Using WADULA Practice Evaluation Tool To Prevent The Occurrence Of Bedsores In Hospitals

The Significance of Preventing Bedsores

A current issue that can be evaluated with the use of WADULA Puzzling Cube Workbook is the issue of bedsores, also known pressure ulcers, in the hospital. This condition often develops when an area of a patient’s body is under pressure for comparatively long period of time, and is often a preventable side-effect of poor patient care (Leigh & Bennet 2011, p. 167). Whereas healthy individuals can easily shift their position whenever the body is feeling sore, in many instances patients cannot do so. They would not be able to change position or they might not even feel the pressure (Neilson et al. 2014, p. 18). The action plan or proposal which shows a good understanding of the purpose of WADULA practice evaluation tool is the proposal that entails using this tool to prevent the incidences of pressure ulcers at the hospital. The main question for the issue is: How to use WADULA practice evaluation tool to prevent the incidences of bedsores?

In this first step of using WADULA, the issue would be turned into a puzzle question. The issue of bedsores is restated as a puzzle question as follows:

How can we prevent the occurrence of bedsores at the hospital?

This second step would entail clarifying the purpose behind one’s thinking (Miskelly, Duncan & Walsh 2011, p. 86). The purpose of the puzzle would be to find ways or strategies of preventing the occurrence of bedsores at the hospital. If a solution to the puzzle is found, patients at the hospital would receive proper care and their risk of developing bedsores would decrease considerably; healthcare workers at the hospital would offer higher quality patient care; the healthcare services offered by the hospital would enhance patient safety; and the hospital would save costs associated with the treatment of hospital-acquired pressure ulcers since bedsores are a significant financial burden on the hospital (Xiaohong 2017, p. 10).

This third step would entail finding evidence which supports the viewpoint that the issue of bedsores at the hospital is something that is, in fact, worth spending time on (Miskelly, Duncan & Walsh 2011, p. 86; Wilson 2011, p. 7). The evidence would help confirm that the issue of bedsores at the hospital is significant and it would help when presenting the proposal to other people. Facility-acquired pressure ulcers, as Haesler, Kottner and Cuddigan (2017, p. 1521) pointed out, are costly and widespread, but they can also be prevented. A lot of patients who have been hospitalized get this condition, with occurrence in acute care settings ranging from 0.4 percent to 38 percent (Haesler, Kottner & Cuddigan 2017, p. 1522). The International Pressure Ulcer Prevalence Study carried out in the year 2005 found a prevalence rate of 7.3% (Bhattacharya & Mishra 2015, p. 12). According to Cooper (2013, p. 58), 1 out of five hospitalized patients have the risk of getting hospital-acquired pressure ulcers. This condition is an expensive problem considering that the costs for treating this condition ranges from $2,000 – $7,000 for every wound, with the average total costs for the hospital annually being between $410,000 and $690,000 (Neilson et al. 2014, p. 19). Pressure ulcers that occur after the patient has been admitted into a healthcare institution is an indication of negligent nursing care and it is inexcusable (Ajami & Khaleghi 2015, p. 1012).

Evidence-Based Strategies for Preventing Bedsores

Elderly patients who have hospital-acquired pressure ulcers could develop joint and bone conditions including squamous cell carcinoma and osteomyelitis that may result in life threatening and/or chronic conditions (Bhattacharya & Mishra 2015, p. 14). The other possible complication of bedsores is cellulitis brought about by an infection which spreads to connected soft tissues. This complication could result in life threatening conditions and causes severe pain (Lyder & Ayello 2008, p. 24). In addition, a patient who has bedsores and suffers from incontinence could easily become vulnerable to sepsis, which is a life threatening infection that could bring about organ failure (Leigh & Bennet 2011, p. 169). The evidence-based strategies for preventing bedsores are shown in the table below:

