Research Korner: Hospital Financial Management

The Role of the State in Globalization

The role of the State in Globalization     Introduction: Understanding Globalization                  Globalization is a multi faceted term that incorporates many ideas in the society. It is a term that has been used to describe and explain many worldwide events in the 20th century. Much debate was been said about the very idea of globalization, yet they can never come up with a concrete answer as to where globalization would bring the entire humanity in the new millennium.             Globalization is relatively a new concept, but all through out history, many wars was been made out of globalization. What really is globalization? Globalization is the term used to describe the changes in societies and the world economy that result from dramatically increased international trade and cultural exchange. It describes the increase of trade and investing due to the falling of barriers and the interdependence of countries. In specifically economic contexts, the term refers almost exclusively to the effects of trade, particularly trade liberalization or "free trade, more broadly, the term refers to the overall integration and resulting increase in interdependence, among global actors, be they political, economic, or otherwise.             Globalization is the beginning of endless debates from two polar points of views. It has been given positive connotations by those who advocate greater economic and cultural integration across national borders, while it has been fiercely criticized by radical groups who perceive it as threat to social cohesion and is only one of the many wheels in the advancement of unfettered capitalism.             Globalization is a complex phenomenon that it brings no justice to label it as sanctified or demonized, nor should it be used as a scapegoat for the major problems that are affecting the world today. It has a multi dimensional character and thus it does not have the privilege of unique definition. It creates both opportunities and costs for different players in the globalization of goods, services, capital, ideas information and people. This unrestricted assimilation produce cross border integration of a number of economic, social and cultural activities.   Main Body (The Role of State in Globalization)             It seems that man has a natural instinct to expand his territories beyond his border, and venture towards horizon. Globalization might be a new concept, but man has been practicing the very basic of ideals of globalization since man found out that “the grass is always greener on the other side of pasture”.             Alexander, Napoleon, Magellan and Columbus all pioneered global expansion of territories. Alexander and Napoleon might be thinking of military might as the reason for its expansion of empire while Magellan and Columbus where thinking of economic gain and advantage by finding the island of spices and controlling the trade route of the old world. All this conquest, were sponsored by the state. Alexander, Napoleon, Magellan and Columbus sailed and conquered the world carrying the name of their state. The mission in the first place was funded and was for their own respective territories.             The modern worlds enjoys and defend well its well defined territories and state which is sovereign from one another, and is recognized by other states and the community of nation.  A state is defined as an organized political community occupying a definite territory, having an organized government, and possessing internal and external sovereignty. Recognition of the state's claim to independence by other states, enables it to enter into international agreements, this is not only important for the establishment of its statehood, but equally important that a state can take part in the activity of nations.             Because of this need for state to enter into international agreements, globalization seemed inevitable. The interdependence of nations and states created a global community. A world, reduced or shrinked into what is now termed as the “global village”.             There are four main driving forces behind increased interdependence of the states. These are trade and liberalization, technological innovation and the reduction of communication costs, entrepreneurship and lastly global social networks. Trade and investment liberalization is important to every state, especially those who lacks in economic materials needed to run their economy efficiently. A state that do not enjoy large oil deposits like the Arab countries have, would engage into trade with states with large oil deposits, large enough for their own consumption. In this way, both state receives advantage and can continue operating their economies smoothly. With the birth and wide use of internet, individuals and states can now communicate freely with out leaving their own neighborhood, again making globalization inevitable. The entrepreneurs, or better known as the multi-national who outsource their businesses to other countries contribute also to globalization. Services and infrastructures are offered by the host country in exchange with the capital investment and jobs the investment would create. And lastly, most sovereign and democratic states need to ally itself to other states to better position themselves in lobbying for their agendas, or just friendly relation aimed at fostering stronger ties between states. Information’s are exchanged, technologies or even humanitarian help are extended between countries who are members of the global social network.   The significant role of the State               Although many believe that technological innovation and entrepreneurship are the main forces behind globalization, these factors cannot alone explain the process of enhanced economic integration. National governments have played a pivotal role in allowing a greater interdependence and economic integration of specific activities through the elaboration and adoption of market-oriented policies and regulation, at both international and local levels. In 1980’s many government supported economic liberalization in number of economic areas which significantly increased global integration. In general, liberalization refers to a relaxation of previous government restrictions, usually in areas of social or economic policy. The latter included “financial sector deregulation, the removal of controls over foreign exchange and enhanced freedom of trade. Financial deregulation has resulted in the progressive elimination of capital controls, the removal of controls over interest rates, and lifting of traditional barriers to entry into banking and other financial services (1995).             