Pressure Injury and Healthcare Industry

Pressure injury is referred to as a key clinical indicator for the different care standards. The Australian Healthcare industry is facing major issues due to the pressure injuries increasing length in the hospitals for staying and cost of $286 Million annually. However, the nurses associated to the healthcare industries must possess proper knowledge regarding the identification of pressure injury and their prevention mechanism as well. In most cases the aged people and the bed ridden patients suffer from pressure fluctuation. Again, the skin, heels, elbow and even tailbone could be negatively affected for the bed ridden people. This project is about the development of an educational package for the nurses so that they could identify the injuries easily. In addition to this, the issues of the emergency department can also be prevented easily with the help of the educational packages. After developing the project overview, aim, scope, objectives, communication plan, risk register, quality management plan is also developed in this report. However, in order to reduce the work pressure the workload should be segmented accordingly. The associate Gantt chart and Work Breakdown Structure (WBS) are also developed in this report.

Continuous pressure fluctuation is a major issue for the bed ridden patients and old age people. Apart from this, the pressure injury is another challenge in the ICUs. Even if any of a patient stays in the ICUs for longer time then, proper skin checking is another thing that the nurses are needed to be done accordingly. Regular skin checkup and pressure checkup are the necessary steps those must be followed by the nurses. Due to lack of knowledge the health of the patients might also get negatively impacted. The project aims to develop an education package for the nursing staffs so they could easily identify and even prevent the pressure regarding injuries. Not only this but also, the nurses should perform a proper skin checkup of the patients, after that they should document the progress report and finally nurses have give a 4 hours of presentation about the current condition of the patients. In order to ensure that the patients are not suffering from the skin injuries the nurses should reposition the patients who are prone to pressure injuries in every 2 hours.

To develop an education package for the nursing staffs so that they could identify the issues associated to patient’s pressure injury

• To prevent the pressure injury occurring in emergency departments
• To perform proper skin checkup, documentation of the progress report and a 4 hours presentation on that
• To arrange repositioning for the bed ridden patients in every 2 hours

• The strategies and skills necessary for the nurses are not elaborated broadly
• The lists of necessary stakeholders are not illustrated
• The necessary steps those the person required to possess, for educating the nursing staffs

Aim of the Project

The aim of the project is to develop an education package for the nurses who are appointed to old age and bed ridden patients. With the help of the education package they would be able to identify the pressure injuries easily and also they could prevent the emergency cases. From the successful development of education package, it is expected that, the issues of the healthcare industries would be expected to be minimized completely.

• To give 4 hours of presentation in the emergency departments about the identified pressure injuries
• To provide a 4 hour of presentation about the test results and progress results of the skin
• Patients who are suffering from high risks in pressure injuries, are to be repositioned by the nurses

It is expected that with the help o the educational nursing packages the nurses would be able to gain effective knowledge regarding the patient’s health. Not only this but also, the text, visual communication approaches are also be developed with the help of the educational packages. In addition to this, it would also provide real world identities, virtual identities and even projective identities to the patients. The nurses would also be able to get to know more about the advanced technical innovation.  The system availability, reliability and the accessibility also gets enhanced with help of the educational packages developed for the nurses. Collectively, it states that the issues related to the healthcare industries associated to the pressure injuries of the old age patients and bed ridden patients.

For this particular project triple project constraints have been considered that are the time, scope and budget. In order to implement the project successfully the project finance manager and the project manager should make a feasibility study so that they could complete the project within the estimated budget. Again, with the help of proper time management the project manager and the project team members associated to the project would be able to complete the project within estimated time. Triple constraints are referred to as a combination of three different constraints in terms of time, cost and budget. In the modern corporate landscape, it is found that any project is bund with three different elements such and based upon the requirement of the consumers the set of triple constraints keeps changing. The set of triple constraints considered for this particular project include the following:

• Scope, time and budget
• Scope schedule and cost
• Good fast and cheap

The results generated from the analytical diagnosis, it has been found that proper scope, time and budget are the necessary elements needed to improve the quality of the project. In addition to this, the other set of knowledge required for successful project management integration, scope and time and procurement management.

