Your patient is 89 year old man home-bound man with dementia. He is cared for by his daughter who he also lives with. He was recently hospitalized for pneumonia and returned to his home after a 7 day hospitalization. The home health aide visits are scheduled for daily, and the home health nurse is scheduled to make visits weekly.
On the first routine visit, you find him lying in bed unable to answer questions. His lungs are clear, breathing is non-labored. BP 110//72, AP is 80 and regular, RR 18, temperature oral is 98.4. He does not have any routine medications and is completing one more day of Levaquin 500 mg for the pneumonia. His daughter is present and tells you she has kept him in bed since he came home the other day so he can “heal.”
You further discover a stage II ulcer on his sacral area. This was not noted on the hospital paperwork and the daughter is not aware of it. You phone the physician for orders.
What are the Quality Improvement priorities for this case:
For the home?
For the hospital?
For you/your organization?
What teaching needs are there?
What data would help you to determine contributing factors to the stage II ulcer?
The physician orders a wet-to-dry dressing twice daily for this wound.
Support the rationale for this treatment.
Consider a setting that you have worked. What Quality Improvement modifications have you seen that support pressure injury prevention?
What are good Quality Improvement Project that is Hospital-based that would support the success of this case.
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