (Center for Medicaid and Medicare Services). The survey asks approximately 20 questions to a patient has been discharged. These questions are regarding the care that they received, cleanliness of the rooms, if the call light was answered in a timely fashion and so on. These scores are then placed on a website for the general public to view describing how each hospital scores compared to another hospital in that area or across the country.

Descriptive Statistics

Descriptive statics looks at similarities and summarizes them. It is used to look at raw data using graphics and sample statistics. An example of descriptive statistics used would be that of looking at what patients come through the emergency department with a diagnosis of CHF, heart failure or respiratory distress. Hospital and nursing administrators are looking at finding the mean of all patients that came through the emergency room over a given time frame in relation to all the patients that were seen in the emergency room. This allows administration to have a better understanding of what the needs of the emergency room to better care for this patient population in relation to time of year and other factors that are obtained in this data.

Inferential Statistics

Inferential statistics infers or estimates population parameters from sample data. An example of inferential statistics is measuring visitor satisfaction. A random sample of visitors not patients are not a patient was asked a few simple and easy questions. A random sample was used because it would be impossible to sample every visitor that came into the hospital. Sample questions could include, “Could you find where you needed to go without difficulty”? Another example would be were you treated well by the receptionist? Inferential statistics are able to summarize the data showing what areas the hospital needs to work on to increase visitor satisfaction.

Four Levels of Measurement

In my workplace, the four levels of measurement are used frequently. The first measure is Nominal Scales. With every patient that comes to the hospital, we measure certain things such as gender, religion, date of birth, height, and so on. After collecting this data, you can filter patients according to their gender religion the month that they were born etc. This filter allows the hospital to look at the different populations, average weight of our patients, and the average height of our patients. It may not seem significant but having the right type of bed and enough of those beds is extremely important in the hospital setting. Nominal Scales can provide that type of necessary information. The second level of measurement is Ordinal Scales. Ordinal Scale measurement would be that used to measure patient satisfaction.

CMS sends out a survey that measures the patient’s satisfaction during their hospital stay. The answers to each of the survey questions are never, sometimes, usually and always. Different from nominal scales, ordinal scales allow for comparisons which two subjects possess an independent variable. One thing to remember is that ordinal scales do not capture important information that is normally present in some of the other scales. The third level of measurement is Interval Scales.

These are number scales in which the interval has the same interpretation throughout. In healthcare, an example of this would be a blood pressure cuff or a thermometer both have scaled or equal measurements. Let’s look at a blood pressure cuff. Each mark indicates 2 mmHg so when you take a blood pressure and you pump it up and listen and obtain a blood pressure of 110/80. You can compare that to another patient using the same blood pressure cuff to obtain blood pressure that may be 170/110. Since the blood pressure cuff has equal intervals, you know that there should be no variation in what the dial reads other than that of the patient.

The fourth level of measurement is Ratio Scales. This measurement scale is the most informational scale. It is in interval scale with the addition of the property that its’ zero position shows that there is no quantity being measured. The scale can be used in healthcare when determining the amount of money coming into the hospital in regards to the money going out of the hospital. The ratio of those two allow the hospital to operate and look at where money needs to be saved or spent.

Advantages of Accurate Interpretation of Statistical Information Without accurate interpretation of the statistics used in the healthcare setting, there would be problems in many areas of the hospital. These problems would occur in a variety of areas including staffing problems, employee satisfaction rates, patient satisfaction rates, visitor satisfaction rates, patients developing infections, poor money management, plus many more. All of these areas are measured and looked at with statistical analysis. Knowing how to interpret this information accurately allows managers to make informed decisions about the organization. We are fortunate as a society to have computers and electronic medical records to help accurately interpret these statistics in the healthcare setting. Accurate statistics and statistical analysis are vital to healthcare in 2015 and beyond.

References
Levels of Measurement. (n.d.). Retrieved January 23, 2015, from http://onlinestatbook.com/2/introduction/levels_of_measurement.html Bennett, J. O., Briggs, W. L., & Triola, M. F. (2009). Statistical Reasoning for Everyday Life (3rd ed.). Retrieved from The University of Phoenix eBook Collection Database

Uses of Statistical Information Essay

A Root Cause Analysis Essay

A Root Cause Analysis Essay.

Healthcare facilities that are accredited by Joint Commission are required after a sentinel event to conduct a root cause analysis (RCA). A root cause analysis is conducted to determine the cause or factors that contributed to the sentinel event. A few things must be asked in the RCA such as who, what, where, why and how in order to identify the cause. After the cause of the sentinel event is determined and a corrective action plan has been put in place a failure mode and effects analysis (FMEA) could be conducted to reduce the likelihood that it should happen again.