State efforts to uphold free trade and to encourage the reduction of trade barriers have been reflected in the eight successive negotiating rounds of the former General Agreement on Trade and Tariffs (GATT), which culminated in 1995 with the establishment of a multi lateral trading system, the World trade Organization (WTO). The latter organization of states in favor of multi lateral trading between countries has not only led to the reduction of barriers to trade in goods, but has also proceeded to liberalize services and capital flows. The WTO has as well focused more closely on an ever growing range of policy measures affecting the terms and conditions of market access, such as standards and regulations, subsidy practices, and intellectual property rights (1998 ).             Contrary to popular beliefs that economic globalization is a blind force that is not controlled by any factor, it is still individual governments that set the policies and the rules in the globalized economy. Economic globalization is, in other words, the result of “policy decisions made by individual countries that allow global market forces to operate (2002).             How the States Operates in Globalized Economy?             Not all states in the world are equal, if it is so then globalization would be redundancy. Some countries or states are more influential than the other. Economic factor as well as military factor plays a big role. But in peace time, it is usually the industrialized nations that are the most influential. The big and real issue here then is which countries set the rules, whom do they favor and how can the least powerful state also influence policy-making in the international arena, and do it in ways that will benefit them.  Due to significant power imbalances among nations brought by the factors mentioned, and are reflected in institutional institutions, some countries do not have as much leverage as others in setting the international economic and political agenda. As a consequence, the present form of globalization is largely shaped by the rules advanced by one part of the world, namely the most influential or industrialized countries, and these rules do not necessarily favor developing countries and countries in transition ( 2002).  “Globalization can be a powerful and dynamic force for growth and development if it is properly managed. And the foundations for enduring and equitable growth at the international level can be laid. For that it is essential to persevere in the search for consensual solutions through open and direct dialogue that takes account of the fundamental interest of all (2000).             As mentioned above, globalization and more in particular economic integration, presents both opportunities and costs. Greater economic openness, foreign direct investment and transfer of technologies offer potential opportunities for economic growth. Free trade allows specialization of services and goods between regions, allowing them to produce according to their own comparative advantage. It also expands the consumption choices of the citizens by providing increased opportunities to buy goods and services from other country. It is in this respect important to keep in mind that international trade is not a game where some countries are winners and some countries are losers. On the contrary, all countries benefits from trades because it enhances the choices of the consumer and the quality of products. It is also worthwhile to underline that countries as to what is commonly believed, compete with each other. Or that any of their major economic problems can be attributed to failures to compete on world markets (1994).             Economic globalization has also provided opportunities for developing countries in that it expands the size of their markets for exports and attract foreign capital, which aids in local development. Foreign investment is conducive to technology transfers and know-how, which in return increases local productivity. Another positive effect of globalization is greater competition among firms, which benefits consumers who have access to products at increasingly lower prices. Those who gain most from the free trade initialized by the government in both developed and developing countries are very often the poorest since they can buy goods at more affordable prices and therefore have a higher standard of living. In this sense, governments and states are seeing free trade as an indirect way to reduce poverty.             Despite many concerns about the loss of sovereignty , the state remains the key factor in the domestic as well as international arenas. The popular assumption that the emergence of global civil society, and increasing levels of cross border trade, finance and investment flows turns the nation or the state into an anachronism is wrong. In the international arena, closer cooperation and concerted actions among states represents an exercise of state sovereignty. Such concerted actions does not necessarily weaken the states, rather it can strengthen them by creating a more stable international environment and by giving them greater scope top expand their exchanges in variety of fields. Moreover, globalization without effective and robust multilateralism is bound to lead to crisis because markets are neither inherently stable nor equitable.             The state will persist because the need for the state has grown over times. It also will continue its existence because the local resource pools and socio economic problem on which states are based are undiminished. Only the state can guarantee, through independent courts, the respect of human rights and justice. It also promotes national welfare and protect the general interest of the state. The role of the state is also fundamental in operating the intricate web of multi lateral arrangements and inter governmental regimes. It is still the state, collectively or singly, that set the rules of the game, that enters into agreements with other states, and that make policies which shape national and global activities.   