Quality Improvement Proposal on Pressure Ulcer.

PART I – Introduction and statement of the issue (pressure ulcer)

• Quality Improvement Problem Statement
Identifies the patient care issue with a clearly written QI Problem Statement.

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• Contributing factors and barriers
Discuss the factors/barriers that contribute to the patient care issue.

• Possible ethical and/or political factors contributing to the problem
Describes any potential ethical and/or political factors that may contribute to the problem
affecting patient care or states as not applicable.
At least 3 references for this part.

Paper written in APA Format
1. APA format: running head
2. APA format: proper page numbering
3. APA format: correct spacing (2.0)
4. APA format: correct margins
5. APA format: correct in-text references

Part II- Review of the Literature
Use peer reviewed articles from a review of the literature to provide the background information
for the QI issue.
1. Conducts a review of the literature and submits 4 articles related to the QI problem
2. Discusses how each article is related to the patient care issue.
3. Includes each article into the reference page.
At least 3 references for this part




Pressure ulcers are injuries that occur to the skin or any underlying tissue as a
result of pressure that is prolonged on the skin. The condition occurs mostly in the
skin that covers areas in the body near bones such as heels, hips, ankles, tailbone, and
heels. The pressure ulcer condition mostly affects the people who are perceived to
have challenges in changing their positions. People who spends a lot of time in bed
and chair are also at risk of contracting the disease. The condition requires treatment
to heal but most of the patients do not heal completely and one has to take care to
assist in the prevention of the disease. The symptoms of the disease include: unusual
skin clour change, swelling in parts of the body, drains of pus-like substances, some
areas of the skin that develops a feeling of coolness or warmness when touched and
tenderness in the skin. The study will establish the contributing factors and barriers to
the pressure ulcer condition and also the political and ethical factors contributing to
the condition.

Barriers and Factors

The pressure ulcer condition is associated with many risk factors. Pressure
ulcers patients are at the risks of experiencing painful injuries. Firstly, people who
develop the challenge of changing their positions due to prolonged sleeping or seating
area at high chances of contracting the disease. The prolonged sleeping or seating
according to Johansen, Bakken & Moore, 2015, exerts much pressure on the bones
resulting in reduced flow of blood to most of the tissues. Reduction in blood flow to
bony tissues results in the production of a plus-like substance which is the initial
symptom of pressure ulcers. Secondly, poor nutritional individuals are at high risk of
contracting the condition. Individuals who compromise their diets are at high risk. A

patient with a nutritional deficiency should contact their health providers to get advice
on the diet.
According to Posthauer, Banks, Dorner & Schols, 2015, compromising
nutrition puts one at higher chances of getting the disease. In addition, the case of a
compromised flow of blood also puts a patient at high chances of contracting pressure
ulcer. Blood flow may be compromised to flow to tissues due to conditions such as
shock, insufficiency of venous and peripheral arterial disease. Patients with
compromised sensation such that one cannot feel pressure or pain are at high risk of
getting pressure ulcers. The reason as to why a patient may experience compromised
sensation is due to spinal cord damages and neuropathy. The patients with either
spinal cord or neuropathy expose their tissues to a lot of tension that eventually results
in pressure ulcer.
Moreover, patients who have the condition of changing the skin color are at
high risk. The change in the skin color due to conditions such as bruising, eczema and
dermatitis increases the chances of contacting pressure damages. The other risk factor
that exposes patients to pressure ulcer is the surfaces that support them. The
supporting surface when one is lying or sitting influences directly the pressure that is
exerted on the bones. People sitting in the same position for a prolonged duration
should ensure that the surfaces checked and tested frequently.
Besides, the pains exert on patients during treatment is also another risk factor.
The pain that reduces the movement of a patient exposes them to immobility and
besides exerts pressure to the tissues. Age is another risk factor, elderly people who
are unable to move or change position finds themselves at the risk. The young babies
who are unable to change their positions are also at the high risk of contracting
pressure ulcers. Lastly, patients with skin damages are at risk of getting the disease.

The skin damage reduces the ability of health care providers to detect the symptoms
of pressure ulcers at the initial stage. When the condition is detected at the advanced
stages, it results in the increased cost of health care, long stays in hospitals or loss of

Political and Ethical Issues related to Pressure Ulcer
The condition of pressure ulcer involves high costs both in terms of amounts
to be incurred in a health facility and also the quality of life for the patient. When the
case on pressure ulcer occurs in a health facility, the health provider should abide by
the ethical theories provided by Center for Medicare and Medicaid. A study by
Haesler, Kottner & Cuddigan, 2017, despite the criticism of the theories due to their
simplicity and generalization in addressing the pressure ulcers, they provide bases for
the condition handling.
According to Posthauer, Banks, Dorner & Schols, 2015, the Center of
Medicare and Medicaid has a role of enforcing all the health facilities to record any
case of pressure ulcers. For example, the Medicare in the 2006 reported about 322946
cares of pressure ulcers in which most of the patients had secondary diagnosis of the
condition. The reconds for Center for Medicare and Medicaid also indicates that about
2.5 million people affected by pressure ulcers are treated in health facilities. After the
high death records of about 60,000 death for patients suffering from pressure ulcers,
the Center for Medicare and Mediciad introduced a Medicare non-payment for the
patients who acquire the conditions in the health facilities. Moreover, the Centers
introduced nutritional education as a means to orevent the pressure ulcers and injuries
(Johansen, Bakken & Moore, 2015).
The federal government of US contributed to the prevention of pressure ulcers
in the country. The government pays an approximately 1.3 trillion due to the overstay

of the patients suffering from pressure ulcers. The government in the year 2008
incurred overstay charges amounting to $40,381.2 per case to pay for patients who
had been hospitalized (Haesler, Kottner & Cuddigan, 2017). In additional the fedelar
government have the responsibility of preventing infection of pressure ulcers. The
government ensure prevention by exploring the past to inform the public for future
prevention. Lastly, the federal government has facilitated training for clinicians who
are charge with the role of taking care of the pressure ulcers patients to a cost of about
$ 1.3 billion.



Haesler, E., Kottner, J., & Cuddigan, J. (2017). The 2014 International Pressure Ulcer
Guideline: methods and development. Journal Of Advanced Nursing, 73(6),
1515-1530. doi: 10.1111/jan.13241
Johansen, E., Bakken, L., & Moore, Z. (2015). Pressure Ulcer in Norway—A
Snapshot of Pressure Ulcer Occurrence across Various Care Sites and
Recommendations for Improved Preventive Care. Healthcare, 3(2), 417-428.
doi: 10.3390/healthcare3020417
Posthauer, M., Banks, M., Dorner, B., & Schols, J. (2015). The Role of Nutrition for
Pressure Ulcer Management. Advances In Skin & Wound Care, 28(4), 175-
188. doi: 10.1097/01.asw.0000461911.31139.62