The scenario

A 67 year old male (Mr. B) was brought into the emergency room for pain to left leg and left hip. The injury occurred when the patient had a fall due to him losing his balance after tripping over his dog. The hospital is a 60 bed rural hospital located in Mr. B’s hometown. Mr. B was brought in by his son and neighbor.

Upon triage Mr. B was complaining of pain 10/10 on the numerical pain scale and his vitals were found to be stable. Mr. B has a history of impaired glucose tolerance, prostate cancer, and chronic pain which he is on oxycodone. The Patient states he had no known allergies or previous falls. Upon the nursing assessment Nurse J. has noticed that the patient has limited range in motion, his left leg has swelling and appears shortened in comparison to the right.

Nurse J. has informed the ED physician which he came to his bedside for evaluation. Upon evaluation the physician decided that Mr. B needed to have a reduction of his left hip, due to the dislocation and will require a conscious sedation. Mr. B requires multiple doses of medication to achieve the desired sedation affect for the reduction. Once the reduction was successful Mr. B is left with son in the room where a full set of vitals were not continuously monitored and goes into respiratory failure which lead to the death of Mr. B. Staffing on this day is the day of the event consisted of a secretary, emergency department physician (Dr. T), and two nurses (one RN and one LPN). A respiratory therapist is in house and available as needed in this six bed ED and sixty
bed hospital.

Events

At 3:30pm- Mr. B was taken to ED for left leg and left hip pain from a fall. Pain is a 10/10 vitals include 120/80 blood pressure (BP), 88 heart rate (HR) and regular, 98.6 temperature, (T), 32 respirations (R), 175 lbs.. At 4:05pm- Mr. B was given Diazepam 5mg IVP which had no affect after 5min. At 4:10pm- Dr. T orders 2mg of hydromorphone to be given to Mr. B. At 4:15pm- Mr. B was given 2mg of hydromorphone IVP.

At 4:20pm- Dr. T is not satisfied with level of sedation and orders Mr. B to be given 2mg of hydromorphone, and diazepam 5mg IVP. At 4:25pm- Mr. B appears to be sedated and reduction of his (L) hip takes place. The patient remains sedated and appears to have tolerated the procedure. The procedures concludes at 4:30pm. No distress is noted, patient is placed on monitor for blood pressure to be taken every 5 minutes along with pulse oximeter but no supplemental oxygen or ECG leads (monitors cardiac rhythm and respirations) was placed on patient at this time. At 4:30pm- Nurse J allows Mr. B’s son to remain in the room with him as he is being monitor by blood pressure machine only. Nurse J leaves the room. At 4:35pm- Mr. B vitals are BP 110/62, O2 sat is 92% still no oxygen or ECG leads are on patient at this time. EMS is transporting a patient in respiratory distress, lobby is beginning to get congested.

LPN and Nurse J. in the process of discharging 2 patients and are checking in the patient that EMS has transported in. LPN enters Mr. B’s room and resets his alarming monitor that was showing a sat of 85% and restarts the B/P to recycle. LPN does not supply oxygen and does not alert Nurse J at this time. Management is not notified that patient acuity and patient load is increasing. Nurse J is now fully engaged with the emergency care of the respiratory distress patient. At 4:43pm- Mr. B’s son comes out of room and informs the nurse that the monitor is alarming with vitas of B/P 58/80 O2 of 79%. The patient has no palpable pulse and is not breathing. A STAT code is called and the son is taken to the waiting room.

The code teams arrives places Mr. B on cardiac monitor where he is in ventricular fibrillation and the team begins resuscitative efforts. CPR is started and the patient is intubated. Mr. B is defibrillated and reversal agents, vasopressors and IV were started. At 5:13pm- After 30 min of interventions the ECG returns to a normal sinus rhythm with Mr. B’s B/P being 110/70. The patient is completely dependent on the ventilator, his pupils are fixed and dilated and there is no spontaneous movements. The family as asked for the patient to be transferred out to a tertiary facility for further advanced care.

Outcome

Seven Days later Mr. B has died. The family had requested that life-support be removed after brain death had been determined by EEG’s. This is a sentinel event.

