The Purpose of this Project
The purpose of this project is to implement repositioning evidence-based practice(EBP), which can be utilized as an effective strategy of managing as well as treating pressure sores among patients hospitalized in medical institutions. In this case,repositioning has been validated by research as an effective and applicable intervention that can be implemented in the health care sector. Traditionally,other interventions such as the use of pharmacological drugs were utilized in pressure ulcer control. Nevertheless, their effectiveness in securing improved health care outcomes among patients has not been successful. As such,repositioning will the best alternative if implemented by medical practitioners among immobile patients admitted in the health care facilities.
Particularly, this project will provide a guideline through which the repositioning EBP will be implemented and integrated to be part of the regular medical intervention implemented amongst patients who have been discharged from the intensive care units (ICUs). The following project plan will define the goals and objectives of the intervention implementers and it will define the project scope prior to the intervention implementation.Other parts of the project that will be communicated in this plan include the required deliverables for the project, as well as the internal and external constraints that may impact the EBP implementation.
Also, the basic assumptions made on the interventions will also be discussed and the project schedule and milestone to be achieved will be outlined. Furthermore, a budget indicating the expected cost of completing the project will also be indicated under risk assessment for the project outlined. Also, the proposed resources to be used in the implementation of the EBP will also be discussed, which will be accompanied by a description of all the standards followed to ensure the correct and ethical implementation of the proposed EBP. Lastly, the change procedures that will be followed will also be discussed which will be accompanied by a work plan as well as post-project sign off development.
Scope of the Project
The scope of this project is to create and implement an EBP practice that can improve the healthcare outcomes of patients admitted to healthcare facilities. Particularly, that is repositioning which can be utilized as an effective clinical intervention for aiding the prevention, management as well as treatment of bedsores for patients hospitalized in medical institutions after undergoing through a surgical operation. This scope of this project is also defined by an elevation in the attained number of immobile patients that have fully recovered in their healthcare environment setting after being supported by repositioning EBP to relieve the level of pressure or force exerted on the surface of their skin. The attainment of the project scope will be marked by the number of patients who have fully recovered and discharged from the ward units in medical institutions.
Goals and Objectives
The primary goal/objective of this project plan is to propose the implementation of repositioning as an effective EBP in the control of pressure ulcer development among patients admitted to medical facilities after discharge from ICU departments. Minor objectives of the plan will be to provide an outline of the desired activities that nursing practitioners,who will be the implementers of the intervention, required undertaking to ensure the attainment of success of the EBP Implementation. The other goal of the project implementation will be to create an attainable deadline for implementing the proposed practice in health care institutions. The additional minor objective of this project plan will be to outline the expected goals of implementing the proposed EBP in the health care settings particularly in reference to the improvement of the overall health and wellness of immobile patients who cannot change their physical position without physical assistance from medical practitioners.
The required deliverables for this project will be all the items that will need to be achieved in order for the implemented project to be considered as a success. In this case, the deliverables of the project will include the project scope statement as well as the preparation of the project schedule. Other deliverables will include the formulation of the project’s milestones as well as the designing of a sufficient budget that can be utilized in planning resources that will be required in implementing the EBP. Other deliverables will include the execution of a risk assessment to investigate possible factors that might affect the successful implementation of the project or EBP. Also, a detailed description of the quality control tours that will be required for this project will be computed and also the proposed resources that will be needed to fully execute the project will be identified.
Furthermore, as part of the deliverables, the resource estimates of all items that will be needed to fully implement the EBP will be provided. Also, a description of the standards of ensuring that repositioning as clinical practice has been fully integrated and implemented in the clinical setting will be created and implemented. Also, change procedures that will be considered essential for facilitating the implementation of the identified interventions will be prepared and also a comprehensive work plan that will be followed via the RNs while implementing the interventions will be applied. Lastly, the post-project sign off forms marking the successful completion of the project upon the EBP implementation will be created and offered to all the stakeholders on the repositioning practice implementation in the healthcare environment.
There will be five fundamental steps that will be involved in the process of implementing repositioning as an effective EBP in the health care setting. The first step will entail communicating about the in practice implementation to the affected stakeholders of the institution. In this case, the RNs in charge of coordinating the project implementation will need to communicate about the change in practice to patients as well as nursing providers who will be responsible for delivering the EBP to the sick in the health care setting. Also, communication with the management authority or board members in charge of hospital operations will also be essential.
