Quality and Safety in Health Care Practice: Project Proposal

This project proposal focuses on improving quality and safety in healthcare practice by addressing the challenges and prevention of Pressure Ulcer among Dementia patients. It explores the importance of service improvement, analyzes relevant policies and guidelines, and applies the PDSA service improvement model.

Quality and Safety in Health
Care Practice: Project
Proposal

Contents
INTRODUCTION...........................................................................................................................1
Aim of the project............................................................................................................................1
Problem, Context and Background..................................................................................................1
Service Improvement.......................................................................................................................6
Usage of PDSA with integration of lean thinking...........................................................................7
Sustaining Change...........................................................................................................................8
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Healthcare is known as improvement in the health of suffering person through consideration
of the various processes like prevention, diagnosis, treatment, recovery, cure of disease, illness,
injury and other physical or mental impairments. The duty of providing optimum health safety is
upon medical professionals allied with specialist health fields. One of the important aspect
associated with deliverance of health facilities is quality and safety. It is the duty upon health
professionals that provide quality services to patient irrespective to the nature of disease. Also,
they have to take all necessary steps for the safety of patient and other associated parties. The
importance of maintaining quality and safety within healthcare facilities is high because life of a
person depends upon the care services ascertained as treatment. Government also takes different
steps in this direction to govern activities of medical professionals with the aid of creating
policies and relevant legislations (McGraw, 2019). The topic selected for service improvement is
related to Pressure Ulcer among Dementia patients. Under this topic, major focus is provided
over ascertainment of challenges and prevention of Pressure Ulcer among Dementia Patients
within different hospital settings. The main aim of this report is to improve the services in local
health care practice regarding to the patients suffering from some specific issue and ascertaining
its support in delivering optimum safety and quality.
The aspects cover in this report includes selection of specific service improvement health
care practice and its importance towards patient safety & quality in healthcare, analysis of the
link between relevant policy, procedure, guideline & relevant research to the topic, analysis and
application of service improvement model along with lean thinking usage for addressing problem
and in last, analysis and application of change management theory along with critique of various
other similar theories.
Aim of the project
To ascertain the challenges and prevention aspects related to Pressure Ulcer among patients
suffering from Dementia within different hospital settings.
Problem, Context and Background
The profession of healthcare is most important as compared any other professions and
industries present within an environment. Healthcare include the activities related to diagnosing,
investigating and treatment of the patient’s health suffering from any kind of disease. It is the
1

duty of medical professional to go through from all different stages of treatment irrespective of
the nature of disease, time and cost. They also have the obligation that all the necessary steps
will be taken that can help in improvement of health. This is the reason that safety and quality
are two important aspects while delivering healthcare services (Lavallée and et. al., 2018). The
point of safety has two different determinants that safety of patient’s, themselves and other. The
scope of safety is wide and different in nature for all associated parties. The safety of patient
means creation of environment where no harm will be ascertained due to performance of any
other activities. Also, the safety is needed to provide from any other kind of infections. Here, the
one more nature of safety is, where, some person already suffer from problem that is incurable in
nature then must focus over providence of personal assistance so no harm will be occurred in
future. On the other hand, the point of quality includes deliverance of services by the medical
professionals and different hospital settings in the any situation when patient visit for treatment.
The importance of this point is high from safety because inappropriate services has life
threatening impact over the health of patient. The point of safety has major characteristics of
prevention whereas quality holds the feature of cure. The importance of both point is similar at
their own positions. Safety works as the preventive measure that will help to elimination of
different kind of harms (Mitchell and Yaffe, 2018). Whereas, quality among services provides
the opportunity in early recover of patient. The both aspects also have relation with each other.
This is understood from the example that creation of safe environment and deployment of safe
practices provides the opportunity regarding quality treatment and early recover. The safe nature
of environment creates the positive working environment where chance of mistakes is less along
with infection from any other kind of disease that can hinder the power of current treatment. In
Solution of same, medical professionals must check the health of patient on regular basis so
ascertain that improvement is ascertained or not. This will not only help in removal other kind of
infraction but aid in ascertaining the viability of current treatment.
It is clear from the above description that importance of service improvement, safety and
quality within healthcare profession is important. The current topic covering report is also about
the service improvement in Pressure Ulcer among dementia patients. The aspects which are
analysing in deep for better understanding and clearing the views include ascertainment of
challenges and preventions in Pressure Ulcer among Dementia patients within different hospital
settings (Jaul and et. al., 2018). The description of the different associated terms along with
2