The changing role of the State   The functions and role of the state have transformed substantially. The general configuration of its responsibilities has changed and this has introduced important modifications both in the policy arena and in the state’s requirements for high level skills, qualitatively and quantitatively. Overall, the course of change points to a shift of focus away from hands-on management and the direct production of services and goods towards strategic planning with a view to the establishment and maintenance, refinement and reform of an enabling framework for private enterprise and individual initiative.             A parallel shift has moved the state’s centre of gravity and with it the locus of power. Decentralization, debureaucratization and deregulation are adding to the importance of the local government and non political actors on whom significant factors and functions are devolved or outsourced. At the same time range of tasks and policy decisions, traditionally handled by the central government in the state capital is being increasingly transposed to an inter governmental level as a result of increased flows between countries of goods, capital, labor and information. Increasingly the state is called upon to act as the link or the bridge of process of planning, consultation, negotiation, and decision making involving all other players in the globalization game. The state is the hub of activities connecting multiple partners and stakeholders from varying fields, regions, cultures, occupations, professions and interests.             In these globally aware state governments, institutions have been created or altered to scan the rapidly changing environment, to promote policy invention and dialogues to speed up decision making in order to take advantage of emerging opportunities, and to embrace short term failures in favor of creating a more long term sustainable strategies. The state are faced with dynamic transformations at the global and local level, the states without adequate capacity to recognize and respond to change are destined to be left behind in the dynamic waves of change. The ability to embrace change is related to an attitude of openness and diversity, to embrace and take comfort with uncertainty and optimism about the future. Globally aware leaders must be chosen by the state to seek and build institutions that can embody these attitudes to inspire the citizens to participate in the emerging aspects of globalization at the same time attracting global forces to participate the states local development. With the advance of globalization, the state has an important role to play in the establishment and preservation of an even playing field and enabling an environment for private enterprise, individual creativity and social action. It can also contribute to the establishment and maintenance of social safety nets, to promote as well as facilitate dialogue and understanding at the sub national, national and international levels. Lastly, a strong democratic state is responsible in the necessary need to protect the children, the sick, the elderly and other vulnerable segments of the society, to combat social exclusion of minority groups and most importantly to ensure a more equitable distribution of the benefits of globalization.   Conclusion               It is increasingly being acknowledged that good governance is the key and the main factor in the development process of any country, state and government. Good governance ensures that the benefits of globalization are benefited by all in the society. The state in partnership with the civil society and the private sector has a major role to play in the quest for peace, freedom, social equity and sustainable development. The state is also responsible to seek improvement and reformation in public administration and governance systems, for this are critical in addressing number of issues, including making globalization work for all. That is, globalization would be used as a tool in alleviating poverty and income inequality. It should also advance human rights and democracy, protect the environment, promote sustainable development, manage violent conflict and in combating international crimes or terrorism. The state can either guarantee people’s freedom and measure of social justice, or it can hold back the state’s development. Therefore, it is how the state structure, administer and operate its public sector and how it pursue policies that makes great impact on people’s well being.               The promotion of higher quality of life and the protection of human dignity should be regarded as a crucial element in ay effort to globalize. Accordingly, globalization also do not mean abandonment of state’s guidance over its market control. The economic sphere cannot be separated from the more complex fabric of social and political life and sent shooting off in its own trajectory. To survive and thrive, a global economy must have a more solid foundation in shared values and institutional practice. It must advance broader and more inclusive social purpose (2000).  The state must at first satisfy the basic needs of its people as an end in itself, but also as a means to allow people to be able to seize a greater extent the benefits of globalization. This is especially true in developing countries should benefit more from  the rapid transformations in terms of technology where the people can have better access to q1uality education and health programs. The improvement of physical infrastructures including transport and communication networks, hospital and water systems improved and if poverty amidst plenty is reduced and technology gap between industrialized nation and developing nation is narrowed, that is to say that people have greater opportunity to make choices (1999).             Simply, what people can achieve in the advancement of globalization can be positively achieve as influenced by economic opportunities, political liberties, social powers and the enabling condition of good health, basic education and the encouragement and cultivation of personal initiatives to improve. And the state have a very important role to play in this aspects.