Particularly, that is in ensuring that the introduction of the new EBP in the health care setting does not conflict with other guidelines of practice implementation that has already been formed by the board. The second step in the project schedule will entail the training of RNs. In this case, all nursing providers that will be involved in implementing the nursing practice will be required to have sufficient training to be taught on how to implement the practice. In this case, the training will take a period of seven days whereby the theoretical and practical performance of each RN will be assessed to determine whether they are capable of effectively implementing the EBP in the health care setting.
The third step in the project schedule will entail the conduction of a pilot test to test the efficacy of repositioning as an EBP for preventing and managing bedsores. In this case, the EBP practice will be implemented on a small number of immobile patients admitted in medical facilities in targeted institutions and then the results of the implemented practice collected to inform the success or failure of the EBP. The fourth step in the project schedule will be the actual implementation of the EBP.In this case, all RNs required to implement repositioning on the targeted patients will commence with the practice and within the desired guidelines in which case their individual performance in implementing the EBP will be monitored and assessed by senior RNs who are already proficient with the repositioning practice.
The fifth step in the project schedule will be the evaluation of the success of the EBP practice. In this case, data will be collected from all RNs who are in charge of administering the repositioning intervention practice to immobile patients admitted in medical facilities. The failure or success of the EBP in alleviating bedsores among patients and in promoting improved health care outcomes of patients will be identified. Subsequently, this will make it possible for implementers of practice change to determine whether the EBP has been effective or not. The last step in the project schedule will be monitoring the performance of the EBP. In this case, monitoring the performance of the EBP will be essential in ensuring sustained effectiveness in helping patients prevent bed sores while in an immobile state and when admitted to medical facilities.
Internal and External Constraints
Internal constraints: There will be three internal constraints that affect the effective implementation of the repositioning as an EBP in managing and averting pressure ulcer development. That first internal constraint will be marked by the poor understanding of how to implement repositioning as an EBP practice by RNs in the healthcare settings. In this case, some RNs in the EBP implementation process might not be fully competent in some guidelines of repositioning such as the need to turn patients every two hours instead of turning them after more than four hours. Such a constraint might affect the overall success of the implementation of repositioning EBP in the healthcare setting.
The second internal constraint will be an insufficient number of RNs available to administer the repositioning practice. In this case, repositioning as a healthcare practice will be largely dependent on manual moving/rotating of patients when on the hospital beds. As such the EBP will require a sufficient number of nurses who can execute the intervention sufficiently to sustain a positive health status of all patients admitted/hospitalized in the medical settings. The third internal constraint will be the medical institutions’ policies. In this case, some medical institutions might have complicated protocols governing the adoption of new EBPs. Subsequently, such complicated protocols may affect the timely adoption of repositioning as an effective EBP that can be utilized in effectively preventing the development of bedsores among immobile patients.
There will be one primary constraint that might occur and affect the overall execution of the EBP implementation process. In this case, the external constraint will be a lack of sufficient resources in terms of finance and human resource to effectively train the RNs that will be involved in the EBP on how to administer repositioning on the targeted demographic of patients. In this case, lack of financial human resources will need that the repositioning in the EBP implementation process might need to be postponed until a time when sufficient team will be available to sufficiently implement the EBP practice in the healthcare setting. As such, the postponing of the intervention implementation process might, in turn, affect the planned implementation period required to fully complete the EBP healthcare integration process.
|Item||Projected/Estimated Cost in $U.S.|
|2.||Health Department permit||$3,000||00|
|5.||EBP support equipment||$73,000||00|
Table1: Table illustrating a simple budget illustrating the cost of resources required to fully implement repositioning as an EBP in the health care environment. Also, the budget was self-developed.
|EBP Activity and Execution Period||Week 1||Week 2||Week 3||Week 4||Week 5|
|Communicating the EBP|
|Training RNs on how to implement the EBP|
|Implementing the EBP|
|Evaluating the effectiveness of the EBP|
|Monitoring and Control of the EBP|
Table 2: table illustrating a Gantt chart that will be employed in organizing all activities that will be undertaken in implementing repositioning as an effective EBP in the healthcare setting. Additionally, the Gantt chart table was self -developed.
Project milestones are management tools that are employed to delineate a point in an underlying projects-schedule. The milestones can mark the start or completion of a project or they can indicate a key achievement made in the project. In this project plan,four fundamental milestones will need to be achieved by the implementers of the proposed EBP to ensure its successful implementation in the health care organization environment. The first milestone is the communication of the EBP whereby the implementers of the EBP will enlighten all the participants of the proposed EBP on the need to adopt repositioning in improving the overall health care outcomes of patients in medical institutions.