importance of service improvement in deliverance of high safety and quality to patients is
understood from the information provided below:
Pressure Ulcers: This is also known as pressure sores and bedsores. These are injuries to
the skin and its underlying tissue. This is primarily caused due to the prolonged pressure upon
skin. This can be happening to anyone but affects more to those who confined to bed, chair or
wheelchair for long period of time. There are many causes that can resultant in to the creation if
pressure ulcer issue includes pressure from hard surface, pressure placed upon skin by
involuntary muscle movements and the moisture that can break the outer layer of skin (Bååth and
et. al., 2016).
Dementia: This is the syndrome that has negative impact over memory, thinking, behaviour
and ability of performing everyday activities. This disease majorly affects older people but not
considered as the normal part of ageing. The common symptoms that are visible in a person
suffering from dementia includes memory loss, difficulty in communication, difficulty in visual
and spatial abilities, difficulty in handling complex tasks, difficulty in handling planning,
organising and coordination etc. This restricts the person in performance of the functions which
are necessary to live normal and healthy life. This also turns as the cause behind the occurrence
of many other kinds of diseases or problems within a person (Karki and Liang, 2019).
It is clear from the above description that disease of dementia attracts other kind of issues
within a person. All the persons who are suffering from dementia are not able to perform daily
routine functions due to the loss of memory and inability of planning, organising and
coordination among different activities. The impact of this is ascertained in the form of physical
injuries, non-medication, forgetfulness of food etc. Pressure Ulcer is one of the common issue
that can raise among the patients suffering from the dementia (Disalvo and et. al., 2016). They do
such activities that resultants into the symptoms of pressure ulcer like sitting long upon hard
surface, moisturised skin etc. The persons suffering from the dementia don’t have idea about that
anything can harm in future or not. This would be the reason that they need special care where
they have stay, either at home or hospitals. This brings an obligation over the parties that they
must take care of the suffering person properly without any mistakes through usage of quality
offerings. Here, the responsibility of delivering improved services is high because the persons
whom are in need, suffering from disease where they not memorise anything (De Meyer and et.
3

al., 2019). The work is not easy as it seems. The different number of challenges faced by hospital
settings while dealing with dementia patients with pressure ulcer is presented below:
Memory loss: This is the common problem that dementia patients faced. The loss of
memory hinders the capacity to adhere the instructions of medical professional along with proper
medication. This resultant into persistence of problem for long period of time (Elkirami, 2017).
Inability of planning, organising and coordinating: The persons who are suffering
from dementia are unable to plan by themselves for the precautions. They also not have the
ability to coordinate themselves with the care taker and description of issue. This restricts the
hospital staff capacity in proper treat of dementia patient as they attract many other issues that
are unknown in nature and impacts the health negatively (Manthorpe and Martineau, 2017).
Difficulty in communication: The patients suffering from dementia are also unable to
communicate. This restricts the ability of hospital staff to know about other internal issues and
problems that patients have due to inability of communication. This also hinders the value of
treatment where improper communication not supports timely medication (Bambi 2018).
Difficulty in visuals abilities: The inability of proper vison hinders the treatment process
within hospital settings because this eliminates recognition and proper use of resources that can
safeguard against other kind of problems like pressure ulcer.
There are many preventive measures that can help to safeguard the dementia patient from
problem of pressure ulcer within hospital settings is provided below:
Provide personal attendant: If possible and feasible in nature then must provide the
personal attendant to the patients suffering from the dementia. This will have large number of
benefits as aid in proper medication, performance of routine functions, proper food intake,
improvement in ability of communication and coordination, activeness in body etc. The result of
all such benefits will be ascertained in the form of less amount of other kind of issues including
pressure ulcer (Vandewalle and et. al., 2019).
Regular skin assessments: This includes skin inspection of high risk pressure points.
The best time to do the same is when assisting the person in bathing.
Floating heels on a pillow: This includes placing of pillow under the calves, not the
knees. This is so because it helps in floating of persons heels instead of resting directly on the
bed mattresses (Sahingoz, 2016).
4

