Effective Service Improvement Strategy for Pressure Ulcer Prevention and Management in Elderly Patients

Nursing Research 1
Nursing Research

Nursing Research 2
Executive Summary
Introduction: Owing to an increment in elderly populace and relative comorbidities, prevalence
of these ulcers has heightened in the last decade. Pressure ulcers essentially result in areas of
bony prominences, like sacrum, heels, greater trochanters, lateral malleoli and ischial
tuberosities. Service improvements in terms of ulcer prevention, care and management can be
employed in a can provide a holistic provision of care that in turn can mandate empathetic care
for aged people
Aim: The aim of the proposed research is to frame an effective service improvement strategy to
develop quality and safe service provision.
Methods: Researcher will collect secondary data from databases and text books.
Anticipated outcome: The proposed research hypotheses frameworks are driven by DMAIC
and PDSA models of six-sigma. Lean management provides certain operating guidelines that can
induce value maximisation in case of patients through reduction in waste and waiting time.
Recommendations and conclusion: Nurses are recommended to practice holistic care that can
cater to the needs of elderly patients from a diverse background. Based on the given information,
it can be concluded that the proposed research will enumerate the effects posed by lean
management and six sigma strategies on the quality of care.
Keywords: DMAIC, PDSA, Lean management, Six sigma, Healthcare, Pressure ulcer, Elderly
patients

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Table of Contents
Introduction and aim 4
Introduction..................................................................................................................................4
Aim...............................................................................................................................................4
Problem, context and background of the study 4
Problem........................................................................................................................................4
Context.........................................................................................................................................4
Background..................................................................................................................................5
Service improvement 6
DMAIC model of service improvement......................................................................................6
PDSA model of ulcer management..............................................................................................6
Principles of lean management....................................................................................................7
Literature review 8
Concepts of DMAIC model.........................................................................................................8
Governing theories of PDSA model............................................................................................9
Appraisal and application of lean management approaches......................................................11
Methodology for sustaining change11
Theory........................................................................................................................................11
Hypothesis..................................................................................................................................12
Research design..........................................................................................................................12
Concept measurements..............................................................................................................13
Data collection and processing..................................................................................................13
Process mapping........................................................................................................................13
Analysis and interpretation of main finding..............................................................................13
Possible solutions 14
Recommendation 15

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Conclusion 15
Reference List 17
Appendices 19
Appendix A: DMAIC model......................................................................................................19
Appendix B: PDSA Cycle..........................................................................................................20
Appendix C: Pre and post test patient design............................................................................21

Nursing Research 5
Introduction and aim
Introduction
Pressure ulcers are common clinical complication in case of elderly care. Owing to an increment
in elderly populace and relative comorbidities, prevalence of these ulcers has heightened in the
last decade. Systemic parameters like skin aging, chronic ailments, functional impairment,
infections and malnutrition contribute to formation and development of ulcers. Low body-mass
index, protein and albumin content are considered predisposing indicators in this situation. The
proposed research would attempt to present an evaluation of clinical change management
paradigms and their affectivity to identify potential influence on prominent ethical issues.
Aim
The aim of the proposed research is to prevent and manage pressure ulcers in elderly patients in
nursing home.

Nursing Research 6
Problem, context and background of the study
Problem
The problem caused by this issue is the formation of pressure ulcers in elderly patients during
their stay in the hospitals. Pressure ulcers are considered localised injuries, which occur due to
unrelieved pressures on the underlying skin and tissues. Despite effective preventive approaches,
pressure ulcers can be unavoidable in some cases. Even it has been observed that pressure ulcer
rate among elderly people has increased over time. Hence it is necessary to propose a specific
guideline to analyse effective service provision in consideration of patient safety and care
quality.
Context
Pressure ulcers essentially result in areas of bony prominences, like sacrum, heels, greater
trochanters, lateral malleoli and ischial tuberosities. As reported by Wang, Walker and Gillespie
(2018), 70% of the people who suffer from these ulcers belong to the age range of 65 years or
above. This result is prevalent in approximately 21% of patients in the nursing homes and 28%
of residents in hospitals in the United Kingdom. Bryant and Nix (2015) denote external as well
as internal risk indicators for checking the formation of pressure ulcers. External risk parameters
involve constant pressure that can give rise to immobility. In addition to this, excessive moisture
or shear forces on patients can be the causes of ulcers. Internal risk parameters malnutrition and
involve reduced sensory perception.
Background
Prognosis for effective treatment of pressure ulcers are further hindered by a drop in the service
provisions rendered by service providers. However, note at least 70% of secondary stage ulcers
are seen to heal after applying appropriate intervention for 6 months (Qaseem et al. 2015).