FADE Quality Improvement Model for Pressure Ulcers in Hospitals Today Essay

FADE Quality Improvement Model for Pressure Ulcers in Hospitals Today Essay

 

Overview of the Quality Improvement Practice Problem

Pressure ulcers (bedsores) pose a patient safety threat by resulting in adverse consequences to the patient. According to Mayo Clinic (2022), pressure ulcers are injuries to the skin and the underlying tissue perpetrated by prolonged pressure on the skin. The at-risk populations for these injuries are people with medical conditions that reduce their ability to change positions and lead to prolonged hospitalization. In the same breath, Getie et al. (2020) argue that these ulcers result from unrelieved friction, shear, pressure, or a combination of the three aspects. Unrelieved pressure on the body and prolonged inclination to one position can result in lesions or injuries to the skin and the underlying tissues over a bony prominence.

Apart from immobility and unrelieved pressure, other risk factors for bedsores include incontinence, medical conditions that affect blood flow, malnutrition and poor hydration, and a lack of sensory perception (Mayo Clinic, 2022). Incontinence exposes the skin to urine and stool, while poor nutrition and hydration deprive the skin of fluids, calories, vitamins, and minerals necessary for preventing skin and tissue breakdown. On the other hand, medical conditions like cardiovascular disease and diabetes and a lack of sensory perception lead to the inability to feel pain and discomfort, affecting individual awareness of early signs and the need to change the position.

Prevalence and Consequences

Pressure ulcers are among the leading causes of mortalities and increased care costs after cancers and cardiovascular diseases. According to Afzali Borojeny et al. (2020), over 60,000 people die of pressure ulcers in the United States annually. In the same breath, the disease accounts for about 2.5 million hospitalizations in the United States. Further, the researchers contend that hospital wards account for 4% to 38% of pressure ulcers’ incidence rate. The disease disproportionately affects older adults susceptible to low physical activity, decreased consciousness, urinary and fecal incontinence, and advanced age. In this sense, its associated complications among older adults are about 68%.

Besides increased mortality rates, pressure ulcers have multiple other ramifications that compromise patient safety and well-being. According to May Clinic (2022), complications associated with bedsores include infection to the skin and proximal tissues (cellulitis), joint and bone infections, squamous cell carcinoma, and sepsis (although rarely). Regarding the economic burden of pressure ulcers, the United States spends about $11 billion annually to prevent and treat bedsores. Similarly, the United Kingdom (UK) spends approximately 4% of the total treatment costs on treating pressure ulcers, rendering it a costly healthcare problem. Equally, patients with bedsores endure significant complications such as pain, depression, and osteomyelitis. Undeniably, the costs of preventing, managing, and treating pressure ulcers and subsequent health complications prompt healthcare professionals to implement evidence-based quality improvement initiatives.

Prevention and Treatment of Pressure Ulcers

Although pressure ulcers can lead to death, infections, increased care costs, and other consequences, they are preventable and manageable by implementing evidence-based practice. Kottner et al. (2017) identify preventive strategies consistent with the three profound indicators: structural, procedural, and outcomes. These preventative approaches include implementing regular risk assessments, training and educating patients, skin inspection, repositioning, and the use of special support services. Although these approaches are indicators of effective pressure ulcers prevention and treatment, they depend massively upon contextual factors like workplace environment, organizational cultures, leadership strategies, and legislative landscapes (Kottner et al., 2017). As a result, it is essential to consolidate them into a comprehensive quality improvement initiative to inform the development of clinical guidelines and the implementation of evidence-based practices.

Purpose Statement/Rationale for Selecting Pressure Ulcers

Undeniably, the reviewed literature presents pressure ulcers as a safety issue, considering their ramifications if preventive and treatment approaches are insufficient. In this sense, an absence of practical and comprehensive clinical guidelines for preventing and treating pressure ulcers can lead to adverse consequences like deaths, infections, prolonged hospitalization, compromised quality of life, and psychological ramifications like stress and depression. The decision to select this issue obtained insights from the opportunities for improving quality and patient safety through utilizing qualitative and quantitative quality improvement models. Therefore, this assessment offers a detailed discussion of the clinical implications of pressure ulcers and opportunities for using the FADE model in improving preventive and management Interventions.

Using FADE Quality Improvement Model in Addressing Pressure Ulcers in Hospitals

Quality improvement is a profound strategy for improving organizational performance by enhancing practices and incorporating advanced approaches. According to Spath (2018), quality improvement entails planning and changing the current practices to achieve better performance. Further, the author contends that quality improvement projects involve activities, including identifying opportunities for improvement, forming the improvement team organized together to accomplish strategic objectives, and using qualitative and quantitative tools to spearhead and implement quality improvement initiatives.

