Adverse Trend and Data Management
University of Phoenix
Health Care Informatics
HCS482
Richard Ong
September 23, 2013

Adverse Trend and Data Management
Part I:
Step by step guide:
Adverse Trend: Immobility. Immobility in hospitalized patients is one of the main risk factors contributing to the development of pressure ulcers.
Objective: Identify risk factors related to complications secondary to immobility such as pressure ulcers on the integumentary system. Immobility also leads to other adverse effects affecting cardiovascular system, respiratory system, and musculoskeletal system as well. The assessment is performed on admission data, then once a week. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, which includes the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, and body temperature (Lindgren & Unosson, 2004).
Results:
25 % of patients developed pressure ulcers. Non-blanchable erythema was the most common pressure ulcer noted among these patients. The majority of these patients were significantly older, and hospitalized for a longer period of time. In the analysis using variables included in the RAPS scale, immobility emerged as a major risk factor.

Conclusion: Immobility is the main cause of pressure ulcer development among adult hospitalized patients.

Part II:
After reviewing patient’s charts and documentation in 4 west, it is concluded that:
37% charts with mobility documented.
63% charts with no mobility documented.
Problem statement: After carefully reviewing patients charts, baseline data was gathered on 4West step down unit revealing that that only 37% of patients with orders for early ambulation were ambulated/mobilized as ordered. Based on this data a decision was made to improve early mobility for patients housed in this unit.
Proposed actions:
Re-enforce with all 4 West staff the standard of practice for early mobility.
Involve rehabilitation services to re-educate 4 west staff on care of patients on hip precautions and with lumbar braces.
Conduct hourly rounds in all patients.
Develop poster with early mobilization expectations in unit.
Consider re-training staff on how to use bed as needed.
Monitor staff practices related to early mobility.
Support staff by having appropriate equipment on unit for early ambulation/mobilization.
Work with hospital administration to add support staff to assist with early mobility.
Technology and methods used:
Education: Staff was able to remember contents of the class provided on management of hip precautions patients and patients with lumbar braces.
Preprinted orders: Doctors orders are specific for early mobility.
Kardex: Kardex reflects activity orders including early ambulation and mobilization.
Monitoring: Daily rounds to review doctor’s orders for activity and documented patient activity.
Equipment: All 4-west staff is aware that there are gait belts, and walkers to assist patient with ambulation. There is also a lift that is for hospital use in heavy patients.
Data: Develop baseline and ongoing graphs to show improvement.
Regular communication with staff: A monthly unit meeting to go over plan and progress.
Data collection can also be performed through interviews; this would help to gather in-depth beliefs and attitudes from staff. Personal contact with participants might lead to a greater and more detailed responses to improve patient mobility leading to a decrease pressure ulcers in hospitalized patients. Collecting data through interviews provides an excellent opportunity to explore questions.
Observation is another method to collect data; through observation we can discover behaviors. Data gathered by observation can many times be more reliable than data gathered by asking people. It is an excellent approach when there are observable data and outcomes such as improving mobility and decreasing pressure ulcers in hospitalized patients.
Surveys can also be used to gather brief written responses on attitudes, and beliefs regarding the adverse trend. Employee can easily manage the distribution and collection of surveys avoiding issues with privacy as well.
Follow-up interviews provide an excellent opportunity to explore and answer any questions; can be done by phone, online or face-to-face. Although technology has a major impact on the gathering, storage, retrieval and dissemination of data its main ethical impact relates to accessibility/inaccessibility and the manipulation of information. The technological manipulation of data, among others, to the merging of documents, translations and the integration of textual and graphical formats and the possible altering of information by electronic means. The use of technology when gathering data can be seeing as a threat because of the loss of dignity and spontaneity, as well as a threat to freedom and the right to privacy. Technology continuous to be viewed as a threat to privacy rather than a possible solution (Hannabuss, 2002).

Conclusion Immobility is the main cause of pressure ulcers, they are usually seeing in buttocks, elbows, heels and any prominent or bony area. They may lead to infection and many other undesirable outcomes. After gathering data I conclude that to reduce pressure ulcers, an effective daily skin assessment and early post-surgery ambulation are key components on the prevention of pressure ulcers in hospitalized patients. In bedridden patients, it is important to change positions frequently, at least every two hours. Maintain a balanced diet when patient is able to eat. Well-nourished patients heal more quickly.

Refences
Hannabuss, S. (2002, May). Ethical issues in information technology. Information Techology, 59(2), 18-22. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/218292784?accountid=458
Kasim, S. (2002, July). How technology affects healthcare. Technology in Healthcare, 22(0), 9-15.
Lindgren, M., & Unosson, M. (2004, March). Immobility: a major risk factor for development of pressure ulcers. Journal of Caring sciences, 35(2), 2-9.