APPLICATION OF DATA TO PROBLEM-SOLVING DISCUSSION

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Application of Data to Problem-Solving discussion

Application of Data to Problem-Solving discussion
To Prepare:
Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1
Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
By Day 6 of Week 1
Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
 In my experience working in long term care and skilled nursing facilities I became aware of several issues that could have benefited greatly from improved collection of data. One such issue is the abundance of pressure ulcers developed during a patient’s admission within the skilled nursing facilities. According to Lavallée et al. (2019) patients who are admitted to nursing homes are at a greater risk of developing pressure ulcers that could lead to an increase in overall healthcare costs, an increase length of patient stays, and a potential for poor prognosis. Sweeney (2017) states nursing informatics integrates nursing and computer science in order to enhance the delivery of quality patient care in the health care setting. Fortunately, the skilled nursing facility that I was a part of was already equipped with an electronic health record system that could be utilized to collect, review, and apply data. Some of the data that could be collected in order to assist in reducing pressure ulcer development would include the raw overall number of pressure ulcer cases that were developed after admission. Additionally, the data would also need to include pre-admission pressure ulcers that have worsened. For example, a patient is admitted with a stage 1 pressure ulcer but during the patient stay it becomes a stage 2 pressure ulcer. Lastly, all patients receive a Braden assessment upon admission and this data could prove useful as well in analyzing data to help prevent pressure ulcer development.
Some of the key information that could be obtained from analyzing the data would be the development of a baseline for the rate at which patients are acquiring pressure ulcers as well as the rate at which existing pressure ulcers are worsening. This data could be utilized by a nurse leader to develop a process improvement project that could prove beneficial in reducing the incidence of pressure ulcers in the long-term care facilities. Nagle, Sermeus, and Junger (2017) state that nursing leaders can make a major impact in the management of care through process improvements. A nurse leader could utilize this data to develop a process improvement project that would require the assistance of a leadership team, a nurse informaticist, and the staff nurses. Ideally, this team would utilize the data to follow trends and produce an improvement plan that would reduce pressure ulcers. This plan could include methods of better tracking patient repositioning, better use of available bed technology, additional skin assessments, and pressure ulcer prevention bundles. This is an ongoing issue that needs to be addressed in order improve overall quality of patient care.
References
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: a feasibility study. Health & Social Care in the Community, 27(4), e417-e427.
Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist. In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionMenard Tchatchou-Tchoubia
Menard Tchatchou-Tchoubia
Dec 1, 2022Dec 1, 2022 at 11:34am
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Discussion Response
 
 
Menard Tchatchou
Walden University
NURS 6051 N
Dr. Lynne Taylor
12/01/2022
 
 
 
 
 
 
 
 
 
 
 
 
Discussion Response
 
Thanks for providing valuable insights on how the facilities you worked with could collect, review, and apply data to help reduce pressure ulcer development. I can see how Sweeney (2017) defines nursing informatics principles as integrating nursing and computer science to enhance the delivery of quality health care that could be applied in this situation. From your insights, I was impressed to learn that all ulcer patients would receive a Braden assessment upon admission. This data could prove helpful in preventing pressure ulcer development.  I would also note from your insights that the nurse leader would use the collected data from ulcer patients to develop a process improvement project in support of Nagle, Sermeus, and Junger (2017) that would be useful in reducing the incidence of pressure ulcers in long term care facilities with the help of other medics. However, I would like to know in more detail how the nurse leader and the team would use the data to follow trends to improve overall patient care quality.
Lastly, I better understood how the nurse leader and health facility team can follow pressure ulcer trends and how nursing informatics principles could be applied. I agree that collecting and using data to reduce pressure ulcer development and identify areas for improvement, using data to develop evidence-based protocols/guidelines, and using data to educate staff and patients are all great ideas. Using data to improve resource utilization (e.g., staffing levels, supplies, etc.) would be another great way to apply nursing informatics principles. Do you have any other thoughts?
References
Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist. In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionMaxine A Lewis
Maxine A Lewis
Dec 1, 2022Dec 1, 2022 at 9:06pm
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Irvin with the collection and reviewing of the data (Braden score) at your facility how meaningful is the data? Is it being used to staff according to the acuity? I am curious of the percent increase or decrease in pressure ulcer  as well at deterioration of existing ones. My rational for asking is that so often the Braden scale and documentation is done but if the manpower is not available to do the frequent turns etc.  the electronic paperwork is meticulous but  the incident of pressure injuries remains the same or increases.
Inadequate  staffing can be a contributing factor in pressure ulcer   studies have “shown a direct relationship between nurse staffing and patient outcomes such as PUs…” (Kim et.al 2022). Pressure injuries are preventable if the preventative measures are instituted however if there is no manpower to initiate evidence base practice then we are back to square one.
Harrington et.al cites “nursing home staffing levels are highly variable and much lower on weekends than during the week.43Links to an external site. RN levels were 42% lower, LVN/LPN levels were 17% lower, and CNA levels were 9% lower on weekends in 2017 to 2018.” Furthermore ” based on resident acuity, 54% of nursing homes did not meet the total CMS expected staffing level 80%of the time. About 75% of nursing homes almost never met the CMS expected RN staffing level based on resident acuity in 2017 to 2018″ (Harrington et.al 2020). Kim et.al cites that  ” the higher the level of nurse staffing, the lower the risk for PU development” (Kim et.al 2022).
 