Foot cradle: This is the tent like device the prevents sheets and blankets from resting
directly on the feet of a person lying on the bed (Preventive measures of pressure ulcer for
patients suffering from dementia, 2020).
Regular position- turning and shifting: Assist in turning at different sides the weight
cannot be bear one body part (Lee and et. al., 2019).
All these preventive measures have huge contribution in safety of the dementia patient
from pressure ulcer along with improvement of hospital care services where they can easily treat
all the different patients properly and work in the direction of speedy recovery. Regular presence
of attendee and check-up help to boost morale and removal of internal problems. Whereas, other
preventive exercises on regular basis improves quality service image of hospitals (Kehinde,
2016).
Policy, procedure, guidelines and research relevant to the topic
Main purpose of this proposal is to improve quality and safety for Dementia Patients who
faced challenges of Pressure Ulcer. It is a main issue or injuries to the skin and underlying tissue
that can happen to everyone, especially that person who sit in a wheelchair for longer time period
(Madden, and Morley, 2016). Along with the enhanced longevity, particularly in frail old
patients, there is an advanced rate of cognitive and functional injury with dementia coinciding by
means of immobility, which outputs in a higher rate of Pressure Ulcer. There is requirement for
improving such type of issues among Dementia Patients. For this, health and social care must
follow number of policy, procedures, and guidelines to the existing topic (Sharp, Moore and
McLaws, 2019).
There is some prevention that must be used in hospital setting and improving quality and
safety for reducing the challenges faced by Dementia Patients due to Pressure Ulcer. These
preventions include find out at-risk persons and developing particular prevention method, such
as following a patient moving schedule; keeping the head of the bed at the smallest safe elevation
to stop shear; following pressure-reducing surfaces; as well as assessing nutrition and giving
supplementation, if required (Bååth and et. al, 2016).
Repositioning a Dementia patient every two hours is the standard of care for prevention of
pressure ulcers. On the other hand, it is a primary intervention that was effective in preventing
pressure ulcer formation within the hospital setting. In the face of repositioning, every 2 hours,
the Dementia patient has a triple difficulty area i.e. sacrum, coccyx, ischial tuberosity etc. on
5

which pressure is not fully reassured with the make use of wedges and pillows to help the
Dementia patient in the lateral position (Manthorpe and Martineau, 2017). There are some
guidelines related to preventing Pressure Ulcer in Dementia patients. These guidelines will be
explained as below:
 Applying special dressings that get faster the healing procedure and may assist to relieve
pressure.
 Moving and regularly changing position of Dementia patient who faced issue of Pressure
Ulcer.
 Hospital must follow a procedure to clean the wound as well as remove damaged tissue
of Dementia patient who faced challenge of Pressure Ulcer.
All these preventions, procedures and policies will be beneficial in preventing Pressure Ulcer
from Dementia patient (Ellis, 2017). There are also different numbers of secondary sources
available according to the topic such as books, articles, magazines etc. These sources will help
researcher in collection of secondary and detailed information about the topic.
Service Improvement
PDSA is called as Plan-Do-Study-Act. It is a service improvement model. This includes the
performance of work in rapid cycles for brining improvement (Leis and Shojania, 2017). This is
a four stage problem solving model which is basically used for improving the existing processes.
Currently, this is applied for the purpose of improving service abilities of different hospitals
regarding treatment of the dementia patients from pressure ulcer.
Plan: This is the first stage where planning is done and alternatives are selected regarding
future improvement. In relation to current case, there are many alternatives as above mentioned
in preventive measures. The best one is focus over personal attendee who carrying different
functions (Knudsen and et. al.,2017).
Do: This is step of application. Here, attendee is provided with group of persons who taking
care about performance of their routine activities, medication, food and other necessary
workings.
Study: This is about the study of results after the application. The results with the
application of personal attendee approach is always best. This is expensive in nature and
indulges ore staff in functioning of various offerings but this contributes in providence of
optimum level of safety and quality.
6