Gantt chart 

WBS	Task Name	Duration	Start	Finish	Predecessors	Resource Names	Cost Variance
0	Schedule development for Education package for the nurses	99 days	Mon 1/15/18	Thu 5/31/18			$23,728.00
1	Project initiation	39 days	Mon 1/15/18	Thu 3/8/18			$8,168.00
1.1	project team members section	6 days	Mon 1/15/18	Mon 1/22/18		Project manager	$960.00
1.2	Understanding the details of basic nursing course	6 days	Tue 1/23/18	Tue 1/30/18	2	Project sponsor ,project team members	$1,392.00
1.3	Data collection	5 days	Wed 1/31/18	Tue 2/6/18	3	Project manager ,project team members	$1,360.00
1.4	Data analysis	4 days	Wed 2/7/18	Mon 2/12/18	4	project team members	$448.00
1.5	Quality management plan	9 days	Tue 2/13/18	Fri 2/23/18	5	project team members ,project working committee	$2,160.00
1.6	Procurement management	5 days	Mon 2/26/18	Fri 3/2/18	6	HR manager ,Project manager	$1,400.00
1.7	Risk management planning	4 days	Mon 3/5/18	Thu 3/8/18	7	project team members	$448.00
2	Project planning	8 days	Fri 3/9/18	Tue 3/20/18			$2,112.00
2.1	Survey on Pressure injury cases	2 days	Fri 3/9/18	Mon 3/12/18	8	project developers	$240.00
2.2	Estimating annual cost for Pressure injury	2 days	Tue 3/13/18	Wed 3/14/18	10	finance manager	$240.00
2.3	Development of skills and strategies	4 days	Thu 3/15/18	Tue 3/20/18	2,11	project developers ,project working committee	$992.00
2.4	Identification of the roles of the stakeholders	4 days	Thu 3/15/18	Tue 3/20/18	4,8,11	Project manager	$640.00
3	Project development	25 days	Wed 3/21/18	Tue 4/24/18			$6,784.00
3.1	Development over the lack of oral care	8 days	Wed 3/21/18	Fri 3/30/18	12,13	project team members ,project working committee	$1,920.00
3.2	Details of the participation of the nurses	4 days	Mon 4/2/18	Thu 4/5/18	15	Project manager ,project developers ,tester	$1,504.00
3.3	Course details to be arranged for the nurses	7 days	Fri 4/6/18	Mon 4/16/18	16	project team members ,project working committee	$1,680.00
3.4	Courses for the surgical nurses	6 days	Tue 4/17/18	Tue 4/24/18	17	Project manager ,project developers	$1,680.00
4	Project testing	22 days	Wed 4/25/18	Thu 5/24/18			$6,072.00
4.1	Individual testing	4 days	Wed 4/25/18	Mon 4/30/18	18	project team members ,tester	$832.00
4.2	Integrated testing	5 days	Tue 5/1/18	Mon 5/7/18	20	Project sponsor ,project team members ,tester	$1,640.00
4.3	Other devices to be added	6 days	Tue 5/8/18	Tue 5/15/18	21	project team members ,tester	$1,248.00
4.4	Skin care solution to be implemented	7 days	Wed 5/16/18	Thu 5/24/18	22	project team members ,project working committee ,tester	$2,352.00
5	Project closure	5 days	Fri 5/25/18	Thu 5/31/18			$592.00
5.1	Stakeholders signoff	2 days	Fri 5/25/18	Mon 5/28/18	23	HR manager	$240.00
5.2	Final documentation	2 days	Tue 5/29/18	Wed 5/30/18	25	project team members	$224.00
5.3	Post project maintenance plan	1 day	Thu 5/31/18	Thu 5/31/18	26	project working committee	$128.00

Figure 2: Gantt chart for Education package development for the nurses

Educational Package for Nurses

(Source: created by author)