Table 1: Strategies for reducing bedsores and improve patient outcomes

	Strategy	Description
1	Risk Assessment	This is the starting point. The sooner a risk is identified, the quicker it could be addressed. A structured risk assessment tool is used in identifying patients at risk of bedsore as early as possible. Other risk factors like existing pressure injuries, as well as illnesses like vascular problems and diabetes are also identified. The risk assessment is repeated regularly and changes are addressed as needed. Basing on the risk assessment, a plan of care is developed. The identified issues are prioritized and addressed (Cooper 2013, p. 65).
2	Skin Care	It is important to protect and monitor the condition of the skin of the patient to prevent bedsores and identify Stage One bedsores as early as possible so they could be treated before they become worse. The skin of the patient should be inspected upon admission and everyday for any signs of bedsores. Assess temperature, pressure points, and skin underneath the medical devices. Do not position the patient on a region of pressure injury (Reddy 2008, p. 2649).
3	Nutrition	Patients in a hospital have a high risk of undernutrition. Assess the individual’s risk for malnutrition using a valid tool. Patients who are at-risk be referred to a registered nutritionist or dietitian. Assess the weight of the patient on a regular basis. Offer supplemental nutrition if necessary (Cooper 2013, p. 66).
4	Mobilization and Positioning	Immobility could be a significant factor in bringing about bedsores. Immobility could be a result of sedation, coma, age, paralysis, or general poor health condition. Patients who at at-risk should be turned and repositioned. Have a scheduled frequency of turning and repositioning the individual. When placing a patient on any support surface, use pressure-relieving devices (Cooper 2013, p. 66).
5	Monitoring, Training and Leadership Support	The change would be successful with appropriate training, monitoring, as well as leadership support. Monitor the incidence and prevalence of bedsores. Train and educate every member of the interdisciplinary team and ensure they understand the plan of care to deliver patient-centered care. Ensure leadership oversight, support, and allotment of sufficient resources (Reddy 2008, p. 2650).

This evidence suggests that change is necessary at the healthcare facility and it supports the proposal.

Those who are likely to be interested in the puzzle and who would be directly involved include healthcare workers at the hospital such as doctors, nutritionist, therapist and nurses; nurse managers and charge nurses; the hospital’s top executives and administrators; and patients/clients (Walsh et al. 2005, p. 126). They would be interested in it since they all want the incidences of bedsores at the hospital to drop. As part of the engagement process, it would be important to work directly with the following key partners: nurses, nurse mangers, therapists, nutritionists and charge nurses (Kitson, Harvey & McCormack 1998, p. 150). During the process, I would need to engage the nurse managers of the hospital in consultation. Moreover, those that I will need to keep informed and with whom I would need to establish communications include the hospital’s top administrators. All in all, working with these people directly, engaging them, keeping them informed and establishing communications with them is vital as it would to gain buy-in from them and obtain their support which would help the change process and ultimately prevent bedsores at the hospital.

Those people who would be supportive of the proposal include the hospital’s top administrators, charge nurses, and nurse manager. This is because they understand that the hospital would be able to save huge costs when incidences of bedsores drop. On the other hand, people who might react negatively to the proposal are the nurses. This is because they know that would be required to carry out more work such as conducting risk assessment, repositioning and turning the patients regularly, and inspecting the skin of the patients upon admission and everyday for any signs of bedsores; all aimed at preventing the occurrence of bedsores.

Proposing a Change Using the WADULA Practice Evaluation Tool

The amount of time that can be devoted to the process is 3 months. There would be nothing else going on in the environment at the time when the process would be implemented, hence the timing is right. The people and staffs at the organization would have both the cultural and emotional capability of coping with the puzzle at this time. The proposal would be seen as applicable to the context as it would be feasible, acceptable, meaningful, and effective (Wilson 2011, p. 6).

