Assessment 3 Project Implementation Plan and Logic Model
Doctoral Project Implementation Plan Example
Organization: Vila Health Regional Hospital
Date: 03/21/19
Project Title: Implementation of Preoperative, Intraoperative, and Postoperative Pediatric Cardiac Catheterization Guidelines
PICO Question
In the pediatric cardiac catheterization laboratory, does implementation of perioperative guidelines improve patient care through decreased delay of procedure start time, decrease pain scores and medication use, and decrease time from recovery to discharge, compared to physician preference as a standard of care over a three-month time frame?
Project Description
This is a study using evidence-based practice guidelines to implement preoperative, intraoperative, and postoperative pediatric cardiac catheterization guidelines to treat patients identified as needing a cardiac catheterization, less than 18 years of age. A total of 20 pediatric patients between the ages of 0 weeks to 17 years who are undergoing a cardiac catheterization, will be enrolled in the study and receive preoperative, intraoperative, and postoperative guidelines. All patients will be evaluated for guideline implementation and require no follow-up.
Preoperative guidelines will include the following:
A history and physical done within 30 days.
A focused assessment updated within 24 hours.
Informed consent and anesthesia evaluation done within 30 days before catheterization laboratory procedure.
A complete blood count and serum electrolyte panel resulted within 24 hours of the procedure.
PT/INR can be considered if the patient is on anticoagulation therapy.
Baseline EKG.
Beta-HCG for females of childbearing age within two weeks of procedure.
Height and weight documented on chart before procedure.
IV access, not placed in the antecubital, as this interferes with positioning during catheterization.
Medications reviewed by the interventionist and medications held per interventionist order: beta blockers, calcium channel blockers, and anticoagulants.
The patient must be NPO according to NPO guidelines from the American Academy of Pediatrics.
Full meal (anything with fat) 8 hours
Light meal (toast, cereal with skim milk), formula for infants 6 hours
Breast milk 4 hours
Clear liquids (apple juice, Gatorade, not orange juice) 2 hours
Chewing gum has no impact (do not swallow)
Intraoperative guidelines will include the following:
Interventionist review of patient’s medical records.
Confirm NPO status.
Allergies addressed.
Pre-procedure timeout.
Infection control with chlorhexidine-based solutions, hats and masks worn, surgical scrubbing performed before each procedure.
Radiation exposure minimized with thyroid shield and lead aprons.
Local anesthetic used, such as lidocaine for patients under anesthesia and lidocaine with Newt for patients under conscious sedation.
Safeguard pressure assistant dressing applied.
Post-procedure debriefing (See Appendix B) completed and handed off to the intensive care unit registered nurse.
Postoperative guidelines will include the following:
Appropriate handoff communication between interventionist and attending.
The attending physician should discuss procedure results, complications, unexpected findings, patient management plans and any further instructions. Cardiac monitoring is required postoperatively.
Vital signs are monitored every 15 minutes for 2 hours according to unit protocol. Unit protocol requires every 15 minutes times four, every 30 minutes times four, every hour times four, then every four hours until discharge.
Diet may be as advanced as tolerated.
Medication reconciliation for discharge is required.
Quality reporting to IMPACT database.
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