The second milestone will be the training of RNs on how to implement the repositioning EBP in the health care environment. The third milestone will be the actual implementation of the EBP. Particularly, this will be the primary milestone in this project as it ensures the desired objectives of the research which is to alleviate or manage the formation of pressure ulcers among patients have been achieved. The last project milestone will be the evaluation of the implemented EBPs performance. In this case, performance evaluation of the EBP will be executed to determine whether the new medical modality has been effective in achieving its desired objective.
Risk assessment will be an imperative undertaking that will be conducted in this project to ensure its successful completion upon the commencement of its implementation. In this project, a risk assessment will involve measuring the likelihood of a risk occurring and in the process affecting the effective implementation of the project. There will be two primary tools that will be used for risk assessment in this project. The first tool will be the use of the Delphi technique whereby the implementers of the project will consult experts of project management seeking information on the most probable risks that may negatively impact the implementation of repositioning as an EBP in the health care setting. In this case, the Delphi technique will be essential for implementers as appropriate on probable risk will be offered to them based on the experts’ past experiences. The second risk assessment tool that will be used in this project will be interviews whereby the implementers of the EBP practice will interview the different participants of the research in an effort to seek their opinions or suggestions on the factors that might negatively impact the EBP implementation process
Description of Quality Control Method
Quality control will be essential in this project as it will ensure that implementers of the repositioning use the high-quality standards in introducing the medical interventions to patients admitted in health care institutions. Additionally, quality control will also ensure that all aspects of the project plan that will be followed when implementing the EBP practice are followed according to the desired quality guideline which will subsequently, facilitate the attainment of the desired scope or objectives of the project. A histogram will be used as the preferred quality control tool. The histogram will illustrate two different frequencies, one for the expected outcomes of the project and one for the actual outcome of the project. Any deviation of the actual outcome from the expected in the histogram graph will indicate the need to improve the quality of the activities undertaken in introducing the EBP practice in the health care setting. Also, the histogram has been chosen as the right tool for quality evaluation due to its simplicity in the creation and ability to support the graphical representation of all activities undertaken in the execution of the project.
Description of Standards
Ethical standards will be emphasized to facilitate the effective execution and completion of this project. In this case, three ethical standards will be followed by the implementers of the repositioning EBP implementation project. The first ethical standard will be informed consent where the implementers of the project will ensure that all participants (patients and RNs) will be fully informed on the reason why the new treatment practice has been introduced into the healthcare environment setting. Also, all patients that will be beneficiaries of the new treatment modality (repositioning) will be required to provide an informed consent stating that they have fully agreed to receive the stated EBP in averting the formation of pressure ulcers while being admitted in medical facilities.
The second ethical standard will be anonymity whereby all participants in the implementation of the EBP practice will have the right to retain their personal/confidential information during the presentation of the implemented treatment modality. Also, none of the implementers of the EBP will expose any personal data regarding an EBP participant without his/her personal approval. The last ethical standard is the truth of findings whereby the implementers of the EBP will be required to provide factual information to the public on their findings of repositioning after it has been implemented in the healthcare sector.
Proposed Control Tools
In this project, the Gantt chart will be utilized as the most preferred control tool in the proposed EBP implementation process. Additionally, the Gantt chart has been considered effective because it aids in breaking down large undertakings of a project into soft tasks that are easy to organize and execute. Also, each of such smaller tasks has a defined timeline of execution which is effective in guiding the researchers on the sequence of activities and the period of time to take in each activity. The use of the Gantt chart will ensure that all activities of the project are assigned to different project stakeholders which will allow different tasks to be executed simultaneously and the process promotes the timely completion of the entire EBP implementation process. Below is the Gantt chart that will be used to organize the activities that will be executed in this project.
Proposed Resource Estimates
There will be three classifications of resources that will be emphasized to effectively implement this EBP project. The first resource will be the availability of competent RNs with the capability of administering repositioning to the targeted patient demographic. In total, under human resources, ten RNs will be required for data training other nurses on repositioning implementation and guiding them on the EBP implementation. Also, all tasks will be delegated to the ten stated RNs in the whole project. The second resource that will be required for this EBP implementation process is finance. In this case, an estimate of $2000 will be sufficient to facilitate the full planning and implementation of the stated EBP project. The last resource will be time, whereby an estimate of five weeks in total will be required by the implementers of the EBP project to fully integrate repositioning as an effective treatment modality in the healthcare environment.