This step would entail measuring the change (Dewing 2010, p. 22; Walsh et al. 2004, p. 93). The change is supposed to make a difference to patients, staffs at the hospital, and to the service offered there (McAllister 2003, p. 530). To know that the change has made a difference to patients, the incidences of bedsores at the hospital will decrease considerably as fewer patients, if none at all, would develop this condition. To know that the change has made a difference to staffs at the hospital, the staffs would start offering proper and higher quality patient care, which includes carrying out risk assessments, protecting and monitoring the skin condition of the patients, and turning and repositioning at-risk patients (McCormack & McCance 2006, p. 473). Lastly, to know that any change has made a difference to the service, the service delivered at the hospital should enhance patient care. The data that would be collected is the number of cases of bedsores before and after the change process and compare to find out whether the rate of occurrence has decreased. The data would be obtained from the hospital’s monthly records of bedsores.

This step would entail mobilizing cooperation instead of resistance (McSherry 2004, p. 141). Generally, the people in the healthcare organization tend to be resistance to change if they do not understand it properly, if they do not understand how the change is going to benefit them and the organization, and if they are not involved or consulted during the change process (Rycroft-Malone et al. 2004, p. 920). It would be helpful to consult with the hospital staffs, managers and administrators, and seek support and advice from them. To communicate the puzzle to other people within the organization in a manner that would mobilize support, the most effective methods to use include organizing face-to-face meetings and conferences to talk about the puzzle, sending email messages to everyone regarding the puzzle, and publication in the hospital’s newsletters and circulating them to everyone. In addition, audio-visual aids such as posters, pamphlets, brochures and charts would be used to educate the hospital staffs as well as patients and their families about bedsores and how to prevent them.   

Measuring the Change

In this final step, the actions that guarantee the greatest chance of success with the puzzle are identified (Wilson & McCance 2015, p. 54). Prior to taking the puzzle out, it would be important to inform everyone in the organization about the change and gain buy-in from them. Before launching the puzzle, it would be beneficial to undertake some relationship building with the nurses and other staffs, as well as with the hospital managers and top administrators. They would be consulted and the benefits of solving the puzzle would be explained to them; that is, how they and the organization in general would benefit. Any concerns raised by the people involved would be addressed appropriately. The statement of engagement would be communicated to everyone who has a stake/interest in the proposal by inviting them to articulate what level of involvement in the process they would wish, for instance do they want to be consulted at key points, to be involved actively, to just be kept informed, or to offer advice?

We are proposing to engage around the puzzle of: how can we prevent the occurrence of bedsores at the hospital?

The purpose of engaging around this puzzle is to prevent the incidences of bedsores at the healthcare facility and in so doing improve patient outcomes and reduce hospital costs associated with the treatment of bedsores.

We hope that by finding solutions for this puzzle, our service, staff, and patients would benefit in the following ways: improved patient outcomes, staffs would provide better quality healthcare services, and services would improve patient safety.

The evidence that we have to support our belief that this puzzle is important is that bedsores are costly, widespread, and preventable, with prevalence rate ranging from 0.4 percent to 38 percent. They cause many complications, increase length of stay, and could even cause deaths. Strategies for preventing them include risk assessment, proper skin care to protect the patient’s skin condition, ensuring adequate nutrition, turning and repositioning the patient regularly, and training and educating staffs about suitable plan of care to deliver patient-centered care.    

Evidence that we still need to collect includes main causes of bedsores at the hospital.

The people that we have identified as most important to this puzzle are patients and nurses and we think that we will need to engage directly with nurse managers, nutritionists, therapists and senior hospital administrators to seek solutions for this puzzle.

Mobilizing Cooperation Instead of Resistance

We have identified the following features of the current context as being important to supporting the puzzle: the hospital’s top administrators, charge nurses, and nurse managers would be supportive of the proposal since they easily understand its benefits to the whole organization.

We have identified the following features of the current context as potentially getting in the way of successful engagement with this puzzle: nurses would react negatively as their workload is likely to increase considering that they would have to assess the patients and reposition them regularly to prevent bedsores.

We propose evaluating any changes generated through the process by comparing the incidences of bedsores at the hospital before and after the process.

In order to facilitate the initial engagement of key stakeholders with the puzzle, we will communicate the puzzle by holding face-to-face meetings, sending email messages to everyone concerning the puzzle, publication in the organization’s newsletters, and using audio-visual aids such as posters.

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