In order to execute the strategic project initiatives, different business companies have developed varied project management offices. In order to implement an education package for the nurses, a structural organizational chart must be created it would help the project manager to define the roles and responsibilities of the staffs associated to the project. The Project Management Office (PMO) also provides game changing Return on Investment (ROI), manageable scope and cultivating PMO talent as well.  However, with the changing organizational structure, the function and jobs of the PMO also varies. The organizational structure for this particular project is as follows:

The project sponsor is responsible to ensure the business needs are valid and prioritized accordingly. The project must be launched accordingly by ensuring project risks. The key project deliverables should be approved and before the initiation of the project an accurate budget must be invested within which the project is expected to be completed. The main responsibility of the project sponsor is to organize the project budget in such a way so that, it could be completed under proper control and demonstration.

The responsibilities of the project steering committee are to provide cross functional leadership and direction with respective managerial governance so that they might get measurable benefits from the implementation.

Project manager is not a member of the steering committee. Project manager is responsible to control and monitor the project although; they are also responsible to attend all necessary meetings. In addition to this, project managers are responsible to process each phase such as project initiation, project planning, development, evaluation, execution. All of these phases are necessary to be followed by the project manager and project sponsors. Collectively, it can be said that, the responsibility of the project manager is to fulfill all the stages properly. Even, before initiating the project properly, the necessary resources, budget for individual resources are also required to be considered by the project manager. The other responsibilities of the project manager include the following:

• Planning and defining scope definition
• Final documentation
• Risk analysis and team leadership
• Strategic influence, time estimation, cost estimation and chart and schedule development

It has been found that both financial and health level implications are associated to the pressure injuries for the old and bed ridden patients. Additionally, pressure injury leads to escalate cost for the hospitalization, dealt for patients and even for the rapid spread of the patient’s infection. After analyzing the details of this particular project, it has been found that, in order to implement an education package for the nurses for both detecting and preventing the pressure injuries, significant changes are required to be developed by the project team. In this case, the project team includes the project developer, project analyzer and project tester. The current healthcare users and public doubts the skills and ability of the nurses. By implementing the evidence based products and evidence based practices pressure injuries can be reduced and even avoided. The responsibilities of this project team are to develop an working as well as education package for the nursing staffs to identify and prevent the pressure injuries in the emergency departments.

Triple Project Constraints

The project team who is working for developing an education package for the nursing staffs should ensure cultural competence among the professionals by serving vulnerable population. They should arrange culturally accurate health education package about pressure injuries and other physical activities. In order to receive accurate services, the underserved individuals should be advocated. Even if any policies are needed to be changed then data and relying information are needed to be collected by them accordingly. The working party is also responsible to build solid capacity for addressing all the necessary heath issues.  

The reporting requirements for this particular project are coupled with the payment schedule and the outline to contribution agreement. As soon as the requirements for this particular project will be satisfied, the project manager will gain the temporary or final payment. However, for longer projects, several progress reports are needed to be served which is another reporting requirement.    

Type of communication	Communication objectives	Medium	Frequency	Audience	Deliverables
Project team meeting	In this phase, the project manager will share the status of the projects with the team members.	Conference call, face to face	Weekly	Project manager and the project team members	Project manager
Project design	In this meeting the education program for the Nursing staffs would be designed and shared with the rest of the project team members.	Face to face	Weekly	Project team	Project manager
Technical design	The technical requirements for developing nursing project are discussed in this meeting and all the relevant options in terms of technical solutions are also discussed in this meeting.	Emails, chat, face to face	Monthly	Project management office	Technical head and system developer
Monthly project status reporting	Reports are presented based on status of the projects.	Face to face, emails and conference	Weekly	Technical staffs	Project manager
Status report for the project	Different activities such as cost, progress and issues should be added and discussed in this meeting.	Conference and emails	Monthly	Project manager and staffs	Project manager

For this particular project, the stakeholders are divided in two different parts internal stakeholders and the external stakeholders. The stakeholder management plan includes different sections those are necessary to be followed for successful implementation of the project. The stakeholder management plan for development of the educational package for the Nursing staffs is illustrated below:

