Pressure ulcers. Are you doing enough to prevent them?



**** Indicates work that will need to be turned in to your instructor following the completion of this Webquest.

Differentiate between the various stages of pressure ulcers and correctly classify the stage of Margaret's Ulcer.

The National Pressure Ulcer Advisory Panel is the foremost authority on prevention  and treatment of pressure ulcers.   They utilize public policy, education and research to improve patient outcomes in relation to pressure ulcers. Please go to their site to refresh your memory regarding the definition of a pressure ulcers and the various stages.  After visiting the site, think about Margaret.  What stage would you classify her pressure ulcer as?  http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-ulcer-stagescategories/

Now go to the following site to review the healing stages of pressure ulcers:  https://members.nursingquality.org/NDNQIPressureUlcerTraining/Module1/HealedPU2.aspx

 Identify the body areas most prone to pressure ulcer development.

While pressure ulcers usually are associated with bony prominences, other areas of the body can be just as vulnerable.  Go to    http://members.nursingquality.org/NDNQIPressureUlcerTraining/module1/PressureUlcerLocations_1.aspx  for a closer look at susceptible areas.  Scroll to the bottom of the first page and hit the "next" button.  Continue to hit the "next" button  until you have reached next section which is healing of pressure ulcers.

Recognize conditions that place a person at risk for development of pressure ulcers and compare them to risk factors identified in Margaret's scenario.

The term "bedsore" often conjures up images of little old ladies confined to a nursing home bed.  While nursing home patients are more vulnerable to pressure ulcers, they are not the only vulnerable population.  The perioperative patient lying flat on his back for hours during surgery, a young paraplegic who does not reposition himself in the wheelchair or an infant in the NICU are all examples of types of patients that are prone to pressure ulcer development.  There are certain circumstances when pressure ulcers are more likely to develop.  This may be due to the vulnerability of the population, a type of service they are receiving or the type of medical device they are wearing.  View the following video: Operating room ulcers: Who is at risk? Can they be prevented?  http://www.npuap.org/resources/educational-and-clinical-resources/complimentary-educational-webinars/    

The Braden Scale for Predicting Pressure Sore Risk is a widely used tools for risk assessment in relation to pressure ulcer development.  It was created by Dr. Barbara Braden and Dr. Nancy Bergstrom  right here in Omaha, Nebraska in 1983.  Dr.  Braden was project director of the Creighton University Teaching Nursing Home Project funded by the Robert Wood Johnson Foundation.  The Braden Scale is one of the tools recommended for use in the Clinical Practice Guidelines on Pressure Ulcers in Adults, published by the Agency for Health Care Policy and Research.  This tool is used not only in the United States, but around the world.  Please go to the website to review the history of the Braden scale and the contribution made by one of Omaha's famous nurse researchers.     http://www.bradenscale.com/about%20us.htm

Once you have reviewed the history of the Braden Scale, go to the following website and print a copy of the Braden Scale for yourself.     http://www.bradenscale.com/products.htm       After reviewing this tool, think about Margaret.  Could her pressure ulcer have been prevented?  Could the use of the Braden scale have changed the outcome of Margaret's pressure ulcer? Why or why not?

Create an educational tool that includes interventions to prevent the occurrence of pressure ulcers.

Pressure ulcers are costly in terms of both total dollars spent and in the time spent in the treatment of them. According to Brem, Maggi and Nierman (2010), the average cost for a hospital stay related to a stage IV pressure ulcer, along with related complications was $129,248 for hospital-acquired ulcers during one admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. In this era of health care reform and cost control, what better way to control costs than to stop pressure ulcers from developing in the first place.  Please go to the following site to review the article. After reading the article, answer the questions below.   http:www.ncbi.nlm.nih.gov/pmc/articles/PMC2950802/

Brem, H., Maggi, J., Nierman, D. High cost of stage IV pressure ulcers.(2010). American Journal of Surgery. 200(4):473-477. doi:10.1016/j.amjsurg.2009.12.021.

**** Answer the following questions and turn in to your instructor.

1. The authors discuss the increased financial burden to hospitals in relation to hospital-acquired stage III and IV pressure ulcers.  Why do hospital-acquired pressure ulcers increase the financial burden?

2.  Reflect back on Margaret's scenario. Do you think it is "fair" to withhold funding  from the hospital for patients with acquired-pressure ulcers? Why or why not? 

3. What can hospitals do to decrease the financial impact from these pressure ulcers?  What can  you do to minimize the financial impact of pressure ulcers?

4.  Do you  think this could lead to hospitals failing to report hospital-acquired pressure ulcers?  Why or why not?

5. This article states that halting the progression of pressure ulcers is a feasible goal.  At what stage of pressure ulcer development would this be a feasible goal and why? 

The Institute for Healthcare Improvement has created a "How-to-guide" for preventing pressure ulcers.  This guide was developed for the "5 Million Lives Campaign".  This campaign was designed to support the improvement of medical care in US hospitals by reducing illness or medical harm such as adverse drug events or surgical complications and reducing death over a period of two years (December 12, 2006 through December 9, 2008).  Go to the website for the Institute for Healthcare Improvement and click on the link for the pdf for  the How-to Guide: Prevent Pressure Ulcers. Cambridge, MA: Institute for Healthcare Improvement; 2011.   http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventPressureUlcers.aspx   

***Create a handout that outlines  interventions that can be used in the Operating room to reduce the development of pressure ulcers.  

**** Outline the steps that should have been taken to prevent Margaret's pressure ulcer from getting worse once Margaret was transferred to the ICU.

Select a treatment regimen for Margaret based on current recommendations 

**** Utilize the following sites to answer these questions regarding Margaret.

1. How often will you assess Margaret's wound? Provide your rationale.

2. What instrument will you utilize to assess the wound? Provide your rational.

3. What treatment options will you utilize for Margaret's pressure ulcer? Provide your rationale.

4.  What ramifications do you foresee occurring from the development of Margaret's pressure ulcer?

5. Who shares the liability for the development of Margaret's pressure ulcer? Provide your rationale.

Assessment of the wound:   http://healthinsight.org/Internal/events/Nursing_Home/Assessment_and_Documentation_Pressure_Ulcers%20_0110719_Color.pdf

Wound bed preparation using TIME: http://www.smith-nephew.com/global/assets/pdf/products/wound/wbp_time_table.pdf

Wound dressing options: http://www.woundsource.com/

PUSH tool for healing:  http://www.npuap.org/resources/educational-and-clinical-resources/push-tool/

Negative Pressure Wound Therapy:   http://www.kci1.com/cs/Satellite?blobcol=urldata&blobheadername1=Content-type&blobheadername2=Content-disposition&blobheadername3=MDT-Type&blobheadervalue1=application%2Fpdf&blobheadervalue2=inline%3B+filename%3D861%252F344%252F2-B-128g_Clinical%252BGuidelines-WEB.pdf&blobheadervalue3=abinary%3B+charset%3DUTF-8&blobkey=id&blobtable=MungoBlobs&blobwhere=1226697053729&ssbinary=true

article:  http://www.goriskresources.com/Docs/NF/article_pulcers.pdf

AHRQ study on pressure ulcer treatment strategies: http://effectivehealthcare.ahrq.gov/ehc/products/308/1491/pressure-ulcer-treatment-report-130508.pdf

  Correctly classify the stages of pressure ulcers as evidenced by receiving an 85% or greater on the quiz located in the evaluation section of this Webquest.

In order to evaluate what you have learned, please go to the evaluation section and click on the link to take a short quiz.  You should be able to correctly classify the stage of each pressure ulcer presented to you.


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