Act: This is about confirmation upon the process on the basis of the study results. The
approach of personal attendee is best in nature and used for the long term purpose.
Lean thinking: This is about the new way of thinking regarding arrangement and
management of different kind of activities for the deliverance of more kind of benefits along
with elimination of wastages. In current report, this used for the purpose of improving services of
different hospitals regarding the treatment of dementia patients suffering from pressure ulcer.
Here, the approach will be used regarding segregation of dementia patients on the basis of
age, nutrition level, stage of dementia etc. The patients who belongs from the severe nature
category are personally take care by attendee. The others who below to the age of 65 years and
have significant level of nutrition’s, assisted in medication and main activities only. Weekly they
checked by up by professionals as normal procedure along with all. This will help to safeguard
the additional workforce for the performance other activities and taking care of other patients in
hospitals (Breckner and et. al., 2017)
Usage of PDSA with integration of lean thinking
The model which will be used for the purpose of service improvement is PDSA with
integration of lean thinking. This aid in improvement of application along with safeguarding of
workforce power (JOHNSON and GLASGOW, 2016).
Plan: Planning over alternatives along with integration of lean thinking aspects. This aid in
development of new and innovative technique of offering service with improved capacity.
Do: Personal attendee provide to them who are above the age of years, less nutritional level
and suffering sever dementia conditions. The rest will be helped in main activities and
medications. Professionals will check all on weekly basis.
Study: Determination of the results on the basis of study. The results are positive and also
supportive towards safeguarding workforce (Reed and et. al., 2016).
Act: Confirmed on the basis of results intensity. It is recommended to use all hospital
settings to apply this integrated approach in treatment of dementia patients including with those
suffering from pressure ulcer.
7

Sustaining Change
The theory which is best for application and management of change on regular basis within
different hospital settings is Lewin change management theory. This has three different stages
includes unfreeze, change and refreeze (McGreevy, 2016).
Unfreeze: This stage includes determination of change. In current project, change is
identified in the form of applying technique of personal attendee with assessment of severity
attached with patients.
Change: This is about providence of information all staff members that how working is
going to be perform in future. This will help to accept change and work accordingly (Batras,
Duff and Smith, 2016).
Refreeze: This is the process where staff is motivated to work with new conditions along
with changed environment so, they can’t get back to old working styles (Breuer and et. al., 2016)
(Willis and et.al., 2016).
There many other change theories of change like Kotter and ADKAR. The application of
both is difficult. Also, the requirement of flexibility is not ascertained under the application of
both these theories (Van Rossum and et. al., 2016).
CONCLUSION
It has been concluded from the above report that service quality is improvement is
important for the purpose of delivering safety and quality to the patients. It is the duty over the
different hospital settings to implement different service improvement models and change
management theories that help to wok according to the current requirements of society and
patient. PDSA with integration of lean thinking is best to apply for improving the service
towards dementia patients suffering from pressure ulcer. Lewin change management theory is
best in the direction of identifying and implementing regular changes along with persuading the
working behaviour of staff.
8

REFERENCES
Books and Journals
Bååth, C., Engström, M., Gunningberg, L. and Athlin, Å. M., 2016. Prevention of heel pressure
ulcers among older patients–from ambulance care to hospital discharge: A multi-
centre randomized controlled trial. Applied Nursing Research. 30. pp.170-175.
Bååth, C., Engström, M., Gunningberg, L. and Athlin, Å. M., 2016. Prevention of heel pressure
ulcers among older patients–from ambulance care to hospital discharge: A multi-
centre randomized controlled trial. Applied Nursing Research. 30. pp.170-175.
Bambi, S., 2018. Hospital-Acquired Injuries: Device-Related Pressure Ulcers, Falls, and
Restraints. In Nursing in Critical Care Setting (pp. 335-373). Springer, Cham.
Batras, D., Duff, C. and Smith, B. J., 2016. Organizational change theory: implications for health
promotion practice. Health promotion international. 31(1). pp.231-241.
Breckner, G., Walker, J., Hanley, K. and Butki, N., 2017. Utilizing PDSA Cycle in
Implementing a Chest Pain Accelerated Diagnostic Protocol. Spartan Medical
Research Journal. 2(2). p.6436.
Breuer, E. and et. al., 2016. Planning and evaluating mental health services in low-and middle-
income countries using theory of change. The British journal of psychiatry. 208(s56).
pp.s55-s62.
De Meyer, D., Van Hecke, A., Verhaeghe, S. and Beeckman, D., 2019. PROTECT–Trial: A
RCT to study the effectiveness of a turning and positioning system and patient-
tailored repositioning to prevent pressure ulcers. In CARE4 International Scientific
Nursing and Midwifery Congress, Third Edition.
Disalvo, D. and et. al., 2016. Systems to identify potentially inappropriate prescribing in people
with advanced dementia: a systematic review. BMC geriatrics. 16(1). p.114.
Elkirami, R., 2017. Using root-cause analysis for pressure ulcer prevention in a long-term care
facility (Doctoral dissertation, Utica College).
Ellis, M., 2017. Pressure ulcer prevention in care home settings. Nursing older people. 29(3).
Jaul, E., Barron, J., Rosenzweig, J. P. and Menczel, J., 2018. An overview of co-morbidities and
the development of pressure ulcers among older adults. BMC geriatrics. 18(1). pp.1-
11.
JOHNSON, C. and GLASGOW, M. E. S., 2016. QUALITY IMPROVEMENT
RESEARCH. Practice-Based Clinical Inquiry in Nursing: Looking Beyond
Traditional Methods for PhD and DNP Research. p.69.
Karki, A. and Liang, L. H., 2019. Challenges for Nurses to prevent pressure ulcers among
institutionalized elderly patients.
Kehinde, O., 2016. Common incontinence problems seen by community nurses. Journal of
Community Nursing. 30(4). pp.46-55.
Knudsen, S. V., Laursen, H. B., Ehlers, L. H. and Mainz, J., 2017. ISQUA17-3217 THERE IS
NEED FOR IMPROVEMENT OF QUALITY IMPROVEMENT-A SYSTEMATIC
REVIEW OF THE PDSA METHOD IN QI STUDIES. International Journal for
Quality in Health Care. 29(suppl_1). pp.45-45.
Lavallée, J. F., Gray, T. A., Dumville, J. and Cullum, N., 2018. Barriers and facilitators to
preventing pressure ulcers in nursing home residents: A qualitative analysis informed
by the Theoretical Domains Framework. International journal of nursing studies. 82.
pp.79-89.
9