Part B: Reflection of the Project Plan
The proposed EBP will play an integral role in promoting the attainment of positive healthcare outcomes among immobile patients hospitalized in medical facilities. Additionally, pressure ulcers can complicate themedical conditions of an individual if he/she is already afflicted by other medical conditions. Specifically, patients who have already undergone surgical operations are already at a weakened state and theirhealth status might not fully sustain body infections that could be caused by the formation of bedsores. As such, constant repositioning of patients can play a critical role in relieving the pressure on the surface of the skin, which could make the life of a patient admitted in a medical facility to be worse.
Impact of the Project Plan in Implementing Repositioning as an Effective EBP Intervention
Issue to Be Addressed By the Proposed EBP
Pressure ulcers are common amongst patients who are bed-bound or those receiving medical care via mechanical ventilation. Particularly, those are the patients admitted to hospital wards after being discharged from the ICUs. As such, nursing practitioners who are charged with the responsibility of caring for patients with this condition must be well trained on the recently developed and most effective strategies that can be employed for pressure ulcers’ management. This research plan will provide an effective guideline on how pressure ulcers management can be achieved through the use of repositioning an effective EBP in the clinical setting.
In a healthcare environment, pressure ulcers among patients are manifested through the inflammation of the skin surface or underlying the tissues on a person’s body. The condition is brought about by prolonged exertion of pressure on a person’s skin surface for a long duration. Patients admitted in the ICUs are exceedingly susceptible to bedsores (pressure ulcers) because of their inability to change positions on their hospital beds, especially after undergoing a surgical operation. As such, educating nursing practitioners on how to use repositioning effectively medical practitioners to improve the rates of patients’ healthcare outcomes and also facilitate a reduction in pressure ulcers-related mortalities.
Scholarly Studies Supporting the Implementation of the Proposed EBP
Repositioning as an effective EBP for addressing the issue of pressure ulcers has been supported by a number of scholarly publications. Among such scientific studies include those executed by Etten (2020) that found out ensuring that a patient understands the importance of repositioning can be effective in guaranteeing that the intervention works in preventing pressure ulcer development for patients while in a sitting position. Additionally, Etten’s (2020) research was presented as a qualitative peer-reviewed article as it largely used literature materials and evaluation to explain the significance of patients repositioning EBP in the deterrence of bedsores.
Different research executed by Woodhouse et al. (2019) found out that repositioning is effectual in deterring the development of bedsores among patients admitted in medical institutions. Moreover, Woodhouse et al. (2019) research also stated that the training on pressure ulcer prevention to nursing care providers should be inclusive of practical demonstrations to ensure that the EBP is implemented correctly in the healthcare setting. A different study executed by Peterson et al. (2013) also supported the effectiveness of repositioning as an effective EBP in deterring the emergence of pressure ulcers.
According to Peterson et al. (2013) research, stated that the training of nursing providers on how to identify at-risk tissues can help in promoting the efficacy of repositioning in pressure sores deterrence. Peterson et al. (2013) research was a descriptive observational study that was executed to ascertain the effectiveness of repositioning if used as an EBP. In a different study executed by Rich et al. (2010), t was evidenced that frequent repositioning of hospitalized individuals in 2-4 hours period to be more effective in preventing pressure ulcers as opposed to longer repositioning periods of more than 4 hours.
Rich et al. (2010) was a cohort study that was executed to investigate whether repositioning can be utilized as an effective methodology for managing as well as treating pressure sores among hospitalized immobile patients. Different research that has supported the effectiveness of repositioning as an EBP was developed by Knibbe et al. (2018) and its investigations found out that powered repositioning systems are immensely effective in deterring the development of bedsores among patients implemented correctly. Additionally,Knibbe et al. (2018) research was a randomized controlled trial created particularly to investigate the effectiveness of repositioning if implemented in the healthcare setting.
National Bodies Acknowledging Pressure Ulcers to Be a Key Healthcare Issue
The problem of pressure ulcers can be linked to several national qualities as well as safety indicators. The first one is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (Joint Commission, 2015). Additionally, this national indicator is also referred as the Joint Commission (Joint Commission, 2015). The JCAHO acknowledges that pressure ulcers are a critical problem affecting numerous patients in the United States (Joint Commission, 2015). Additionally, JCAHO offers essential guidelines for managing pressure ulcers development, which is focused on mitigating the development of this condition at their Stage one of development.
