138 Chapter 5 However, when a member of the project team explained the PU risk, most of the nurses agreed that these patients actually had several risk factors. Some nurses were of the opinion that DRAAI identified patients with PU rather than patients with a risk of developing PU. Thereupon, the project team clarified the difference between risk predictions and PU detection during the regular informal visits and educational sessions. Additionally, some nurses found it unnecessary to register PU risk for patients who had not yet developed PU. Another adaptation was systematically addressing particular frequently asked questions (FAQs). These FAQs, along with detailed answers on how to address them, were distributed to the nurses via mail and, if possible, during educational sessions. The FAQs included the frequency of DRAAI’s predictions, reasons for patients not receiving at-risk predictions, and guidelines on preventive measures. Additionally, nurses expressed uncertainty about when they could discontinue preventive measures. However, DRAAI is designed to identify patients at high risk early in their admission, focusing on prompting nurses to initiate preventive measures rather than indicating when to stop them. Nurses proposed changes to the nursing care plans in the electronic patient record, specifically requesting the automatic inclusion of preventive measures into the nursing activities. And additional preventive measures, such as providing patient education or distributing educational material. Furthermore, the implementation of DRAAI sparked discussions about the essence of the nursing profession. Should PU prevention be an integral part of routine care? Do nurses truly need predictive tools to remind them, or should they be able to deliver this care independently? ‘What is the balance between thinking for oneself and receiving these prechewed risk predictions at the beginning of your shift?’ During the pilot period, we could not solve some feasibility issues, but managed to address these issues a few weeks later. Examples include integrating DRAAI directly into electronic patient records and providing summaries of the risk factors contributing to the daily risk predictions for each patient. Such summaries could enhance nurses’ understanding of the predictions and suggest potential preventive actions. Some nurses also envisioned a similar approach for other nurse-sensitive outcomes in the future. ‘Nice to incorporate this [opening DRAAI and identifying patients at risk for developing a PU] into the joint daily stand-ups; perhaps this is also suitable for future nurse sensitive outcomes.’
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