The FADE model is an upgrade of the PDSA (Plan-Do-Study-Act) improvement cycle. It consists of four profound phases: focus, analyze, develop, and execute (Bakhai et al., 2019). During the Focus phase, it is essential to analyze the problem, write a statement, and generate a list of issues attached to the identified problem. In the second phase (analyze), it is possible to determine the influential factors, collect data baselines, and decide the intervention to address the problem. During the development phase, the quality improvement team can generate a promising solution, select the most feasible intervention, and plan its implementation (Spath, 2018). Finally, the execution phase entails implementing the plan, monitoring the impact, recording findings, and sustaining the organizational commitment to change. Also, it is possible to adjust the plan consistent with finding from formative and summative assessments.

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Why is the FADE model effective in addressing pressure ulcers?

The four-phased FADE model provides opportunities for integrating evidence into quality improvement initiatives. In this sense, the first phase (Focus) requires professionals to assess the magnitude of the clinical problem and establish a purpose statement (Spath, 2018). When addressing bedsores, it is essential to analyze contextual factors, including their prevalence, the existing organizational capacities, clinical guidelines, and the hospital dashboard. Proper analysis of the problem would enable the identification of other related issues that prompt attention.

The second phase of this quality improvement model (Analyze) requires the quality improvement team to leverage informatics and use internal and external evidence in assessing the problem. Gathering performance data helps identify loopholes and decide on effective interventions for addressing clinical problems. At this point, the model allows the quality improvement team to obtain information about the prevalence of pressure ulcers and establish organizational preparedness and constraints that facilitate a high prevalence rate of the problem.

The third and fourth stages focus on developing, implementing, and monitoring the solutions to performance problems. The quality improvement team can use these phases to compare various approaches for preventing and treating pressure ulcers, including risk assessments, patient positioning, relieving pressure, and educating patients. After settling on the best combination of the solutions, it is possible to implement and evaluate the plan to identify areas of improvement. Therefore, it is valid to argue that the FADE model is profound in focusing on a clinical problem, analyzing the issue and its causal and contributing factors, developing and implementing solutions, and evaluating outcomes measures.

Conclusion

Although pressure ulcers result in multiple health and economic ramifications, it is essential to understand their risk factors, potential solutions, and contextual factors that facilitate them. Quality improvement emerges as a dimension of changing current practices to achieve better outcomes and improve performance. The quality improvement team tasked to identify and implement interventions for preventing and treating pressure ulcers can use the FADE model of performance improvement to explore the issue, gather performance data to learn more about the problem, compare potential solutions and settle for the best, and implement the quality improvement plan, alongside monitoring it to identify areas of improvement. This model is crucial because it supports the integration of evidence-based practice into clinical practices and solutions.

 

 

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_19

Bakhai, S., Bhardwaj, A., Phan, H., Varghese, S., Gudleski, G. D., & Reynolds, J. L. (2019). Optimization of diagnosis and treatment of heart failure in a primary care setting. BMJ Open Quality, 8(4), e000660. https://doi.org/10.1136/bmjoq-2019-000660

Getie, A., Baylie, A., Bante, A., Geda, B., & Mesfin, F. (2020). Pressure ulcer prevention practices and associated factors among nurses in public hospitals of Harari regional state and Dire Dawa city administration, Eastern Ethiopia. PLOS ONE, 15(12), e0243875. https://doi.org/10.1371/journal.pone.0243875

Kottner, J., Hahnel, E., Lichterfeld-Kottner, A., Blume-Peytavi, U., & Büscher, A. (2017). Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators. International Wound Journal, 15(2), 218–224. https://doi.org/10.1111/iwj.12854

Mayo Clinic. (2022, April 22). Bedsores (pressure ulcers) – symptoms and causes. https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893#

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.

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Name: NURS_4220_Week3_Assignment_Rubric

