Improving Patient Care: Addressing Pressure Ulcers and Dietary Needs

1 Western Governor University Paige Richards Organizational Systems and Quality Leadership C489 Task 1

2 Mr. J. is a retired rabbi who has been diagnosed with mild dementia and is being treated for a fractured hip at a nursing home. His daughter is at his side, but he is restrained and needs restroom assistance. The CNA responds and helps Mr. J, but the daughter is concerned about redness on his scaral area. The daughter also had some dietary concerns because the rabbi was to be on a kosher diet. The CNA did not take the daughter's concerns as important as the patient was at risk for pressure ulcers. The correct way the CNA could have addressed the patient and family would have been to address the toileting needs and pressure ulcer. With restraints and redness, the patient is at risk for HAPI (Hospital-acquired pressure injuries), which can happen when patients are in long-term care facilities. The CNA could have told the RN so that they could apply wound dressing and ask the doctor for an order to turn the patient q2 and use wedges. The facilities failed to inform the family that the patient did not have a kosher diet for some time, and he consumed regular meat. How Mr. J and his family were treated is unprofessional and can lead to poor patient satisfaction scores and possibly a lawsuit if he was injured. These errors could have been corrected if the nursing staff had adhered to the nursing quality indicators. Nursing quality indicators play a significant role in safe patient care. The indicators are metrics that can be measured to help Leadership provide good quality care and identify issues that may arise. These indicators that need focus in the scenario are Prevention Quality Indicators (PQIs) and Patient Satisfaction. We prefer no problems within patient care, but as you can see in the scenario, it does happen more often than we think. Pressure ulcers can be prevented if good quality care is provided. The pressure ulcer was due to the patient lying down for an extended time and restrained. Pressure ulcers could be reduced by helping the patient turn every 2 hours

3 and providing a low-air mattress for the patient. There should be an educator that keeps every employee up to date on interventions like pressure ulcers. Mr. J should not have been restrained because he was medicated and seemly re-directable. Using evidence-based practice could highlight the gaps in pressure ulcers to lead to better outcomes. In the acute care setting, several studies have attempted to demonstrate that implementing comprehensive pressure ulcer prevention programs can decrease pressure ulcer incident rates ( Lyder, Ayello, 2008). Mr. J could follow commands and listen, so restraints should be used last. In the Scenario, Mr. J was fed a pork cutlet instead of a kosher diet, and neither his daughter was informed of the error. The CNA was nonchalant about the dietary mistake, which could significantly affect future patient satisfaction scores. THE CNA said, "Pork has never killed anyone," Leadership encouraged staff to be quiet about the incident. Even Mr. J's doctor expressed concern and frustration over the dietary mishap. Mr. J should have been informed, as well as the family, since he has mild dementia. The facility has a prominent Jewish community, which should all be cared for similarly. The diet staff and nursing staff have zero compassion for other cultures. Learning modules and classes should be taught on biases and cultural competence yearly. "Patient satisfaction is directly linked to key success metrics for hospitals and other healthcare providers: it impacts clinical outcomes, patient retention, and reimbursement claims." ( Centegix, 2022). Good practices and evidence-based policies can help improve the way patients are treated. Good data on Incidents of pressure ulcers and the prevalence of restraints can help reduce cost and HAPI. The entire staff needs proper training on pressure ulcers and restraints. The facility needs to start tracking pressure ulcer rates to help assess how effective the

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4 interventions are and what needs improvement. Advancing quality of care happens when the data received can provide healthcare institutions with what's required to evaluate and change. They should start with a good team of Educators, Nursing staff, and Leadership to ensure they can continue benefiting from patient quality indicators.

5 References Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2650/ Why Hospital Safety is Critical to Patient Satisfaction and Hospital Profitability., (2022) https://www.centegix.com/why-hospital-safety-is-critical-to-patient-satisfaction-and-hospital- profitability/

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PAR C489 Task 1

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