1. RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
PICO
Do patients 65+, in nursing homes, who have scored 18-15 on the
Braden scale, show a decrease in prevalence of Pressure Ulcers by
receiving a supplement of 30g of protein in their daily diet, compared
to patients 65+, who do not receive the 30g of protein in their daily
diet?
Literature Review
• Nutrition supplementation such as increased protein in conjunction
with vitamins and minerals such as zinc, arginine, vitamin A etc.
may aid in the prevention of pressure ulcers in this specific
population (Ishida, I., Kameda, T., Sanada, H., Sato, A., Taguchi, F., Takanao, K., Ueno, S., Watanabe, T.,
Yatable, J., & Yatabe, S.M., 2013).
• Protein supplements should be offered in between meals to patients
at risk of malnutrition in addition to regular meals to aid in
prevention of pressure ulcers (Alderden et al, 2011).
• Nutritional supplementation should be given to patients who are not
receiving adequate amounts of nutrition (Avital, L., Jones, K., Marsden, G., Stansby,
G., 2014).
• Greater reduction in ulcer size was found when protein
supplementation was used (Avital et al, 2014).
• Other modalities must be taken in addition to protein
supplementation. These included frequent repositioning, skin
assessments and the use of pressure relieving devices (Alderden et al, 2011).
Major EBP recommendations
Evaluation
Methods of Implementation
Goal: Decrease Pressure Ulcer prevalence by increasing protein
intake.
Clinical Setting: Long-Term care facility- Bethel Nursing and
Rehabilitation Center.
Sample Population: Patients included must be 65 and older with a
score of 15-18 on the Braden Scale.
Implementation:
• Resident will receive an extra 30g of protein in a smoothie
during lunch. The protein powder, Optimum Nutrition powder,
will be mixed with fruit and other smoothie ingredients.
• Nurses and CNAs will observe residents intake of the smoothie
and record the data on a flow sheet.
• Skin will be assessed according to the Braden Scale by a nurse
trained in pressure ulcer and wound assessment three times a
week for the development of pressure ulcers.
Adrian
Anderson,
Emily
Elisha,
Hannah
Hirsch,
Samantha
Stewart
Pace
University,
College
of
Health
Professions,
Lienhard
School
of
Nursing
Evidence
Based
Prac/ce
Improvement:
The
Benefits
of
Protein
in
Pressure
Ulcer
Preven/on
Pressure
Ulcer
points
Background
• The development of pressure ulcers continues to be a problem
for older adults, age 65+ in the hospital, home and long-term
care setting (Ayello, 2012).
• Prevalence rates are estimated to be 11.9% in acute care, 29.3%
in long term acute care, 11.8% in long term care, and 19% in
rehabilitation centers”. The yearly incidence rate of all
populations, for pressure ulcers is 6-7%. (Ayello, 2012).
• Morbidity rate of 4.5% and mortality rate of 2.81%. (Curry et
al, 2012).
• An estimated national cost of 9.1-11.6 billion dollars,
individual patient cost of $20,000- $151,000 per pressure ulcer
(AHRQ, 2014).
Search Strategy
• Databases: CINAHL, PubMed, and the National Guideline
Clearinghouse.
• Search Terms: Pressure Ulcer, Nutrition, Prevention and
Braden Scale.
• Delimitations: Publication dates from 2010 to present, full
text only and English language only. Studies excluded
were those including patients under age 65 and those
negating the sole benefit of protein on wound prevention.
• Additional Search Criteria: Studies involving patient’s
ages 65+ in nursing homes with a Braden Scale grade of
15-18. Articles discussing the benefits of protein and
nutritional supplementation on prevention and healing of
pressure ulcers.
• Offer nutritional supplements to “at risk” patient (Atival, Jones, Marsden &
Stansby, 2014).
• Frequent turning of patient every 2 hours (Barrett, Bergstrom, Horn, Rapp, Stern
& Watkiss, 2013).