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• List View
Excellent Proficient Basic Needs Improvement
Required Content
Identified the quality improvement practice problem in measurable terms that reflect quality indicators. 9 (6%) – 10 (6.67%)
Provided a fully developed quality improvement problem in measurable terms that reflect quality indicators with insightful analysis of concepts and related issues. 8 (5.33%) – 8 (5.33%)
Provided a developed quality improvement problem in measurable terms that reflect quality indicators with reasonable analysis of concepts and related issues. 7 (4.67%) – 7 (4.67%)
Provided a minimally developed quality improvement problem in measurable terms that reflect quality indicators with limited analysis of concepts and related issues. 0 (0%) – 6 (4%)
Provided an under-developed quality improvement problem or is not in measurable terms that reflect quality indicators with little or no analysis of concepts and related issues.
Required Content
Included data that suggests a practice problem exists. 9 (6%) – 10 (6.67%)
Provided a fully developed description of data that suggests a practice problem exists with insightful analysis of concepts and related issues. 8 (5.33%) – 8 (5.33%)
Provided a developed description of data that suggests a practice problem exists with reasonable analysis of concepts and related issues. 7 (4.67%) – 7 (4.67%)
Provided a minimally developed description of data that suggests a practice problem exists with limited analysis of concepts and related issues. 0 (0%) – 6 (4%)
Provided an under-developed description of data that suggests a practice problem exists with little or no analysis of concepts and related issues.
Required Content
Provided the purpose statement/rationale for selecting the practice problem including the importance of improving patient outcomes. 18 (12%) – 20 (13.33%)
Provided a fully developed purpose statement/rationale for the quality improvement problem with insightful analysis of concepts and related issues. 16 (10.67%) – 17 (11.33%)
Provided a developed purpose statement/rationale for the quality improvement problem with reasonable analysis of concepts and related issues. 14 (9.33%) – 15 (10%)
Provided a minimally developed purpose statement/rationale for the quality improvement problem with limited analysis of concepts and related issues. 0 (0%) – 13 (8.67%)
Provided an under-developed purpose statement/rationale for the quality improvement problem with little or no analysis of concepts and related issues.
Required Content
Synthesize the findings from the analysis of evidence that support the practice problem and meets all requirements. 36 (24%) – 40 (26.67%)
Provided a fully developed synthesis of findings from the analysis of evidence. 32 (21.33%) – 35 (23.33%)
Provided a developed synthesis of the findings from the analysis of evidence. 28 (18.67%) – 31 (20.67%)
Provided a minimally developed synthesis of the findings with limited analysis of the evidence. 0 (0%) – 27 (18%)
Provided an under-developed synthesis with little or no analysis of the evidence.
Required Content
Applied a quality improvement process and quality model to the practice problem and explain why they were chosen. 23 (15.33%) – 25 (16.67%)
Provided a fully developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues. 20 (13.33%) – 22 (14.67%)
Provided a developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues. 18 (12%) – 19 (12.67%)
Provided a minimally developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with limited analysis of concepts and related issues. 0 (0%) – 17 (11.33%)
Provided an under-developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with little or no analysis of concepts and related issues.
Required Content
Chose a specific quality improvement tool that will be used throughout the project and explain why it was chosen. 14 (9.33%) – 15 (10%)
Provided a fully developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues. 12 (8%) – 13 (8.67%)
Provided a developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues. 11 (7.33%) – 11 (7.33%)
Provided a minimally developed discussion of the selected quality improvement tool including a justification of its selection with limited analysis of concepts and related issues. 0 (0%) – 10 (6.67%)
Provided an under-developed discussion of the selected quality improvement tool including a justification of its selection with little or no analysis of concepts and related issues.
Professional Writing: Clarity, Flow, and Organization 9 (6%) – 10 (6.67%)
Content is free from spelling, punctuation, and grammar/syntax errors. Writing demonstrates very well-formed sentence and paragraph structure. Content presented is completely clear, logical, and well-organized. 8 (5.33%) – 8 (5.33%)
Content contains minor spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates appropriate sentence and paragraph structure. Content presented is mostly clear, logical, and well-organized. 7 (4.67%) – 7 (4.67%)
Content contains moderate spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates adequate sentence and paragraph structure and may require some editing. Content presented is adequately clear, logical, and/or organized, but could benefit from additional editing/revision. 0 (0%) – 6 (4%)
Content contains significant spelling, punctuation, and/or grammar/syntax errors. Writing does not demonstrate adequate sentence and paragraph structure and requires additional editing/proofreading. Key sections of presented content lack clarity, logical flow, and/or organization.
Professional Writing: Context, Audience, Purpose, and Tone 9 (6%) – 10 (6.67%)
Content clearly demonstrates awareness of context, audience, and purpose. Tone is highly professional, scholarly, and free from bias, and style is appropriate for the professional setting/workplace context. 8 (5.33%) – 8 (5.33%)
Content demonstrates satisfactory awareness of context, audience, and purpose. Tone is adequately professional, scholarly, and/or free from bias, and style is consistent with the professional setting/workplace context. 7 (4.67%) – 7 (4.67%)
Content demonstrates basic awareness of context, audience, and purpose. Tone is somewhat professional, scholarly, and/or free from bias, and style is mostly consistent with the professional setting/workplace context. 0 (0%) – 6 (4%)
Content minimally or does not demonstrate awareness of context, audience, and/or purpose. Writing is not reflective of professional/scholarly tone and/or is not free of bias. Style is inconsistent with the professional setting/workplace context and reflects the need for additional editing.
Professional Writing: Originality, Source Credibility, and Attribution of Ideas 9 (6%) – 10 (6.67%)
Content reflects original thought and writing and proper paraphrasing. Writing demonstrates full adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 8 (5.33%) – 8 (5.33%)
Content adequately reflects original writing and paraphrasing. Writing demonstrates adequate adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 7 (4.67%) – 7 (4.67%)
Content somewhat reflects original writing and paraphrasing. Writing somewhat demonstrates adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 0 (0%) – 6 (4%)
Content does not adequately reflect original writing and/or paraphrasing. Writing demonstrates inconsistent adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and reference.
Total Points: 150
Name: NURS_4220_Week3_Assignment_Rubric