The Role of the State in Globalization

The role of the State in Globalization Introduction: Understanding Globalization Globalization is a mul...

Risk Management

Introduction Within the myriad of incidents that occur in a healthcare organization a small, but significant, number result in avoidable death or life long injury to either patients or members of staff. Creating a framework to review such incidents, learn from them and institute appropriate improvement strategies is central to any risk management strategy. As well as defining what constitutes a serious event in multi professional teams, occupational health departments and staff side committees there are also considerable learning outcomes to be gained from assessing those incidents that do not have tragic consequences for the affected parties. Some, although not defined as serious, may highlight significant risk potential for a local health provider, including loss of public confidence, loss of ability to provide a service and adverse publicity Within the health economy there is clear value in 'taking a second look' at all incidents that do not result in severe harm, as part of the overall safety and quality improvement process. Using a risk assessment tool can help provide a structured management framework to evaluate each incident and assign clear accountability for actions and learning, post event. Instituting a systematic approach to the risk assessment of incidents that do not result in tragic harm (life long injury or death) delivers significant benefits. It enables organizations to introduce clearly defined levels of accountability for action and learning from adverse events and the identification of potential future disasters. It also aids in the exploration of quality and safety failures before anyone is hurt and the development of a safety culture Local teams and organizations can demonstrate 'due process' in their decision making and this would also lead to the introduction of qualitative analysis within the incident management process and the systematic determination of which events deserve closer review. Risk Assessment and Prevention of Pressure Ulcers               Pressure ulcers, also known as pressure sores, bedsores and decubitus ulcers, are areas of localized damage to the skin and underlying tissue. This damage is generally a result of external forces – pressure, shear and/or friction. Pressure ulcer development occurs in institutional and community settings, and is most often seen in elderly, debilitated and immobile (e.g., orthopaedic) clients, those with severe acute illness (e.g., those in intensive care units) and in individuals with neurological deficits (e.g., spinal cord injuries) ( 1995).             The high prevalence of pressure ulcers is a significant health care concern. A recent study reported by  (2004) reviewed data that surveyed over 14,000 patients from 45 health care institutions across Canada, and estimated the prevalence of pressure ulcers as follows: Acute Care Hospitals: 25.1% Non-Acute Facilities (Long-term care, Nursing Homes, etc) 29.9% Mixed Health Care Facilities (acute and non-acute) 22.1% Community Care 15.1% Overall, the estimate of the prevalence of pressure ulcers in all health care institutions across Canada was 26.2%. This data suggests that pressure ulcers are a significant concern in all health care settings in Canada (2004). Estimates have indicated that up to 10% of those admitted to hospital develop a pressure ulcer, the elderly being at the highest risk with approximately 70% of all pressure ulcers occurring in elders (2002). In those individuals who develop pressure ulcers, approximately 60% occur in the acute care setting – usually within the first two weeks of hospitalization (1989). With the increased acuity of those admitted to hospital, it is estimated that 15% of elderly patients will develop pressure ulcers within the first week of hospitalization ( 2002). In the long term care setting, pressure ulcers are most likely to develop within the first four weeks of admission ( 1992). Malnutrition is a significant problem for the elderly, and is a risk factor for the development of pressure ulcers. Rates of malnutrition in the institutionalized elderly are estimated to affect 23-85% of the population, while the rate for those being admitted to hospital is estimated to range from 20-50%. Pressure ulcer risk increases by 74% with the combination of immobility, stress to the immune system and loss of lean body mass (muscle) (2004).             Mortality is associated with pressure ulcers – several studies have reported mortality rates as high as 60% for elders with a pressure ulcer within one year of discharge from hospital. The pressure ulcer is not generally the cause of death, but rather it develops after a decline in the health status of the older person (2002).  