Stakeholder	Communication need	Communication method	What and when	Responsible person
Project manager	For understanding the impact of patient critical pathway and the different work practices.	Face to face meeting, emails and  conference	All the necessary requirements are to be gathered by the project team between 31/01/2018 and 12/02/2018.	Nurse Unit manager and CNC
CNC	To discuss about the need of education package development for the nursing staffs to avoid Pressure Injury (PI) in emergency departments.	Face to face and paper sheet documentation	The operation details will be discussed between 5 days.	CNC and project manager
Nurse Unit manager	To demonstrate the requirements for the education package.	Conference and meeting	The requirements for the nursing education packages are to be collected in between 6 days
Registered nurses	The registered nurses will discuss in the meeting about the day to day changes occurring in the patient’s health.	Meeting and email	Within 7 days the details about the necessary changes to be adopted are discussed.	Project manager and nurse unit manager
Clinical nurses	The clinical nurses will share their experiences and explore the roles of other stakeholders in this meeting	Conferences  and meeting	To share about the experiences of the nurses among the stakeholders within a work force package of 7 days	Registered nurses and Project manager
Doctor	The doctors will demonstrate how the current health condition of a patient be checked by considering the experience of the nurses.	Face to face and paper sheet documentation	Collect data about the relevant analytical tools	Project manager
Nurse educators	In order to strengthen the nursing work force the necessary responsibilities those should be served are discussed in this meeting.	Face to face and paper sheet documentation	Will share the necessity of education package development to avoid Pressure injuries in emergency department.	Nurse Unit manager

Name of the stakeholder	Key purpose	Responsibilities	Opportunities	Engagement plan
Project manager	In this meeting the project manager will share the project details with the project team members.	The project manager is responsible to control and monitor the project progress details.	If the project manager serves his or her job role properly then, the project would be expected to be finished in the estimated time and budget as well.	In order to engage the project team members with an education package development project, proper support and leadership approaches are needed to be possessed by the project manager.
Project team	The project team members are required to serve their job roles accurately so that they could meet the project requirements.	In order to reduce the work burden from the project manager and other project executives the work load should be divided among the project team members based upon the their skills and knowledge.	If the project team member successfully serves their job roles then, the project manager would be able to complete the project successfully within estimated time and budget as well.	For engaging the project team members with their job role appropriate alignment are required.
Project developers	The project developers should collect and analyze the necessary information.	The project developers are responsible to collect the necessary information those are necessary for the implementation of the education package for the nursing staffs.	The education package should be helpful for the nurses and it must define the ways through which the nurses can detect and even prevent the pressure injuries.	The developer should implement additional elements so that the project team members feel engage to their job roles.
Project tester		The project testers are responsible to test the education package developed for the nursing staffs.	The detail outcomes generated from the test result, defines the opportunities of the project.	The project test result should focus on development of the health status of the bed ridden pressure injured patients.

Three main, leading elements that the Human Resource Manager should ensure include management and motivation, selection and assessing and development and reorganization. The purpose of the HR management plan is to demonstrate about the ways through which all the members associated t the project team could be managed well. Even for each individual the reward functions are different in two levels such as organizational and personal. While developing the education packages for the nurses for detecting and preventing the patients from pressure injuries, the HR plan that has been developed is as follows:

Identification of project associated elements	Management process
Project team	The project team would be managed through creating proper HR strategies, motivational approaches and by ensuring the recognitions.
External issues	The external issues of the project could be managed through serving compliance requirements and also by adopting safety requirements.
Matches skills and project requirements	The project need is needed to be managed by the HR team, through aggressed acquisition and release to the team.  Proper training and scheduling are also needed to be performed by the HR team to manage the project team members.