• Skin assessments and frequent skin checks (Alderden et al, 2011).
• Nutritional assessments in conjunction with the Braden Scale
(Ishida et al, 2013).
• We will evaluate each residents score on the Braden Scale before
implementing protein supplementation.
• At the end of six weeks, each residents Braden Score will be re-
assessed, to determine if the level of risk for developing pressure
ulcers has improved, stayed the same or deteriorated. Based on this
assessment we will be able to determine whether protein
supplementation is effective.
• The statistical program that will be used for data analysis is the
Statistical Package for the Social Sciences (SPSS). Data will be
analyzed using T tests with p value of 0.05 to determine statistical
significance.
Change Process
• Obtain consent from administrative and nursing directors to
implement intervention.
• Discuss with dieticians if 30g of protein is contraindicated for any
patient.
• Inform CNAs of the idea and request their assistance in encouraging
the residents to comply.
• Inform each resident of the benefits of protein smoothies in
prevention of PU.
• Serve smoothies every day during lunch.
• Perform weekly PU assessments on each resident.
• Assess if those at risk for developing PU, did not develop a PU after
six weeks.
References
Level of Evidence: 1- Systematic Reviews, Meta- Analysis, EBP Guidelines
Agency for Healthcare Research and Quality. (2014). Preventing Pressure Ulcers in
Hospitals: A Toolkit for Improving Quality of Care. Retrieved from http://www.ahrq.gov/
professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/
index.html
Level of Evidence: 4- Cohort Studies or Case Control Studies
Alderden, J., Taylor, S. M., Whitney, J. D., & Zaratkiewicz, S. (2011). Risk profile
characteristics associated with outcomes of hospital-acquired pressure ulcers: A
retrospective review. Critical Care Nurse, 31(4), 30-43. doi:10.4037/ccn2011806
Level of Evidence: 1 – Systematic Reviews, Meta-Analysis, EBP Guidelines
Avital, L., Jones, K., Marsden, G., & Stansby, G. (2014). Prevention and management of
pressure ulcers in primary and secondary care: summary of NICE guidance. BMJ, 348.
doi:10.1136/bmj.g2592
Ayello, E. A. (2012). Predicting pressure ulcer risk. Try This: Best Practices in Nursing
Care To Older Adults, 5. Retrieved from
http://consultgerirn.org/uploads/File/trythis/try_this_5.pdf
Level of Evidence: 4- Cohort Studies or Case Control Studies
Curry, M., Hunt, D.R., Kliman, R., Lyder, C.H., Metersky, M., Wang, Y., & Verzier, N.R.
(2012). Hospital-acquired pressure ulcers: Results from the national medicare patient
safety monitoring system study. Journal of The American Geriatrics Society, 60(9),
1603-1608. doi:10.1111/j.1532-5415.2012.04106.x
Level of Evidence: 2 – Randomized Controlled Trial
Barrett, R., Bergstrom, N., Horn, S. D., Rapp, M. P., Stern, A., & Watkiss, M. (2013).
Turning for ulcer reduction: A multisite randomized clinical trial in nursing homes. Journal
Of The American Geriatrics Society, 61(10), 1705-1713. doi:10.1111/jgs.12440
Ishida, I., Kameda, T., Sanada, H., Sato, A., Taguchi, F., Takanao, K.,…Yatabe, S.M.
(2013). Mini nutritional assessment as a useful method of predicting the development of
pressure ulcers in elderly inpatients. Journal of the American Geriatrics Society, 61(10),
1698-1704. doi:10.1111/jgs.12455
LeMone, P., Lillis, C., Lynne, P., &. Taylor, C.R. (2015). Fundamentals of nursing: The
art and science of nursing Care (8th Ed.). Philadelphia: Lippincott.
Cancerresearchuk.org
what-when-how.com
www.bedsorefaq.org
Blog.bcbsnc.com