C493 Task 1 - JLP TASK 1: LEADERSHIP EXPERIENCE PDF

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You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the rel...

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Leadership Experience Meagan Mayes C493 Task 1 Western Governors University

2 Leadership Experience A. Proposal A1. Pressure injuries are a never-ending issue for my organization. Efforts by nurses, physicians, healthcare technicians, and nutritionists to prevent pressure injuries are admirable, but still not wholly effective in the critical care patient population. There is more we could be doing to promote patient outcomes and decrease the occurrence of pressure injuries. A1a. Pressure injuries occur more frequently in the critical care patient population due to immobility, critical illness, and malnutrition. Because hospital acquired pressure injuries are a Nursing Quality Indicator, it is important to track the development of injuries and use that data to promote preventative measures. A2. The Joint Commission (2016) identifies pressure injuries as “A significant health issue and one of the biggest challenges organizations face day-to-day.” The impact on patients’ lives, ability to provide appropriate care, and high treatment cost are just some of the reasons pressure injuries are a clinical practice problem (The Joint Commission, 2016). The cost of treating healthcare acquired pressure injuries (HAPI) is astronomical, in both monetary value and cost to the patient and their families. HAPI are the cause of up to 60,000 deaths annually (Padula & Delarmente, 2019). The Centers for Medicare and Medicaid (CMS) made changes to reimbursement for hospital-acquired conditions (HAC) in 2008. CMS recognizes stage three and four pressure injuries that are not present on admission as preventable conditions and will no longer reimburse the hospital for treatment costs related to those HAC (Fleck, 2009). As part of

3 maintaining magnet status, my hospital tracks the development of pressure injuries using audit tools. A2a. According to the quarterly audit of patients in the critical care division of my hospital from February 2021, approximately 30% were found to have hospital acquired pressure injuries. A3. “Approximately 2.5 million individuals in the United States develop a pressure injury in acute care facilities yearly” (Padula &Delarmente, 2019). A3a. Both intrinsic and extrinsic risk factors exist regarding the development of pressure injuries. Some critically ill patients are not hemodynamically stable enough to be moved, while others do not tolerate turning due to injuries or pain. There are not always adequate staffing resources available to reposition patients at least every two hours. Patients may also refuse to be repositioned. A4. I propose investing in pressure redistribution mattresses (PRMs) for the entire critical care division to help prevent pressure injury development. “Pressure redistributing foam mattress was associated with a significantly reduced incidence of pressure injuries and postponed the occurrence of pressure injuries without compromising patients’ comfort” (Bai et al., 2020). “This mattress and cushion evaluation, although quite small, has shown that together with a regimen of regular repositioning of residents, a good diet, and performance of pressure-relieving exercises, the support surfaces were an effective tool in preventing pressure ulceration” (Chamanga & Butcher, 2016).

4 A5. Utilizing hospital funds to rent or purchase PRMs for the critical care division is the best option. The cost of one pressure redistribution bed for a hospital ranges from $15,000 to $20,000 dollars. The cost of patient care ranges from approximately $20,000 to $150,000 per pressure injury, and an added $43,000 in costs to the hospital (WSHA, n.d.). The benefits of renting or purchasing the pressure redistribution mattresses outweigh the costs due to the overall savings in treatment costs. A6. The timeline for transitioning the critical care division to a PRM bed would begin immediately, with every bed being a PRM by the end of 2021. A7. The hospital administration is important for implementation of the solution because it is the supplier of finances to purchase the PRMs. The transport team is important for delivering the beds to the units and removing the beds that will no longer be used. The nurses are important because they will be the ones utilizing the controls on the beds to adjust the PRMs according to individual patient needs. A7a. I discussed my proposal with the wound care team, who were in favor of escalating the proposal to hospital administration. The nurses on the unit I work on were also in favor of implementing the PRM beds, especially for patients unable to turn. The transport team was reluctant to add the extra work to their staff, as they are currently understaffed. My manager encouraged me to work with the wound care team to write a formal proposal.

5 A7b. I intend to coordinate a meeting with the clinical nurse specialist from the wound care team to develop a formal proposal to present to hospital administration. I intend to create a rollout schedule for the transport team to prevent overburdening their staff. I intend to coordinate with a representative from the manufacturer to educate the nurses and healthcare techs on how to use the bed controls. A8. My solution could be implemented in each unit in the critical care division at the start of each month through the rest of 2021. Starting with the pulmonary ICU on August 1st, one bed could be exchanged each day for a new PRM bed. On September 1st, the medical ICU would start their exchange, and so on and so forth. At the end of 2021, every patient room in the division will have a PRM bed. B. I fulfill the role of a scientist by interpreting the pressure injury development data and researching the costs of PRM beds. I fulfill the role of a detective by investigating the research surrounding PRMs and the various ways to prevent pressure injuries in the critical care population. I fulfill the role of a manager of the healing environment by proposing new ways to promote healing and prevent HAPI development.

6 References Bai, D. L., Liu, T., Chou, H., & Hsu, Y. (2020). Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. Plos One, 15(11). doi:10.1371/journal.pone.0241276 Chamanga, E., & Butcher, A. (2016). An evaluation of a novel alternating mattress and cushion technology. Nursing and Residential Care, 18(4), 207-213. doi:10.12968/nrec.2016.18.4.207 Fleck, C. A. (2009). Implications of the New Centers for Medicare & Medicaid Services Pressure Ulcer Policy in Acute Care. The Journal of the American College of Certified Wound Specialists, 1(2), 58-64. doi:10.1016/j.jcws.2009.01.001 Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634-640. doi:10.1111/iwj.13071 Sala, J. J., Mayampurath, A., Solmos, S., Vonderheid, S. C., Banas, M., Dsouza, A., & Lafond, C. (2021). Predictors of pressure injury development in critically ill adults: A retrospective cohort study. Intensive and Critical Care Nursing, 62, 102924. doi:10.1016/j.iccn.2020.102924 The Joint Commission. (2016, July 20). Quick Safety Issue 25. Retrieved July 22, 2021, from https://www.jointcommission.org/resources/news-andmultimedia/newsletters/newsletters/quick-safety/quick-safety-issue-25-preventingpressure-injuries/

7 WSHA. (n.d.). Worldwide pressure injury prevention day is Nov. 19, 2020. Retrieved July 31, 2021, from https://www.wsha.org/articles/worldwide-pressure-injury-prevention-day-isnov-19-2020/...