this week I focused in the Braden scale scores for the patients to determine if help protectors should be in use and the importance of the interventions according to the braden scale please include info on that
im doing a capstone project at a nursing home, my topic is to audit to determine if heel protectors are in use, to do this i will be visiting the nursing home and filling out a spreadsheet to see if the patients are wearing heel protectors.
- This is phase 3 of Plan, Do, Check, Act (PDCA) of a performance improvement project. During the past year, the nursing home has already determined the issue and planned to choose a heel protector vendor and educate the staff on the correct usage of heel protectors.
- i have created an audit sheet to include the resident’s initials, MR#, whether the heel protector is in use and whether it is used correctly.
- i collected the first weeks data which is my baseline data and I will use it to compare to data at the end of the project.
- You will share each week’s data with the WOCN and Nurse Manager, so they can share the compliance rate for any needed improvements.
1. What unit/department/organization will you be completing your Capstone Project at and where is it located?
The unit I will be completing my Capstone Project at a Subacute Ventilator Unit at a Nursing Home.
2. Talk to the site preceptor and think of a topic of interest to both you and your preceptor. What will your topic be?
The topic I chose for my capstone project is to conduct an audit to determine if heel protectors are in use on the unit.
3. How does preliminary research support my topic?
Heels are a high-risk area because the posterior heel has a small surface area with little subcutaneous tissue and no muscle to distribute pressure and provide cushioning over the bone; which leads to higher pressures being exerted directly over the bone when a person is in a supine position; therefore people who have reduced mobility, or who spend extended periods supine (e.g. patients in acute and long‐term care facilities), have an increased risk for heel pressure ulcer development (Greenwood, Nelson, Nixon, & McGinnis, 2017). The risk of ulceration is thought to be related to both the amount of pressure on the skin, and the duration for which it is applied; some of the methods to reduce or remove the pressure put at the heel are by changing a person’s position, using equipment that reduces pressure at the heel; heel‐specific offloading heel protectors like pillows or wedges and heel‐specific low friction devices like dressings or booties are used to remove pressure and reduce friction and shear at the heel for the overall goal of reducing the incidence or preventing deterioration of pressure ulcers that develop on the heel (Greenwood, Nelson, Nixon, & McGinnis, 2017).
4. Is it feasible to do the project in a semester?
It is feasible to do the project in a semester, pressure ulcers can develop very quickly and the patients at the Subacute Ventilator Unit Rutland Nursing Home are bed-bound or spend an extended amount of time supine. A whole semester so about 4-5 months is a good amount of time to observe if interventions like heel protectors really reduce the incidence or prevent deterioration of pressure ulcers that develop on the heel.
5. How will your project improve client outcomes?
This project will improve client outcomes by helping them reduce the incidence or prevent deterioration of pressure ulcers that develop on the heel, which improves patient outcomes and health‐related quality of life and cost.
6. What do you need to accomplish your project?
To accomplish my project I will need time and staff cooperation in making sure heel protectors are being used on the unit and we are doing our best to remove pressure and reduce friction and shear on the patient’s heels as well as doing daily skin assessments to make sure that the patients are not to prevent pressure ulcers from developing or progressing.
Reference
Greenwood, C. E., Nelson, E. A., Nixon, J., & McGinnis, E. (2017). Pressure‐relieving devices for preventing heel pressure ulcers. The Cochrane Database of Systematic Reviews, 2017(5), CD011013. https://doi.org/10.1002/14651858.CD011013.pub2
The measurable outcomes I expect to achieve with my Capstone project using SMART goals is:
Specific: The main goal for my project is to determine which heel protectors are being used on the unit. I will do this by auditing patients’ charts to see if heel protectors are in use as well as checking the patients themselves and make sure that they are on. A quality improvement initiative involves robust skin-assessment practices, staff education, and the intervention of heel protection devices to evaluate the efficacy of current practice interventions (Rajpaul & Acton, 2016).
Measurable: The data that I will measure is to determine whether the patients are wearing heel protectors and if they are put on properly and are adequately being used.
Achievable: I believe the goal is doable. I think I have the necessary skills to perform this audit, I will need the cooperation of the Rutland Nursing Home staff so I can adequately perform my rounds and make sure the patients are wearing their heel protectors. The resources I’ll need are time and the spreadsheet I plan on making to collect my weekly data.
Relevant: This goal aligns with broader goals by checking for compliance to prevent/reduce pressure ulcer rates. The result is important because adequate patient-centered care involves making sure we do our best to be compliant with evidence-based practices especially when it comes to skin breakdown in bedbound patients. By being compliant with these interventions and continuously auditing that these interventions are in use we are continuously educating people and staff on the importance of compliance and performance improvement.
Time-Bound: The time frame for accomplishing the goal is this fall semester, 14 clinical days in the next 4 months.
The target population for my project is the patients in the Subacute Ventilator Unit at a Nursing Home. Most of these patients are bedbound patients who are at risk of developing pressure ulcers and the pressure ulcer rate at the nursing home is very high and compliant with the interventions to reduce the pressure ulcer rates.
Reference
Rajpaul, K., & Acton, C. (2016). Using heel protectors for the prevention of hospital-acquired pressure ulcers. British journal of nursing (Mark Allen Publishing), 25(6 Suppl), S18–S26. https://doi.org/10.12968/bjon.2016.25.6.S18
need to use this reference it is the class text