Unformatted text preview: Running head: CAPSTONE PROJECT CHANGE Capstone Project Change Proposal
Grand Canyon University
January 26, 2019 CAPSTONE PROJECT CHANGE
Capstone Project Change Proposal
It is beneficial for health care professionals to be aware of how to improve the quality
of patient care and safety. As such, there is a need to reduce the risk associated with hospitalacquired infections. In practice, the administration of vancomycin is recommended as a part
of treating Clostridium difficile infections, but it is advantageous to determine whether it is
more effective in the oral capsule form, or in the oral compounded form (Bass et al., 2015). It
is expected that these treatment options may differ in terms of how they are metabolized, and
it is expected that treatment options that start working more quality will be more effective in
reducing the severity of the patient’s symptoms (Jump, 2013). As such, it is valuable for
nurses to participate in the investigation that is needed to determine the best practices that
could be used to treat the patients.
Since preventing infections in the hospital setting, including Clostridium difficile
infections is a common problem in health care, is important, it is necessary to determine how
nurses could help lessen the impact of the illness once it does occur (Asempa & Nicolau,
2017). When this information is gained, it has the potential to contribute to a nursing practice
that will significantly improve the quality of care offered to patients. Injury as well as death
could result from uncontrolled Clostridium difficile infections, so it is important to use best
practices in ensuring that prevention is achievable in practice. This evidence-based practice
has the potential to influence the work environment by increasing focus on reducing errors,
which may be more time consuming for nursing (Carmo et al., 2015). However, nurses could
be personally reliable for errors related to preventable infections, so it is important for them
to implement recommended prevention practices (Galarneau, 2016). This is significant to the CAPSTONE PROJECT CHANGE
nursing profession because it could be used to reduce harm to the patient and to prevent
unintended deaths. It also prevents the hospital from needing to protect itself against legal
Purpose of Change Proposal
The peer-reviewed articles on this topic, described below, aim to characterize
Clostridium difficile infection in elderly patients (Bass et al., 2015). In addition, Bass et al.
(2015) compare the efficacy of vancomycin administration methods. Since elderly adults are
at a greater risk for injury as a result of these infections, in addition to being at a greater risk
for the infection in general, it is important to consider how to create interventions that are
targeted to specifically increase the health and wellness of elderly adults (Bass et al., 2015).
There are important economic and health care expense implications regarding the prevention
and treatment of Clostridium difficile infections, and this investigation will enable my health
care organization to put forth evidence-based recommendations for the treatment of elderly
patients with this side effect of the treatment process or increased risk as a result of the
patient’s age (Bunnell et al, 2017). The research will be used to further define this problem
and determine how to effectively investigate the answer to this research question that will
contribute to improvements in the outcomes associated with the care that these patients
The PICOT Statement
Based on these findings, the PICOT statement follows:
P: Inpatients with C. difficile infections
I: Reducing the rate of infection through use of a checklist reminding the nurse of best
practices CAPSTONE PROJECT CHANGE
C: Not using a checklist for comparison
O: A reduction in the rates of C. difficile infections
T: 2 months
Based on this information, the PICOT question reads, “For inpatients, is the use of a
checklist effective in reducing the rate of C. difficile infections over a two-month period, but
reinforcing nurse practices?” This information will help health care professionals understand
how to improve the quality associated with health care practice as well as increase the safety
associated with patient care.
Literature Search Strategy Employed
The literature was reviewed to find sources that were published within the past five
years, and sources included peer-reviewed journal articles as well as sources that play a role
in health care research and regulations, such as the Centers for Disease Control and AMN
Healthcare. Articles were included in the literature search if they discussed the reduction of
hospital acquired infections or the treatment of C. difficile infections.
Evaluation of the Literature
Hospital acquired infections are a common clinical concern. “Hospital-Acquired
Infections are defined as infections which are not present at the time of admission and occur
during the process of care or even after discharge; they are frequently-encountered and
constitute a major public health issue that impacts morbidity, mortality and quality of life”
(Kirtil & Akyuz, 2018, p. 399). As such, it is important to prevent these infections from
occurring in practice.
Hospital acquired infections and other issues such as bed sores, falls, and readmission
rates are essentially lumped together in Medicare’s reimbursement guidelines. In particular, it CAPSTONE PROJECT CHANGE
would be effective to explore C. difficile infections among my patients. These infections
impact patient outcomes and the hospital’s bottom line. Reducing the prevalence of hospital
acquired infections (HAI) will not only improve patient health outcomes but will also
increase the profitability of the facility, which ultimately generates retained earnings that can
be used to increase nursing salaries, staffing ratios, or improve supplies, technology, and
more for the hospital. According to the Centers for Disease Control, “Unfortunately, HAIs
affect about ten percent of hospitalized patients in the U.S. annually which is approximately
1.7 million HAIs resulting in 99,000 deaths and an estimated $20 billion in healthcare costs”
(Centers for Disease Control, n.d.). As such, it is important to put forth an intervention that
will help prevent this from occurring in practice.