Investigation of sentinel event should begin with a Team and method of investigation. Interdisciplinary team included in the RCA should include the Director of Nurses, Nursing Supervisor, Risk management, Nursing Coordinator, and Manager of the department. Once the team is put together the RCA should be started. The team should set up interviews with all staff that was involved and present in the department the day the sentinel event happened. A complete chart review should be conducted by team.

The policies on conscious sedation, staffing of department, and standardized work should be reviewed. When the cause is identified a corrective action plan should be conducted. The corrective action plan will allow a series of projects can be put in place to help create or change polices if needed. The new or changed polices should be put into education models to teach to current and new staff as needed.

The Root Cause Analysis

Causative factors- (why it happened) determined cause

Individual’s cause factors

Nurse J did not follow procedure for conscious sedation. The patient was not placed on continuous B/P, ECG, and pulse oximeter throughout the procedure. Respiratory Therapist was not informed of the conscious sedation. LPN did not address low o2 saturation of 85% between the 4:35pm-4:43pm. Dr. T did not take in account of the patient’s weight and chronic pain medication use. Nurse J did not question the medication that Dr. T ordered.

Team’s cause factors

Management was not called and informed of staffing needs and acuity of patients. Back up staff was not called in to help when acuity and patient load had increased. Commination between Nurses and Dr. T were not present when the patient began to decompensate.

Management /Organizational cause factors

Unsafe Staffing at ED. There was not enough staff present to safely manage emergencies in the ED. RCA Findings:

Errors and/or Hazards

1. Per protocol the patient was not hooked up to the proper monitoring equipment at the bedside. The facility procedure police called for continuous B/P ECG, and pulse oximetry during and after procedure until patient meet the discharge criteria. The nurse should have remained with patient during the recovery period. Crash cart with defibrillator was not present during the procedure nor was the proper reversal agents that could reverse the medication given for sedation. 2. Nursing staff communication was very poor. LPN did not notify Nurse J or ED physician when the patient’s o2 saturation dropped down to 85%. Oxygen was not placed on patient when O2 saturation dropped which led to respiratory failure causing the patient to code and eventually led to Mr. B’s death.

3. Communication between ED staff and management lacked when staffing needs increased. Patient safety was put at risk when the patient load and acuity increased in the ED and the staffing did not increase. Staffing shortage caused the nurse and nursing support staff to attend to other patients and leave Mr. B unmonitored which led to respiratory distress due to the patient being over medicated for sedation which led to respiratory failure and eventually led to Mr. B’s death. 4. The ED physician did not request the patient be transferred to the nearest trauma center due to lack of recourse’s in the emergency department.

Recommended Corrective Action Plan/Change Theory/Improvement Plan

1. Improved patient safety during conscious sedation: Effective immediately all conscious sedation procedures will be conducted per protocol. Within 10 days the conscious sedation procedure should be evaluated by a committee to ensure the best practices are being used. Within 30 days of this RCA all staff should be educated on conscious sedation protocol. All nursing staff should use review protocols for conscious sedation before a conscious sedation procedure is to take place. 2. Communication within the department should be evaluated immediately by a group of staff members to find out where the miscommunication failure lies. This could be that the nursing support staff is unaware of the parameters that should be reported to nurse or physician. With 10 days of this RCA a policy on documentation of communication should be put in place to ensure that all nursing staff are documenting the communication of a patients change in status has be reported to physician.

Effective immediately all nursing support staff should be educated on parameters that should be reported to nursing staff and physicians. This should be put into a policy along with documentation of communication. 3. Improved patient to nurse ratios: Management should put in place a safe nurse to patient ratio for the emergency room. Communication policy between department and management should be put in place effective immediately to ensure that no other patient should be placed in harm’s way due to staffing shortage. The emergency department should be put on diversion if the patient load and acuity places patients at risk for harm in any manner. A copy of the RCA should be given to management and leadership. Management should share the finding with all emergency department staff.

Feedback should be done 30 days after corrective action plan or change theory have been put in place to ensure that everything that has been put in place is effective for the department to improve patient safety. Constant reevaluation of patient safety should be conducted and feedback given to improve patient safety by all providers involved. Management will continue to ensure that all staff follow all protocols to ensure that patient care and safety are not compromised. At a 90 days bench mark after the corrective action plan has been put in place management should revisit the any changes made to protocols and polices to ensure compliance and effectiveness is still in place and reevaluate the process to ensure patient safety.