Lee, Y. J., Kim, J. Y., Dong, C. B. and Park, O. K., 2019. Developing risk‐adjusted quality
indicators for pressure ulcers in long‐term care hospitals in the Republic of
Korea. International wound journal. 16. pp.43-50.
Leis, J. A. and Shojania, K. G., 2017. A primer on PDSA: executing plan–do–study–act cycles in
practice, not just in name. BMJ quality & safety. 26(7). pp.572-577.
Madden, M. and Morley, R., 2016. Exploring the challenge of health research priority setting in
partnership: reflections on the methodology used by the James Lind Alliance Pressure
Ulcer Priority Setting Partnership. Research involvement and engagement. 2(1). p.12.
Manthorpe, J. and Martineau, S., 2017. Home pressures: failures of care and pressure ulcer
problems in the community–the findings of serious case reviews. The Journal of
Adult Protection.
Manthorpe, J. and Martineau, S., 2017. Pressure points: learning from Serious Case Reviews of
failures of care and pressure ulcer problems in care homes. The Journal of Adult
Protection.
McGraw, C. A., 2019. Nurses’ perceptions of the root causes of community‐acquired pressure
ulcers: Application of the Model for Examining Safety and Quality Concerns in
Home Healthcare. Journal of clinical nursing. 28(3-4). pp.575-588.
McGreevy, J., 2016. Implementing culture change in long-term dementia care settings. Nursing
Standard (2014+). 30(19). p.44.
Mitchell, S. L. and Yaffe, K., 2018. Care of patients with advanced dementia.
Reed, J. E., Davey, N. and Woodcock, T., 2016. The foundations of quality improvement
science. Future hospital journal. 3(3). p.199.
Sahingoz, A. M., 2016. Evaluating Structured Education in Acute Care Setting Targeting
Pressure Ulcer Risks (Doctoral dissertation, Walden University).
Sharp, C. A., Moore, J. S. S. and McLaws, M. L., 2019. Two-Hourly Repositioning for
Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?. Journal
of bioethical inquiry. 16(1). pp.17-34.
Van Rossum, L. and et. al., 2016. Lean healthcare from a change management
perspective. Journal of health organization and management.
Vandewalle, J and et. al, 2019. The development and validation of a tool to measure the quality
of contact between mental health nurses and patients who experience suicidal
ideation. In CARE4 International Scientific Nursing and Midwifery Congress, Third
Edition.
Willis, C.D. and et.al., 2016. Sustaining organizational culture change in health systems. Journal
of health organization and management.
Online
Preventive measures of pressure ulcer for patients suffering from dementia. 2020. [Online].
Available Through: <https://www.verywellhealth.com/prevent-pressure-sores-in-
dementia-3573624>
10

11