Create a 500‐750-word comprehensive outline that communicates the_ following about your

chosen topic: Some areas need support & citations. Each section needs support. The_se sections are

not opinion based.

1. Introduction:

1. Identify the_ risk management topic you have chosen to address (Part of your

the_sis is a stat that needs a citation. Please rewrite.) (Be sure to include a the_sis in

the_ next work, solid intro & conclusion for_ any presentation.)

1. 2019 increased number of HAPI’s. In particular those missed on

admission & the_ following 48-hours.

2. The_re is a current policy & procedure (P&P), Pressure Ulcer Prevention

& Treatment, that covers the_ necessity of a thorough skin assessment at

admission to establish baseline which should be done by two registered

nurses (RN’s).

3. The_sis: in spite of a PI prevention & treatment policy & procedure

HAPI’s have increased by 100% in 2019 from 2018, 20% of which are PI

being missed on admission skin assessments & subsequent 48 hours

making the_ condition hospital acquired, costing the_ hospital money,

putting the_ patient in danger, & the_ hospital at risk for_ lawsuits.

2. Why it is important within your health care sector.

1. The_ statistics: 2015-2018 number of HAPI’s dropped from 31 to 15

(LeMieux, 2017). 2019 had a total of 25. 5 of the_ 25 were due to poor

admission skin assessments that missed a community acquired (already

present) pressure injury (PI). It was the_n missed multiple shifts, for_ 48

hours from admission, which the_n classifies it as hospital acquired.

2. Patient: PI not cared for_ leads to increased area damage, pain, possible

infection, sepsis, & even death.

3. Hospital: ethical & legal duty to do no harm. Financial penalty since

Medicare doesn’t cover hospital acquired conditions, including stage 3 &

4 PI (CMS, n.d.)

4. Community & nursing profession: Nurses not doing the_ basics does not

make for_ a profession that is trusted.

2. Rationale:

1. Illustrate how this risk management strategy is lacking within your selected

organization's current risk management plan

1. Having a lot of travelers & new nurses the_ current P&P doesn’t have a

checks & balance to whethe_r the_se nurses are doing a proper head to toe

assessment. Nurses have orientation for_ a h&ful of shifts, but who’s to

say the_ orienting nurses are setting a good example.

2. Assistant Nurse Managers (ANM’s) must play an active role in decreasing

HAPI’s. Admission skin assessments should be done with a RN & the_

ANM, not 2 staff RN’s

1. Greater responsibility

2. Accountability

3. Skill check for_ new nurses

4. Support

5. Team effor_t – leaders part of the_ team, not just on the_ side lines

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2. Explain how its implementation will better meet local, state, & federal

compliance st&ards.

1. Developing competent nurses & increasing responsibility at admission

skin assessment will:

2. local: good perception of nurses, patients/community taken care of,

organization is properly reimbursed. Maintain licensure & getting paid

from Medicare by complying with joint commission

3. state: help the_ state achieve overall goal of protecting the_ patients

(CDPH, n.d.)

4. federal: no federal tracking exists (The_re are no federal st&ards for_

State reporting systems (West, Eng, Lyda-McDonald, McCall, 2010)

3. Support:

1. Provide data that indicate the_ need for_ this proposed risk management initiative

1. In 2008 the_ Centers for_ Medicare & Medicaid Services (CMS) started

denying claims for_ stage 3-4 HAPI’s & penalize with 1% reduction in

reimbursement for_ hospitals with the_ highest HAPI rates (Black, 2019).

2. Stage 3 PI average cost $4,546, stage 4 $13,138 (surgical treatments,

medications, wound dressings, legal/investigation expenditures (Lim &

Ang, 2017).

3. Untreated PI result in: increased length of hospital stay, hospital costs,

increased nursing care time, chance of cellulitis, osteomyelitis, sepsis &

mortality (Agostini, Baker, & Bogardus, 2001)

2. Demonstrate how it falls under the_ organization's legal responsibility to provide

a safe health care facility & work environment.

1. Nonmaleficence: nurses follow a code of ethics. Proper assessment &

prevention of furthe_r damage is an ethical & moral responsibility of the_

healthcare team.

2. Keeping the_ patient safe from harm is a legal issue, & the_ hospital can

be sued for_ outcomes from poor treatment, or poor result of an untreated

PI.

4. Implementation:

1. Describe the_ steps to implement the_ proposed strategy in your selected health

care organization.

1. Stakeholders: ANM’s, nurses, house supervisors, upper management,

HAPI committee, community.

2. Proposal of P&P change first brought to HAPI committee (RN’s,

physician, ANM, patient care technicians). Infor_mation gathe_red.

Process of shooting holes through proposition in order to make argument

stronger.

1. EBP identified on quality improvement when management is h&s

on. (multiple current articles found – see reference section)

3. House supervisor considered the_ proposition

4. P&P committee

5. Brought to ANM’s, teaching for_ ANM’s regarding the_ reasons for_ the_

change, as well as refresher on proper skin assessments.

6. Infor_ming the_ nurses via start of shift huddles

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