Failure Mode and Effects Analysis (FMEA)

A Failure Mode and Effects Analysis is proactive versus the RCA which is reactive. A FMEA assesses a process for risks of failures or adverse effects of a process and prevents them by correcting what is wrong proactively (Institute for Heathcare Improvement, 2004). A Healthcare facility may use FMEA tools on the Institute for Healthcare Improvement website to evaluate a process in the facility. This tool will calculate a risk priority number (RNP) of a process, evaluate the impact of the process and the changes that are being considered, and tract the improvement over time (Institute for Heathcare Improvement, 2004).

PRE-FMEA

1. Step one: Select a process to be evaluated with FMEA. The FMEA for this paper will focus on the conscious sedation protocol. 2. Step Two: Recruit a multidisciplinary team and include a member from every department that may be involved or affected. This team for the conscious sedation protocol should will include.

Registered Nurse

Physician
Management
Pharmacist
Respiratory therapist
A member from Legal
Laboratory Tech
Emergency Department Tech

3. Step Three: Information needs to be gathered by the team. A list of steps in the process being evaluated should be put together or even an outline of steps would be helpful to the team. All internal and external data, clinical practice guidelines, current policies and procedures, current literature and any other information that may pertain to the process that is being evaluated. For the purpose of this paper we would use data on outcomes of conscious sedation protocols, RCA’s on bad outcomes, clinical practice guidelines and any research documentation that would aid in best practices for conscious sedation.

Team meetings should be structured with an agenda. A leader or primary person with extensive knowledge of the FMEA knowledge (Department of Defense Patient Safety Center, 2004) 4. Step Four: The Team should list the failure modes and causes. In each process all failure modes should be listed, and then for each failure mode a list of possible causes should be listed as well. In this scenario we will use this as an example

Preparing medication

Wrong medication prepared
Wrong dose prepared

5. Step Five: A Risk Priority Number (RPN) will be assigned to each failure mode for the likelihood of occurrence, for the likelihood of detection, and for the severity. This step is also known as the three steps FMEA. The RPN is a numerical rating. For this scenario here is an example Likelihood of Occurrence: This will measure the likelihood a failure mode is to occur. The score range will be 1-10 with 1 meaning it is very unlikely to occur and 10 meaning very likely to occur. Example- Wrong medication prepared = 5

Likelihood of Detection: This will measure the likelihood a failure mode is to be detected if it should occur. The score range will be 1-10 with 1 meaning it is very likely to be detected and 10 meaning very unlikely to be detected. Example- Wrong medication prepared = 6

Severity of occurrence: This will measure the severity of the failure mode should it occur. The score range will be 1-10 with 1 meaning no effect and 10 will be death should a failure mode occur. Example- Wrong medication prepared= 9

6. Step Six: The team will evaluate the results. For each failure mode the three scores are multiplied with each other. The failure mode with the highest RPN will be the one that will be evaluated by the team to ensure patient safety. The higher the RPN a failure mode has the higher the potential for harm it may cause. The RPN score can be as high as 1,000 and as low at 3. Example- Wrong Medication Prepared

Occurrence- 5
Detection- 6
Severity- 9
5x6x9= overall score =270

7. Step Seven: An improvement plan will be made based on the RPN. Likely to Occur. Have a triple check put in place. Have team attempt to eliminate all possible causes. Example-Have medication scanned when pulled from Pyxis to check providers order. Have patient scanned before medication may be prepared to check providers order. Have patient and medication scanned to ensure correct patient with the correct medication and proper providers order.

Unlikely to be detected.
Look for warning signs that the error may not be detected.
Use data from any previous or prior errors.
Severity.
Use any data available to determine severity of error.
Make available any and all resources to prevent further errors and severity of errors.

Final Step- The final step in the FMEA is to plan an observation or test. A plan should be clear of its objections and should have some sort of predictions or outcomes. During the test all data should be documented. In this data collection phase all observations including problems or unexpected issues should be documented and later evaluated. After the test is complete and all data collected the team should meet for analysis of the data. A summary of the analysis should be documented.

All changes or modifications to the process will be based on the test and analysis of data conducted. Any and all changes should be communicated to all staff members. These changes may or may not show improvement to the process, this is why constant reevaluation of all process should be conducted and any feedback should be given to leadership for the reevaluation of the process.

Nurses play a vital role in health care. Nurses have the most contact with a patient. Nurses carry out any orders and or processes. A nurse is the patient advocate, they are the ones who will advocate for patient safety. Nurses are the advocates who will be looking for evidence base practices to improve patient care and patient safety. Improving quality of care for each patient will improve the outcomes for each patient.