 
Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health services insights, 13, 1178632920934785. https://doi.org/10.1177/1178632920934785
Kim, J., Lee, J., & Lee, E. (2022). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of Nursing Management (John Wiley & Sons, Inc.), 30(5), O1–O9. https://doi.org/10.1111/jonm.12928
 
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Collapse SubdiscussionIrvin Michael Jones
Irvin Michael Jones
Dec 3, 2022Dec 3, 2022 at 2:20pm
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Hi Maxine and Mernard,
In my previous experience working in the nursing home, pressure ulcer development became such a major issue due to the federal survey team that came to do a full inspection of the facility. The facility was tagged with several areas of improvement in the appropriate prevention of pressure ulcers. During this time my team and I were responsible for collecting the data, reviewing the data, and developing project proposals. Some of the plans we came up with were to start weekly wound rounds where we contracted a physician assistant that would come each week to do assessments. This was a great help because the nurses could assess patients then submit a referral for the physician assistant to see them that week. Nurses were trained to submit referrals even at the sign of redness to coccyx to help provide treatment early. We also purchased additional pressure-relieving air mattresses to provide to patients immediately upon admission.
We also increased the Braden assessment from weekly to BID and the unit managers were expected to review any changes or trends. According to Anaba-Wright and Kefas (2020) quality improvement projects to reduce pressure ulcers are beneficial when staff are able to buy-in. Through various trainings and meetings with the staff we were able to come up with additional improvements based on staff feedback. We initiated the use of the patient turning clock as well so that the nurses could assist the CNA’s in making sure the patient is repositioned every 2 hours. As you mentioned Maxine, with staffing being variable to low maintaining these initiatives proved difficult. We decided to have the entire leadership team rotate through the units daily to assist in any way that they could. We did see a reduction of pressure injuries when reviewing the data 3 months later and the facility was able to pass the inspection as well.
Thank you all for your feedback.
References
Anaba-Wright, U., & Kefas, J. (2020). Reducing pressure ulcers in care homes in Barnet: a quality improvement project. British Journal of Community Nursing, 25(Sup9), S33–S37. https://doi.org/10.12968/bjcn.2020.25.Sup9.S33
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionChristiana Nuworsoo
Christiana Nuworsoo
Dec 2, 2022Dec 2, 2022 at 2:59pm
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Irvine,
I consider your topic of interest a hot topic of great importance and priority at all health facilities.  In the United States alone, approximately $2.5 million in hospitalizations are due to pressure ulcers (Afzali Borojeny et al., 2020). Surgical and ICU patients are at the greatest risk for pressure ulcers in the hospital setting due to bedrest and immobility (Truong et al., 2016).  What sets each facility apart are the standards and protocols in place to decrease the development of pressure ulcers.  I have had the privilege of working with 3 of the major hospital systems in Maryland, and only one has a rigorous approach to prevention.  This one hospital system I’ve worked with has a Pressure Ulcer Prevention Committee that includes, at minimum, two nurses from each unit, one for the day shift and the other for the night shift.  Each week they compile a list of all patients with a Braden Score of 18 or less. Using the electronic charting system information, they can tell who is being turned and who is not.  To confirm best practice, they must visit the patients with low Braden Scores to ensure that turns are indeed being done according to the charting and that the types of equipment needed are present in the rooms.  They do random checks to ensure that the charting matches the patient’s disposition.  If a patient is not turned, they turn the patient.  The list of patients with low Braden Scores and nurses not adhering to prevention tactics are then sent to the Unit Manager.
Although I agree with you about determining a baseline Braden Score, one thing I have learned working at the hospital is that Braden Scores change by the day.  Therefore, the best practice should be to determine a daily or shift Braden Score because it indicates whether a patient is declining or recovering.  A patient with a decreasing Braden Score will need to be turned more.  A program that automatically sends a list of low Braden Score patients to the Unit Managers daily for analysis can be written.
 
References
Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171. https://doi.org/10.4103/ijpvm.IJPVM_182_19Links to an external site.
Truong, B., Grigson, E., Patel, M., & Liu, X. (2016). Pressure Ulcer Prevention in the Hospital Setting Using Silicone Foam Dressings. Cureus, 8(8), e730. https://doi.org/10.7759/cureus.730Links to an external site.
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Collapse SubdiscussionBertina Boma Soh
Bertina Boma Soh
Dec 2, 2022Dec 2, 2022 at 9:33pm
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Hello Irvine,
Pressure ulcers, primarily in-house-acquired, are a real issue for every facility. While working at a nursing home, I found a pressure ulcer as a clinical priority. Pressure ulcers can lead to significant health conditions and increase the patient’s morbidity and mortality. A pressure ulcer is important because patients come to the healthcare facility to cure their disease. However, patients suffer from pressure ulcers that can lead to life-threatening conditions such as infection of the wound, osteomyelitis, sepsis, and the reimbursement system to the health care organization. Residents in long-term and skilled care facilities have impaired mobility due to chronic illness; these residents are at increased risk for further disability due to pressure injuries. It is our responsibility to prevent this from occurring. Most nursing homes cure pressure ulcers in nursing homes using a care bundle (Lavallee et al., 2019). Routine assessment of skin, nutritional assessment, hydration, repositioning, and pressure ulcer care bundle. The nursing evidence-based practice committee should focus its next research project on this nursing practice problem. Pressure ulcers can be the gateway to many life-threatening health conditions and increase the patient’s mortality risk (Lavallee et al., 2019).
Reference
Lavallee et al., 2019. Preventing pressure ulcers in nursing homes using a care bundle: A
feasibility study. Health &Social Care in the Community. 27(4). Permalink https://chamberlainuniversity.
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Collapse SubdiscussionOlufunke Ajayi-Festus

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