“Nurses play a pivotal role in preventing the occurrence of HAI, not only by ensuring
that all aspects of their nursing practice are evidence based, but also through nursing research
and patient education” (AMN Healthcare, 2015). There are various evidence-based practices
that can be successful as a means of prevention of HAI. They include hand washing, hand
sanitizer stations placed at hospital entrances, patient screening protocols, and facility
procedures for surveillance are amid the top mechanisms of preventing HAIs within a facility.
While all hospital patients are at risk for developing a HAI, nurses can be aware of vulnerable
populations and the most prevalent instances of occurrence. The most at risk populations
include the very young, the very old, and those with compromised immune systems.
Applicable Change Theory
The change theory that was applied to acclimate nurses to the use of a checklist in
preventing infections is Lewin’s theory of change (Shirey, 2013). These steps guide nurses
through the process that is needed to become more acclimated to a proposed change, until it CAPSTONE PROJECT CHANGE
eventually becomes a more permanent part of practice. This inclusion enables other nurses to
understand how to apply the infection prevention checklist in a clear and consistent manner.
Proposed Implementation Plan with Outcome Measures
This issue will be observed in the inpatient setting. Elderly patients with a range of
conditions will be included; however, it is expected that cancer patients will develop this
condition if they are on chemotherapy, since this is one of the conditions that cause a
weakening of the immune system leading to Clostridium difficile infection (Mahabir et al.,
2013). In general, elderly adults have a weakened immune system and are more susceptible.
As such, the specific outcome measure that will be observed for this purpose is the rate of
Clostridium difficile infection development that occurs for the elderly population in the
inpatient setting. Comparing these figures prior to and following the intervention will help
determine whether this action contributes to improved clinical outcomes in practice.
Identification of Potential Barriers to Plan Implementation and A Discussion of
How these Could be Overcome
A barrier in practice is knowing which protocols to face to reduce the spread of
infections (Wager & Wiffen, 2011). In particular, some reports in the literature suggested the
use of additional sanitary procedures when working with patients, while others indicate the
benefits of handwashing and educating health care professionals as well as visitors about how
they could reduce the spread of infections within the health care facility (Centers for Disease
Control, n.d.). Some systematic reviews indicated that a checklist should be used to promote
safety guidelines in practice. As such, this method could be used to ensure that nurses and
health care professionals have sufficiently considered the safety standards that should be
followed when working with patients as a part of practice (Kirtil, & Akyuz, 2018). Instead of CAPSTONE PROJECT CHANGE
focusing on one practice to improve this health care outcome, it is worthwhile to collectively
focus on a range of practices that will promote an improved quality of care. CAPSTONE PROJECT CHANGE
Asempa, T. E., & Nicolau, D. P. (2017). Clostridium difficile infection in the elderly: An
update on management. Clinical Interventions in Aging, 12, 1799-1809.
Bass, S. N., Lam, S. W., Bauer, S. R., & Neuner, E. A. (2015). Comparison of oral
vancomycin capsule and solution for treatment of initial episode of severe
Clostridium difficile infection. Journal of Pharmacy Practice, 28(2), 183-188.
Bunnell, K. L., Danziger, L. H., & Johnson, S. (2017). Economic barriers in the treatment of
Clostridium difficile infection with oral vancomycin. Open Forum Infectious
Diseases, 4(2), 1-3.
Carmo, J., Marques, S., Chapim, I., Túlio, M. A., Rodrigues, J. P., Bispoa, M., et al. (2015).
leaping forward in the treatment of Clostridium difficile infection: Update in 2015.
Portuguese Journal of Gastroenterology, 22(6), 259-267.
Centers for Disease Control & Prevention. (n.d.). CDC at work: Preventing healthcareassociated infections. Retrieved from
Galarneau, C. (2016). Communities of health care justice. New Brunswick: Rutgers
Kirtil, I., & Akyuz, N. (2018). Precautions taken by nurses about the prevention of
hospital-acquired infections in intensive care units. Pakistan Journal of
Medical Sciences, 34(2), 399–404.
Jump, R. L. (2013). Clostridium difficile infection in older adults. Aging Health, 9(4), 403–
414. CAPSTONE PROJECT CHANGE
Mahabir, S., Lim, R. Y., Fitzpatrick, F., Magee, C., & Keogan, M. (2013). Oral vancomycin
desensitisation to treat Clostridium difficile infection in a vancomycin allergic patient.
World Allergy Organization Journal, 6(14), 1-3.
Shirey, M. (2013). Lewin’s theory of planned change as a strategic resource. JONA: The
Journal Of Nursing Administration, 43(2), 69-72. doi:
Wager, E., & Wiffen, P. J. (2011). Ethical issues in preparing and publishing systematic
reviews. Journal of Evidence-Based Medicine, 4, 130-134 ...
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