References
Department of Defense Patient Safety Center. (2004, 12 26). Failure Mode and Effects Analysis. Retrieved from FMEA Info Centre: http://www.fmeainfocentre.com/handbooks/FMEA_Guide_V1.pdf Institute for Heathcare Improvement. (2004). Failure Modes and Effects Analysis (FMEA). Retrieved from Institute for Heathcare Improvement: http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx

A Root Cause Analysis Essay

Prevention and care of pressure ulcers Essay

Prevention and care of pressure ulcers Essay.

PREVENTION AND CARE OF PRESSURE ULCERS

Pressure ulcers are a commonly seen problem among elderly hospitalized patients. Despite new findings about the causes and approaches to treatment, the incidence of these wounds is still increasing. Scott, Gibran, Engrav, Mack and Rivara (2006) revealed that during the thirteen years of their study, the incidence of pressure ulcer development has more than doubled. As our elderly population becomes greater in number, and older in age, this problem is expected to escalate. It is of great importance for the patients as well as for the institutions to find the best practice guidelines to control the occurrence of preventable wounds.

Many hospitals incorporate strict prevention measures with good effects, and others are more concentrated on treating the problem after it occurs, without paying much attention to prevention. In XY hospital, patients at risk do not receive the necessary preventive care, and many patients’ existing wounds often become infected, and instead of healing, they deteriorate. This paper will review the research regarding the best prevention methods, as well as the best evidence based treatment of pressure ulcers, followed by suggestions how to implement those findings in XY hospital.

PICO QUESTION

In elderly and immobile patients, what are the most effective prevention and treatment methods to reduce the occurrence and complications of pressure ulcers, compared to no prevention and standard wet-to-dry dressings?

SUMMARY AND APPLICATION OF RESEARCH ARTICLES

Effective management of pressure ulcers begins with a comprehensive assessment of the patient, with careful consideration of the risk factors. Hess (2004) reported that the Braden Scale is the most commonly used risk assessment tool. Also, it is important to regularly inspect the skin of the patients found to be at risk. Such inspection should focus particularly on the areas around bony prominences. Bethell (2005) argues that once stage one pressure ulcer develops, the irreversible damage to the tissue forms, and this will progress to open, deeper wound if pressure is not relieved. Stage one is defined as a change of intact skin in one or more of the following: skin temperature, color, tissue consistency and/or sensation (Hess).

Unfortunately, the staff at XY hospital is only concerned with skin breakdown, when assessing for pressure ulcers. No prevention strategies are implemented for patients at risk until they develop stage two ulcers, when skin breakdown is visible. One article notes that educational in-service for the staff is effective, and results in the professionals’ better understanding and ability of staging pressure ulcers (Thompson, Langemo, Anderson, Hanson and Hunter, 2005). It is necessary that prevention techniques are implemented for all patients at risk from the moment that risk is identified, whether there is an existing tissue injury or not.

Another study indicates that the body can endure great amount of pressure for short time periods, but low pressure for a long amount of time causes significant tissue damage (Maklebust, 2005). Repositioning of patients should be performed at least every two hours or more often if necessary. The author suggests that when repositioning the patient onto the side, he or she should be supported in a 30-degree lateral position rather than at a 90-degree angle. Such position avoids the pressure of the bony prominences on the softer tissues. Also, the head of the bed should be maintained at less than 30 degrees to avoid the shearing forces caused by patient’s sliding in bed (Maklebust).

Moreover, studies advise that appropriate lifting devices should be used to prevent friction during transfer and repositioning (Grey, Harding and Enoch, 2006). Also, patients’ heels are often subjected to pressure and friction. The staff at XY hospital occasionally elevates patients’ heels by placing them on folded blankets. Literature suggests that the heels should be suspended, with a pillow or a blanket placed under the lower legs (Maklebust). Additionally, the use of pressure relieving mattress is encouraged, but it does not eliminate the need for frequent position changes (Hess, 2004).

Furthermore, another factor creating a risk for pressure ulcer development is malnutrition. Wysocki (2002) observed that 10 to 50% of hospitalized patients are malnourished. Nurses should be alert to inadequate nutrition and its effects. Also, Cobb and Warner (2004) noted that when thirty percent of weight is lost, spontaneous pressure ulcers begin to develop, and prevention strategies might not work. In addition, urinary and fecal incontinence are also significant risk factors. Incontinence results in excess moisture, and irritation of the skin. The nurses and assistive personnel in XY hospital often do not assist their incontinent patients for long periods of time, and they do not utilize the available skin protectants.

