that pressure ulcers often occur in bony prominences such as the sacrum and heels. For instance, a non-experimental study by Kwong et al. (2016) found that modifying the frequency of assessment based on the resources and staff available increased compliance with skin assessment procedures. B. Standardized pressure ulcer risk assessment The AHRQ toolkit also emphasizes the criticality of standardized risk assessment for the likelihood of pressure ulcers in patients. The systematic review by Sullivan & Schoelles (2013) shows evidence of efficacy of initial and continuous assessment of risk in patients as opposed to One-Time evaluation mentioned earlier. Of the numerous tools utilized for risk assessment, the AHRQ guidelines specifically single out the Norton and Braden scales. There is evidence to
SCIENTIFIC UNDERPINNINGS OF THE DNP PROJECT 7 suggest the efficacy and validity of the Braden scale in assessing risk for pressure ulcers, which might explain its popularity in quality improvement projects. For instance, Gadd and Morris (2014) utilized the Braden Scale to assess the risk of pressure ulcers in patients in a community hospital and highlighted the efficacy of utilizing subscale scores to trigger preventive intervention as opposed to total Braden Scale scores. Specifically, they confirmed the importance of integrating an assessment tool in the routine prevention of HAPUs development. What is pertinent in this regard is the use of the Braden Scale subscale scores to plan preventive care for HAPUs. In this study, the tool proved effective for preventing the condition given its ability to show patients at risk of the condition (Gadd & Morris, 2014). Similarly, Šáteková et al. (2015) compared the predictive validity of various tools including the Braden Scale, Norton scales, and Waterflow scale. They found that all had moderate predictive validity. However, the Braden scale demonstrated better predictive values and capabilities albeit the little differences. The Norton and Waterflow scales followed closely in that order as relates to the accuracy of their predictive values. Of note, however, the three scales show significant potential in predicting the likelihood of pressure ulcers as recommended by the AHRQ toolkit. C. Care planning and multidisciplinary approach In response to the complex nature of pressure ulcer management, the AHRQ recommends careful planning of care through an interdisciplinary team. Research has shown the efficacy of a comprehensive assessment plan and multidisciplinary team in reducing pressure ulcer incidence in urban healthcare facilities (Clarkson et al., 2016). However, Clarkson et al. (2016) noted
SCIENTIFIC UNDERPINNINGS OF THE DNP PROJECT 8 differences in attitudes of nurses and healthcare administrators, which resulted in barriers towards prevention among the nurses. Therefore, care planning can stabilize the barriers to change that might occur in a multi-professional focus group for pressure ulcer prevention.
- Fall '19
- Randomized controlled trial, AHRQ, Evidence-based medicine, Intensive care medicine