In order to accomplish the project “Development of education package for the Nursing staffs”, it is necessary for the project manager to go through a feasibility study so that whether the project is beneficial at all or not can be measured. For reducing the work pressure from the project team members, based on the skills and knowledge the works are divided among the project team members. For calculating the total cost of the project, each activity associated to the task, should be measured. With the help of cost management plan the project manager would be able to measure about whether the project result would be beneficial or not. However, in order to gain profit from the project, the project is required to be completed within estimated budget and time as well. If the time limit exceeds or even if the resources changes then additional budget would be needed that would affect the project outcome and profit as well.

Project Management Office

While analyzing the details of the education package development project for the nursing staffs, working in the healthcare industries, different risks might raise those are again needed to be mitigated accordingly. It is the responsibility of the project managers to identify the risks and will also provide their respective solution to the project team members.

Risks	Solution
Improper time management: If the project manager fails to allot accurate time, necessary to implement the project then, the project manager will not be able to implement the project for the nursing staffs on time.	Based on the requirements of the consumers, and the nursing staffs it is necessary for the project manager to consider proper time frame within which each of the task is required to be completed.
Budget risks: If the project manager fails to estimate accurate project budget then due to budget over allocation, the project will not be completed within budget and time.	In order to resolve the issues of budget overflow the finance manager should consider all required resources and activities at the very initial project development phase. It will help the project manager to avoid budget related risks
Wrong Information: If the project manager and other project team members fail to collect accurate data for developing the project, then, the members working for the project development will fail to provide accurate data to the nursing staffs to become professionally knowledgeable and skilled as well.	In order to mitigate the issues of wrong information,  the project manager and the rest of the project team members should analyze the collected data properly within time before application.

Project quality management plan is a summary document of a project that highlights only the necessary activities those are necessary to be estimated by the project managers and other project team members to gain success from the competitive market. The quality management plan holds all the necessary information those are effective for project planning and even for project implementation. Proper policies, procedures and criteria for the application areas and respective role and responsibilities of the project managers and the project team members are also elaborated in the quality management plan.  

For managing the quality of this particular project accurate mentoring, coaching, audit processing and identification of the necessary tools are the elements those should be considered for managing the success of the project.  The other three different practices necessary for maintaining the project quality include quality planning, quality assurance, and quality control. For this particular project the necessary identifications are as follows:

In order to fulfill the project with approved quality, the necessary metrics and steps those should be followed are as followed for this particular project:

• Clarification of vision and mission and values
• Identification of critical success factors
• Development measures and metrics for tracking the success factors
• Key customer group identification
• Survey of the improvement plan
• Implementation f healthcare marketing plan

In the project closure phase the three necessary activities those are necessary for the project managers to be considered include the stakeholder signoff, final project documentation and post project maintenance plan. It means that, all the associated stakeholders will be signed off in this closure phase. However, the project does not come to a conclusion in this phase rather the project manager, is also responsible to develop final document of the project and the also strategies for post project maintenance.

It has been assumed that, after successful implementation of the education package for the Nursing staffs would be able to identify the pressure injuries of the old age and bed ridden patients. They will also be able to perform proper skin care checkup as per the requirement of the patients. Apart from this, they will also learn about the repositioning the patients to avoid their skin oriented issues.

Conclusion

From the overall discussion it can be concluded, that with the rapid growth of technology, each industry has started using technology including healthcare. However, healthcare industry is referred to as one of the sensitive industries, where the skills and knowledge of the nurses are very much important things to be considered. In order to reduce the rate of pressure injuries of the old age people and bed ridden patients, the project manager is aiming to implement an education package for the nursing staffs so that they could detect the issues of the patients and even can prevent the pressure injury based issues in emergency departments. At the project initiation phase, it has been assumed that after successful completion of the project the project manager will be able to serve the necessary knowledge to the nursing staffs so that they could face the challenges and even also resolve the challenges accordingly. The project is developed by healthcare professionals to avoid the health risks. In order to implement this project at the planning phase, proper goal, objectives and aim are needed to be highlighted. The aim, objective, communication plan and risk register are also developed in this report. In addition to this, for reducing the work pressure from the project team members, proper schedule and Work Breakdown Structure (WBS) are also elaborated in this report.

Work Breakdown Structure

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