Studies confirmed the effectiveness of no-rinse cleansers and moisture barrier creams, and found that they were less likely to harm skin integrity than soap and water (Thompson, et al., 2005). The findings also advise that checking the patients for soiling every two hours adds to the effectiveness. Although not all pressure ulcers are preventable and curable, the literature provides supportive evidence that appropriate prevention protocols decrease the incidence of stage one and two pressure ulcers, and in turn decrease the number of pressure ulcers that could progress to stage three and four (Thompson, et al.).

Moreover, an important part of existing wound management is wound bed preparation, and use of appropriate dressings. Cobb and Warner (2004) suggest that applying dressings without debriding will not heal the wound, and constitutes wasted time and effort. The authors also point out that: “debridement must be thought of as an ongoing process. Initial debridement should be followed by maintenance debridement”(Cobb & Warner). Necrotic tissue and excess slough encourage bacterial proliferation, therefore the debris has to be removed in order to promote healing. Three types of debridement, as described by McGuckin, Goldman, Bolton and Salcido (2003), can be performed or applied by a registered nurse. Mechanical debridement, which is performed with wet-to-dry dressings, although effective, can be painful when dry gauze is pulled off, and can also remove healthy tissues. Enzymatic debridement is the application of enzymatic ointments that digest the dead tissue, but can also digest the viable tissue.

The last, autolytic debridement, involves the action of natural enzymes under hydrocolloid or film dressings. One of such dressings, Polymem, is available in XY hospital. The product contains a wound cleanser, a bacteriostatic, a moisturizer, and an absorbing agent which absorbs ten times its own weight in exudate. Polymem also promotes formulation of granulation tissue (McGuckin, et al.). Another useful dressing available in XY hospital is Aquacel Ag, an absorbent dressing composed of hydrofiber impregnated with ionic silver. Research findings recommend it for autolytic debridement, as well as for the prevention and treatment of infection (Dowsett, 2004). In the presence of moisture in the wound, silver ions are released and bind to cells including bacteria. It is recognized as an effective broad-spectrum antimicrobial dressing (Dowsett).

In addition, Ovington (2001) pointed out the distinction between the standard wet-to-dry and wet-to-moist dressings, which are often erroneously considered as one. Wet-to-dry is intended for debridement, and the gauze should be allowed to dry before it is removed. Wet-to-moist is intended to remain moist until removal, but it often becomes wet-to-dry in practice. However, the author indicates that the standard wet gauze dressing is not an optimal wound care, but despite hundreds of new more beneficial products, gauze is still widely used. In vitro studies have shown that bacteria were capable of penetrating up to 64 layers of dry gauze, and moist gauze presents even less barrier to bacteria. It has been also shown that infection rates in wounds with moist gauze dressings are higher than in wounds with film or hydrocolloid dressings (Ovington). New dressings become widely available, and ongoing research is needed to provide the evidence for the most effective options.

IMPLEMENTATION

Successful leaders thrive on continuous change. Implementation of a change is never a single action but involves a well designed, comprehensive plan, and a step-by-step process. The first step of implementing change is to identify the problem. The staff in XY hospital has to be aware of the need to change their practice related to pressure ulcers. According to Lewin (Marquis & Huston, 2006, p. 173) this is called unfreezing. Presenting statistical data of pressure ulcer occurrence on the unit, and comparing it to other units or hospitals, and to state or national goals reveal the existing problem. The staff has to recognize and understand the issue, and be motivated to do something about it. Educating the staff on the subject through verbal and written communication will facilitate sending the message.

The second phase is movement (Marquis & Huston, 2006, p. 173). This next step starts with creating an imbalance by increasing the driving forces, which lead people toward the change, or reducing restraining forces, which repel change. It requires developing an action plan, defining objectives, and establishing goals. The appropriate strategies have to be planned and implemented gradually. A careless approach to resolving the matter can cause frustration. Educational in-service for the staff informing about preventive guidelines described in research, commonly seen problems, and most effective evidence based strategies will initiate the exchange of ideas.

The leader has to acknowledge that people might respond to change in various ways. Some will feel motivated and energized, while others will feel threatened and dissatisfied. Marquis and Huston (2006, p. 180) inform that it is most effective when all those affected by a change are involved in planning that change. Collaboration and dialogue with staff are needed to gain an understanding of what they value and hold as important. Gearing the communication toward a common desire will lead to establishing an effective and achievable plan. As was previously done on the unit in XY hospital, a notice could be posted in the staff break room encouraging all to write ideas and suggestions on how to implement the needed changes. Then, action steps using those ideas should be structured cooperatively.