The burden of pressure ulcers and their treatment impacts on quality of life for the client and family, but also creates significant financial strain for those living with a pressure ulcer, their families, and the health care system. Costs associated with the treatment of pressure ulcers in the United States have been conservatively estimated to be $500 to $50,000 (US) per ulcer, with more severe wounds being significantly more expensive to manage than less severe ulcers (2001). AHCPR (1992) estimated that the total national cost (United States) for pressure ulcer treatment was at that time $1.3 billion dollars (U.S.) annually and rising. Although there is no comparable Canadian data related to national costs, the (2004) reported on a study conducted in the late 1990s that estimated the cost of treating an individual with a pressure ulcer within a long term care facility to be an average of $24,050 for three months of treatment. Similarly, a recent case study ( 2004) estimated the total cost for 12 weeks of treatment in the community, including electrical stimulation, to be $27,632. These costs, however, do not address the burden of pain and suffering and the impact on the individual’s quality of life.   Risk Assessment Outline for Pressure Ulcers                         Early intervention is essential for those at risk of developing pressure ulcers. The principle components of early intervention are outlined as follows: (1) Identification of at-risk individuals who need preventive interventions and of the specific factors that place them at risk (2), protection and promotion of skin integrity (3),  protection against the forces of pressure, friction and shear and (4) reduction of the incidence of pressure ulcers through educational programs for health professionals and clients.   Practice Recommendation for Risk Assessment             A head-to-toe skin assessment should be carried out with all clients at admission, and daily thereafter for those identified at risk for skin breakdown. Particular attention should be paid to vulnerable areas, especially over bony prominences. As pressure ulcers usually develop over bony prominences, it is recommended that these areas be the focus for assessment (1992;  2000; 2000; 2001). Skin inspection should be based on a head-to-toe assessment of those areas known to be vulnerable for each patient. These areas typically include the temporal region and occiput of the skull, ears, scapulae, spinous processes, shoulders, elbows, sacrum, coccyx, ischial tuberosities, trochanters, knees, malleoli, metatarsal areas, heels, and the toes. In addition, areas of the body covered by anti-embolic stockings or restrictive clothing, areas where pressure, friction and shear are exerted during activities of daily living, and parts of the body in contact with equipment are also considered vulnerable. Additional areas should be inspected as determined by the individual’s condition ( 2001;  2001). The client’s risk for pressure ulcer development is determined by the combination of clinical judgment and the use of a reliable risk assessment tool. The use of a tool that has been tested for validity and reliability, such as the Braden Scale for Predicting Pressure Sore Risk, is recommended. Interventions should be based on identified intrinsic and extrinsic risk factors and those identified by a risk assessment tool, such as Braden’s categories of sensory perception, mobility, activity, moisture, nutrition, friction and shear. Risk assessment tools are useful as an aid to structure assessment. In order to determine the client’s level of risk, the AHCPR guideline (1992) recommends the use of a standard risk assessment tool. The Braden Scale and the Norton Scale have been tested sufficiently for reliability and validity to be useful adjuncts to nursing assessments and care planning. The Braden Scale has good sensitivity (83-100%) and specificity (64-77%), while the Norton Scale has a sensitivity of 73-92% and specificity of 61-94%. Positive predictive values are documented as: – approximately 40%;  – approximately 20% ( 2002).             Frequency of Risk Assessment Although the optimum frequency of risk assessment has not been substantiated in the literature, there are clinical standards that are widely accepted and reported. It has been noted that the majority of pressure ulcers develop within the first two weeks after admission to a facility (1996). One prospective study of new admissions to a nursing home over three months showed that of those who developed pressure ulcers, 80% did so within the first two weeks and 96% did so within three weeks ( 1992). These results support the need to identify those clients “at risk” for developing pressure ulcers early in their care, preferably on admission. The literature also supports reassessments for “at risk” individuals ranging from daily to weekly, however, many sources agree that whenever a client’s condition changes, reassessments should be conducted (2000;  2000;1996;  2001;2000).  (2001) suggests that the frequency of risk assessments should be based on the findings of the initial admission assessment and the rapidity of the client’s change in health status. Ideally, the client should be assessed for risk on admission, again in 48 hours and as often as the level of morbidity indicates. In addition,  (2001) makes recommendations for assessment of specific populations according to the following schedules: (1) Long-term care facilities – At admission, then every week for four weeks and quarterly thereafter.  (2)Intensive Care Units – Daily. (3)General medical/surgical units – Every other day. (4)Community – Every home visit.   Intrinsic/Extrinsic Risk Factors in Pressure Ulcers               The determination of risk for pressure ulcer development is established by the combination of the use of a reliable risk assessment tool and clinical judgment. There is discussion in the literature regarding the need to look beyond assessment tools in considering risk, as the development of pressure ulcers may be influenced by factors not addressed within these tools. The potential to develop pressure ulcers may be influenced by intrinsic risk factors that relate to aspects of the client’s physical, psychosocial or medical condition. These factors should be considered when performing a risk assessment, and include nutritional status (malnutrition and dehydration), reduced mobility or immobility, repetitive stress syndrome (involuntary movements), posture/contractures, neurological/sensory impairment, incontinence (urinary and fecal), extremes of age, level of consciousness, acute illness, history of previous pressure damage, vascular disease, and severe chronic or terminal illness (1998; 2000;  2002; 2001; 2000). Extrinsic factors derived from the environment can also influence the development of pressure ulcers. These include factors such as hygiene, living conditions, medication, pressure, shearing, friction, garments, transfer slings, restraint use and the support systems used to relieve pressure (1998; 2000; 2001; 2001; 2000). Clinical assessment of all factors that increase the client’s risk for skin breakdown must be considered to facilitate early identification of those at risk. All data should be documented at the time of assessment and reassessment. Proper documentation provides an accurate record of a client’s progress and risk status. Any skin changes should be documented immediately, including a detailed description of what was observed and what actions were taken (RCN, 2000) and should be made accessible to all members of the health care team (2001). The literature addresses the need for the use of clinical judgment, in conjunction with a recognized risk assessment tool, in the identification of risk (2000;1998; 2000). Both the development and revision panel strongly support the need for clinical nursing judgment in conjunction with the overall client profile as a basis for determining risk and planning of appropriate care. This recommendation is based on current practice, clinical experience and opinion.   Intervention Voluntary and involuntary movements by individuals themselves can lead to friction injuries, especially on elbows and heels. The use of products to minimize contact with surfaces (including bed linens) can reduce the potential for injury (1992;  2000;  2003). Use turning devices such as sheets, trapezes, or manual or electric lifts that will decrease the risk of skin damage (1992;  2000). After using turning equipment, slings, sleeves or other components of the device should not be left underneath the individual after repositioning (2001). Consider the impact of pain. Pain may decrease mobility and activity. Pain control measures may include effective medication, therapeutic positioning, support surfaces, and other nonpharmacological interventions. Monitor level of pain on an on-going basis, using a valid pain assessment tool. Consider also the client’s risk for skin breakdown related to the loss of protective sensation or the ability to perceive pain brought by analgesics, sedatives and neuropathy, and to respond in an effective manner with it and the impact of pain on local tissue perfusion. Pain is a factor that may result in decreased mobility in clients who are dealing with chronic conditions such as arthritis, multiple sclerosis, cancer, and musculoskeletal injuries. Any decrease in mobility as a result of such pain may increase the risk for the development of pressure ulcers. At the same time, however, analgesia and sedatives may depress the central nervous system. This may result in reduced mental alertness, activity and mobility, thereby altering the individual’s ability to respond effectively to ischemic pain ( 2003).   