savonna_1.26.19.docx - Running head CAPSTONE PROJECT CHANGE Capstone Project Change Proposal Savonna Ormond Grand Canyon University CAPSTONE PROJECT

savonna_1.26.19.docx - Running head CAPSTONE PROJECT CHANGE...

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Unformatted text preview: Running head: CAPSTONE PROJECT CHANGE Capstone Project Change Proposal Savonna Ormond Grand Canyon University January 26, 2019 CAPSTONE PROJECT CHANGE Capstone Project Change Proposal Background 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. Problem Statement 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 actions. 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 receive. 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 References 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 University Press. 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: 10.1097/nna.0b013e31827f20a9 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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