With the plan in hand, the leader should initiate the change process. Marquis and Huston (2006, p. 181) state that leaders must be engaged in change by role modeling and assisting staff to encourage them. The nurses and the assistive personnel should be reminded and encouraged to check incontinent patients more frequently to ensure that they are not wet and soiled for prolonged periods of time, but the leader should initiate these actions him/herself. Asking staff to help distribute the skin protection supplies to each incontinent patient’s room will ease the transition. It is necessary to show commitment and consistency in implementing the change to avoid discouragement. Moreover, the innovations which will result in easier and less work can be expected to be adopted almost immediately.

For example, applying Polymem and Aquacel Ag is much easier and faster than time consuming wet gauze dressings. It can also be expected that the most difficult part of the plan would be implementing prevention strategies for patients at risk, but without pressure ulcers. Repositioning patients, lifting them appropriately, checking for wetness, and appropriate feeding are time consuming and labor intensive. The leader has to be able to energize others, and be consistently interested and committed to the plan, until completed. Each of the strategies has to be introduced one at a time, to allow slow adjustment. Marquis and Huston (p. 173) advise that to be accepted, change needs at least three to six months.

The last phase of the change theory is refreezing. The change has to be stabilized and integrated into the status quo (Marquis & Huston, 2006, p. 173). Recognizing and acknowledging the hard work of the staff should never be forgotten. Thanking for the commitment improves work performance and satisfaction. Also, reevaluation is necessary to modify and improve the change as needed. Prevention strategies to reduce the incidence of pressure ulcers need to be a team effort in order to be effective.

CONCLUSION

Pressure ulcers remain a serious type of wound seen among many hospital patients. Despite the newly developed strategies to prevent and manage those wounds, their incidence is still growing. Evaluating risk factors and identifying optimal prevention techniques are the first line of defense. Regular relief from pressure, use of lift sheets, use of incontinence skin barriers, and maintenance of adequate nutrition are the main preventive interventions. Nevertheless, some patients may develop skin breakdown despite high quality care. Optimal wound care requires an ongoing debridement of devitalized tissue, and appropriate dressings which promote healing.

Healthcare professionals have a wide variety of new treatment options from which to choose from, and should be moving away from using the ineffective and labor intensive gauze dressings. Implementing appropriate methods to better control pressure ulcers based on up-to-date evidence requires good leadership skills. The key aspects of accomplishing the goal are: developing a good plan, gaining interest of the staff, and being committed to the end. To implement any change successfully, leaders have to approach it with dedication and enthusiasm. After all, the end goals of our ongoing clinical challenges always are to promote the patient’s healing, to reduce needless suffering, and to improve the quality of life.

REFERENCES

Bethell, E. (2005). Wound care for patients with darkly pigmented skin. _Nursing Standard, 20_ (4), 41-49. Retrieved April 14, 2006, from OVID MEDLINE database.

Cobb, D.K., Warner, D. (2004). Avoiding malpractice: the role of proper nutrition and wound management. _Journal of the American Medical Directors Association, 5_ (4 Suppl), H11-6. Retrieved April 14, 2006, from OVID MEDLINE database.

Dowsett, C. (2004). The use of silver-based dressings in wound care. _Nursing Standard, 19_ (7), 55-58. Retrieved April 14, 2006, from OVID MEDLINE database.

Grey, J.E., Harding, K.G., Enoch, S. (2006). Pressure ulcers. _BMJ, 332_ (7539), 472-5. Retrieved April 14, 2006, from OVID MEDLINE database.

Hess, C.T. (2004). Care tips for chronic wounds: pressure ulcers. _Advances in Skin and Wound Care, 17_ (9), 477-9. Retrieved April 14, 2006, from OVID MEDLINE database.

Maklebust, J. (2005). Choosing the right support surface. _Advances in Skin and Wound Care, 18_ (3), 158-61. Retrieved April 14, 2006, from OVID MEDLINE database.

Marquis, B.L., Huston, C.J. (2006). _Leadership roles and management functions in nursing._ Philadelphia, PA: Lippincott Williams and Wilkins.

McGuckin, M., Goldman, R., Bolton, L., Salcido, R. (2003). The clinical relevance of microbiology in acute and chronic wounds. _Advances in Skin and Wound Care, 16_ (1), 12-23. Retrieved April 14, 2006, from OVID MEDLINE database.