A systematic review conducted by (2004) examined to what extent pressure-relieving surfaces reduced the incidence of pressure ulcers compared with standard support surfaces, and reviewed how effective different pressure-relieving surfaces were in preventing pressure ulcers, compared to one another. It was concluded, from the 41 randomized controlled trials included in the review, that in those at high risk of pressure ulcers, the use of a higher specification foam mattress (low interface pressure) should be considered rather than the standard hospital foam mattress. Standard hospital mattresses have been consistently outperformed by a range of foam-based, low pressure mattresses and overlays, and also by “higher-tech” pressure-relieving beds and mattresses in the prevention of pressure ulcers. Clients at very high risk of developing pressure ulcers may benefit from an alternating pressure mattress or other high-tech pressure redistributing systems ( 2000; 2000). Alternating pressure devices generate alternating high and low interface pressures between the body and support surface (bed), usually by alternate inflation and deflation of air-filled cells. These devices are available as mattress overlays, and single or multi-layer mattress replacements. The systematic review conducted by  (2004) indicates that the relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear.  (2001) outlines criteria and selection modalities for the use of support surfaces in the prevention of pressure ulcers. Regardless of the type of surfaces used for high-risk clients, thorough and frequent skin assessments should be conducted for evidence of tissue damage (2004; 2003). Clients experiencing surgery are at risk for development of pressure ulcers because of factors that cannot be controlled – length of procedure (2002), hemodynamic state and the use of vasoactive medications during surgery. There are, however, many risk factors that can be controlled to reduce the incidence of pressure ulcer development, including pooled prep solutions, negativity, shearing, friction and the use of warming blankets beneath the client. Another factor that can be controlled in order to decrease pressure ulcers is the surface on which the person is placed during the surgical procedure ( 2001;  2003). Wet skin is fragile and more susceptible to friction and tearing injuries, especially during cleansing. Moist skin also has a tendency to adhere to bed linens, potentially leading to damage when linen is removed. In addition, it is more susceptible to irritation, rashes and infections, such as candida. When the source of moisture cannot be controlled, use of protective barriers and moisture absorbing products are recommended. Absorbent pads, dressings or briefs should be changed as they become saturated, rather than delaying until they reach their absorptive capacity. These products should not interfere with any pressure-redistributing surface an individual may be placed on ( 1992;2000; 2000). When skin is moist from perspiration, cotton linens are recommended to promote evaporation, skin aeration and faster drying. Frequent changing of moist linens is recommended to maintain dry intact skin. Rehabilitation Program Immobility and inactivity has been associated with larger ulcers, and bed and chair-bound persons are at higher risk for pressure ulcer development. Researchers have reported that the use of active and passive range of motion exercises promotes activity and reduces the effects of pressure on tissue. Exercise, ambulation, proper positioning, strengthening and increased range of motion all assist in the prevention process ( 1992;  2000). Conclusion All health care providers should receive relevant education in pressure ulcer risk assessment and prevention. Frequently, the focus of care is on maximizing functional gains in activities of daily living and mobility, and education is informal or minimal. It is essential, however, that individuals be provided with the basic knowledge necessary to return them to home and their communities ( 2000),

Risk Management

Introduction Within the myriad of incidents that occur in a healthcare organization a small, but significant, number result in avoid...

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