Additionally, the National Database of Nursing Quality Indicators (NDNQI) has also established that pressure ulcers development is a critical problem affecting most patients in healthcare facilities (Roux & Halstead, 2017). As such, the NDNQI has developed atraining program for healthcare practitioners, which is focused on improving the nursing accuracy and reliability in the identification and staging of pressure ulcers. The program is also designed to provide a differentiation between the hospital-acquired pressure ulcers (HAPU), and the community-acquired pressure ulcers (CAPU).
Limitations/Barriers to Note with the Repositioning an Effective EBP
Nevertheless, it would also be essential to not barriers to effective implementation of the repositioning as an effective EBP. Such limitations can be evidenced through evaluating Etafa, Argaw, Gemechu and Melese’s (2018) research. In this case,Etafa, Argaw, Gemechu and Melese’s (2018) found out that nurses’ attitude as well as perceived barriers to effective prevention of people’s pressure sores among patients admitted in medical institutions. The stated research sought to address two fundamental research questions. In this case, the first question was – does the attitude of nurses in a healthcare setting contribute to the emergence of pressure ulcers among hospitalized patients?
On the other hand, the second question was – what are the barriers that hinder nursing providers from implementing practices to can be employed in preventing the emergence of pressure sores among patients in a healthcare setting. The majority of nurses (n = 116, 52.2%) were evidenced to have a negative attitude towards the prevention of clients’ pressure sores. The mean scores of all the tests performed on the sample population were 3.09 out of a total of 11, which could be represented by the standard deviation SD =0.92 and a range = 1–5 (Etafa, Argaw, Gemechu&Melese, 2018). The barriers in nursing to pressure ulcer prevention were identified to include heavy workload on nurses and the presence of inadequate staff. Other barriers identified in the study included a shortage of sufficient nursing equipment/resources and inadequate training of nursing personnel.
In conclusion, the identification of an effective medical intervention to address the issue of pressure ulcers among ICU-admitted persons is a critical medical issue that medical practitioners should address today. Additionally, that is because it will improve the rates of patients’ healthcare outcomes and also reduce the recorded numbers of pressure ulcers-related mortalities. Furthermore, pressure ulcers are caused by the prolonged exertion of pressure on the skin surface. Furthermore, the manual repositioning of patients can help nursing providers in protecting patients from pressure ulcers. Additionally, that is because changing the body positions of patients can help in shifting the pressure exerted on specific parts of the body, which could cause pressure ulcers. Today, organizations like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and National Database of Nursing Quality Indicators (NDNQI) have identified pressure ulcers to be a key healthcare issue. However, the organizations have developed atraining program for healthcare practitioners, which is focused on improving the nursing accuracy and reliability in the identification and staging of pressure ulcers. Conclusively, it would be ideal to recommend that repositioning should be adopted and implemented in all healthcare organizations, so as to promote the attainment of improved healthcare outcomes among all immobile patients admitted in the clinical facility settings.
Etafa, W., Argaw, Z., Gemechu, E., &Melese, B. (2018).Nurses’ attitudes and perceived barriers to pressure ulcer prevention.BMC Nursing, 17(1). doi: 10.1186/s12912-018-0282-2
Etten, M. V. (2020). Repositioning for pressure ulcer prevention in the seated individual. Wounds International, 11(1), 18-21. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=141958119&site=eds-live&scope=site (Accessed: 18 April 2020).
Joint Commission. (2015). National patient safety goals effective January 1, 2015. The Joint Commission, 1-7.
Knibbe, N. E., Zwaenepoel, E., Knibbe, H. J., &Beeckman, D. (2018). An automatic repositioning system to prevent pressure ulcers: a case series. British Journal of Nursing, 27(6), S16-S22. https://doi.org/10.12968/bjon.2018.27.6.s16
Peterson, M. J., Gravenstein, N., Schwab, W. K., Van Oostrom, J. H., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer risk Monitoring interface pressures of at-risk patients. The Journal of Rehabilitation Research and Development, 50(4), 477. https://doi.org/10.1682/jrrd.2012.03.0040
Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., &Baumgarten, M. (2010). Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair and Regeneration, 19(1), 10-18. https://doi.org/10.1111/j.1524-475x.2010.00644.x
Roux, G., & Halstead, J. A. (2017). Issues and trends in nursing. Burlington: Jones & Bartlett Learning.
Woodhouse, M., Worsley, P. R., Voegeli, D., Schoonhoven, L., & Bader, D. L. (2019). How consistent and effective are current repositioning strategies for pressure ulcer prevention? Applied Nursing Research, 48, 58-62. https://doi.org/10.1016/j.apnr.2019.05.013
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