Ovington, L.G. (2001). Hanging wet-to-dry dressings out to dry. _Home Healthcare Nurse, 19_ (8), 477-83. Retrieved April 14, 2006, from OVID MEDLINE database.

Scott, J.R., Gibran, N.S., Engrav, L.H., Mack, C.D., Rivara, F.P. (2006). Incidence and characteristics of hospitalized patients with pressure ulcers: state of Washington, 1987 to 2000. _Plastic and Reconstructive Surgery, 117_ (2), 630-34. Retrieved April 14, 2006, from OVID MEDLINE database.

Thompson, P., Langemo, D., Anderson, J., Hanson, D., Hunter, S. (2005). Skin care protocols for pressure ulcers and incontinence in long-term care: a quasi-experimental study. _Advances in Skin and Wound Care, 18_ (8), 422-9. Retrieved April 14, 2006, from OVID MEDLINE database.

Wysocki, A.B. (2002). Evaluating and managing open skin wounds: colonization versus infection. _AACN Clinical Issues, 13_ (3), 382-97. Retrieved April 14, 2006, from OVID MEDLINE database.

Prevention and care of pressure ulcers Essay

Difference between Qualitative and Quantitative Research Essay

Difference between Qualitative and Quantitative Research Essay.

The first question asked by any researcher with a new topic to study is: ‘What sort of research should I use?’ Reference to the literature can be confusing: so much research has been done, so many questions asked and sometimes answered, and so many conclusions have been drawn that it can be difficult to sort out one research technique from another. The decision most beginners to research find taxing is: ‘Should I use quantitative or qualitative methods?’At the most basic level, quantitative research methods are used when something needs to be measured, while qualitative methods are used when a question needs to be described and investigated in some depth.

Often, the two methods are used in tandem to provide measurements for comparison and evaluation and to give an in-depth explanation of the meaning of an idea.

Quantitative researchThe words themselves hold the clues. Quantitative research includes so-called benchtop science (where experimental tests are carried out), drug trials (where the effects of drugs are measured), epidemiology (where rates of illnesses in populations are calculated), intervention studies (where one technique is used and its effects compared with another), and so on.

Quantitative research usually contains numbers, proportions and statistics, and is invaluable for measuring people’s attitudes, their emotional and behavioural states and their ways of thinking.

In one section of a study on child care in hospitals, I asked a group of parents to give a ‘yes’ or ‘no’ response to a range of questions on their attitudes to paediatric hospital care (Shields 1999). I then measured the number of ‘yes’ answers and compared them with responses from nurses and doctors to the same questions. The study showed differences in attitude between parents and staff that could have affected communication between them and influenced the delivery of care. In another example, a researcher in Iceland measured the most important needs of parents during their children’s admission to hospital and found that they rated emotional needs as more important than physical requirements, such as rest and food (Kristjansdöttir 1995).

Qualitative researchQualitative methods are used when the meaning of something needs to be found. Exploring the question: ‘Who owns a child in hospital?’ (Shields et al 2003), or examining the meaning of an experience, illness, or condition, for example, of what it means to be a mother whose child has died (Laakso and Paunonen-Ilmonen 2001), are all forms of qualitative research. Qualitative research usually has no measurements or statistics but uses words, descriptions and quotes to explore meaning. It can even use arts techniques, such as dance (Picard 2000).

The question to ask when planning a research project, therefore, is: ‘Do I want to count or measure something, or do I want to find the meaning of something, and describe it?’ Which comes first? This is sometimes a chicken-and-egg question but if no one has investigated the topic before, qualitative research is used first to try to tease out ideas, which can then be turned into questions — that can be tested quantitatively

REFERENCES

Kristjansdöttir G (1995) Perceived importance of needs expressed by parents of hospitalized two-to-six-year-olds. Scandinavian Journal of Caring Sciences. 9, 2, 95-103.

Laakso H, Paunonen-Ilmonen M (2001) Mothers’ grief following the death of a child. Journal of Advanced Nursing. 36, 1, 69-77. Picard C (2000) Pattern of expanding consciousness in midlife women: creative movement and the narrative as modes of expression. Nursing Science Quarterly. 13, 2, 150-157.

Shields L (1999) A Comparative Study of the Care of Hospitalized Children in Developed and Developing Countries. Doctoral thesis. Brisbane, University of Queensland.

Shields L et al (2003) Who owns the child in hospital? A preliminary discussion. Journal of Advanced Nursing. 41, 3, 1-9.

Difference between Qualitative and Quantitative Research Essay